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patient stories

It’s called Chorea

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A man in his 70s with a history of diabetes mellitus and myasthenia gravis presents with severe, involuntary movements of both upper and lower extremities coupled with uncontrollable nausea, vomiting, and diarrhea. It looked like this man was having a never-ending grand-mal seizure while remaining conscious and not foaming from the mouth. He was brought into the ED after sustaining multiple falls while at home, and was treated with increased doses of Mestinon which caused the vomiting and diarrhea.. we tried to fix the movements, while causing fluid volume deficits.

Myasthenia gravis is a neuromuscular disorder that results in easy fatiguability of muscles, whereas this man was having excitability of all muscles. The neurologist coined these involuntary movements as chorea and attempted to treat with Olanzapine (antipsychotic), Keppra (antiseizure), and pyridostigmine/Mestinon (anti-myasthenia gravis) medications. The MD thought the chorea could potentially be caused by hyperglycemia (I have never heard of this as a cause), which was also a problem during this admission.

I do not know what the ultimate cause of the choreic movements was, but after sleep and medication therapy, the patient was discharged from the hospital with vastly reduced movements and was working with physical therapy the next day.

Until next shift,

Shania

A Faith of Thorns

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I recently had a patient encounter with an elderly woman and the conversation is as follows:

“Do you think God is creating this virus to destroy the world like he has done in the past? Like he is wanting us to learn something?”

(Me) “I think God is good and would not create this kind of destruction. He has said after the flood that he would not destroy the earth like that again. He said that he works everything out for good. He did not say that everything will be good. The enemy is present to kill, to steal, and to destroy. I believe this is not God.”

(Patient) “I grew up in the Church of Christ and do love God. I have lived for over 70 years and never in my life has something like this happened. I just can’t wrap my head around why. Where is God in this?”

I didn’t really know what to say at this point, other than to listen and ponder with her. I know God did not send this pandemic, but I will never know why it has occurred in this lifetime. I have tried to focus on only positive thoughts such as having more time to learn a new hobby, catching up on Netflix, spending time at home, and enjoying the presence of immediate family; however, the energy of the world is filled with fear, anxiety, and isolation.

Jesus describes the purpose of parables in Mark 4 by defining three different foundations of faith:

1. Rocky soil= hear the word, accept the word, but have no root and when tribulation comes, the faith falls away.

2. Thorns= hear the word, however the desires of the world overpowers the faith.

3. Good soil= hear the word, accept the word, and spread fruit (joy, faith, success) in multiples.

I would like to think that my faith has a foundation of good soil. I like to think that my optimistic persona will radiate and disperse the fear that is all around me. However, as I write this post, I feel like my faith is grown in thorns. The stresses and worry of current life are drowning my joy and hope I have in Jesus. In the words of my sweet lady, “where is God in this?”

I don’t know, but I do know that I will find out one day. For now, I will hope for the future as I know this too shall pass. I will continue to find joy in the little things. And I will continue to trust that God is with us.

Until next shift,

Shania

“And these are the ones sown on rocky ground: the ones who, when they hear the word, immediately receive it with joy. And they have no root in themselves, but endure for a while; then, when tribulation or persecution arises on account of the word, immediately they fall away. And others are the ones sown among thorns. They are those who hear the word, but the cares of the world and the deceitfulness of riches and the desires for other things enter in and choke the word, and it proves unfruitful. But those that were sown on the good soil are the ones who hear the word and accept it and bear fruit, thirtyfold and sixtyfold and a hundredfold.””
‭‭Mark‬ ‭4:16-20‬ ‭ESV‬‬
https://www.bible.com/59/mrk.4.16-20.esv

Terminal Agitation

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Terminal agitation. I have never heard of this term before until my last shift. A patient I had a week ago, who was admitted with a fall, died today after being placed on Hospice care. The previous week, the patient was not oriented to person, place, time, or situation, and was very restless. She was able to communicate, however inappropriately. She constantly wanted to get out of the bed, and never went to sleep. She had dementia and I thought this was a progression of her dementia. I found out on this past shift that this agitation was actually her quick decline to the end of her life.

Another nurse on the floor worked in Hospice care for several years and had a hint that this was terminal agitation. The patient was seen to be picking at the air and stated that she was seeing her late husband. I have never encountered these signs before and contributed them to hospital delirium and her baseline dementia. I could not believe that the next shift I had, was this same patient who was now comatose and passed within 24 hours after transitioning into Hospice care.

Until next shift,

Shania

Criticals, Cultures, and Codes

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Today was a tough day from the beginning. At 0800, I got a discharge before I even completed the assessment or given any medications, then at 0900 I got a direct admission coming to an empty room, putting me at six patients. Throughout the rest of my med pass I got 3 critical labs, one unhappy family, beeping IVs, calls for pain medications, a positive blood culture, and telemetry notifications of abnormal rhythms. I finally got finished charting assessments, discharging my one patient, and admitting my new patient by 1430, which meant lunch time. Immediately upon my return, I got a second admission. Then, my extern ran to me and was concerned about our patient who was all of a sudden slow to respond to commands… that led to a rapid response call. Luckily, everything turned out to be fine with her and she slowly started to return to her baseline. By now I was at least an hour late on all of my medications, and got a call with a low blood sugar. Quickly, it was shift change at 1845 and I had yet to give 1700 medications.

Long story short, this was one of the worst days I have ever had as a nurse. It was a day where I barely had time to complete my checklist, could not build rapport, or read any progress notes. My motto of the day was “just keep swimming” and I was just treading water.

Until next shift,

Shania

Nurse-physician communication

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The first time I ever got yelled at by a physician was my first month off of nursing orientation. The patient’s chart was “r/o stroke”. One of the core measures for stroke patients was to provide a handbook and educate them on stroke diagnosis, prevention, and treatment. Apparently, no one had told this patient that we were ruling out a stroke, and as I began my teaching, she got very upset. The physician walked into the room and was flooded with questions from the patient and family about her stroke. The patient was found not to have a stroke, but was not told of any of this. The physician found me in the hallway and immediately starting yelling at me and told me to not tell someone that they have had a stroke. I pointed out on the chart that it clearly stated that they were ruling out a stroke and to provide education. The physician was not even aware of this. I walked back into the patient room and they were appalled by how this doctor had treated me. They ended up leaving AMA because they didn’t want to be in a facility where the doctors treated their nurses like that..

The Chief Medical Officer found me later in the day and told me that the physician actually felt bad for yelling at me because he was having a hard day.

Communication is extremely important in healthcare, however patient surveys often rank this category as in need of improvement. Communicating with doctors can seem intimidating, especially as a new nurse or one who is new to the unit. The best doctors are those who are not only knowledgeable, but personable, make efforts to communicate with nursing staff, allow time for questions, and those who are patient. Unfortunately, many doctors do not act this way. Below are some tips to utilize when contacting the physician.

  1. If you have even a slight feeling that something is wrong, contact the physician. You see them for 12 hours/day. They are only in the room for 20 minutes.
  2. Use SBAR– provide the situation (why are you contacting?), background (labs, dx, hx), assessment (lungs, bowels, VS, etc.), recommendations (what does the patient need?).
  3. Be confident in yourself.
  4. Remember that you do not work for the physician. You work for the hospital.
  5. You are the patient advocate.

Until next shift,

Shania

Please, do not wish to die

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Our God is a way-maker, miracle-worker, promise-keeper, a light in the darkness. God will put you out of any situation no matter how wide, how deep, how high, or how low it may be. It breaks my heart to see hurting people believing that ending their life is the only solution.

Suicide is the 2nd leading cause of death for ages 10-24 year olds and continues to increase yearly. Speaking with suicide survivors actually reveals that a majority of them regret their decision to take their life and are thankful that their attempt was unsuccessful.

Patients so often state how “they want to die, they are a burden to their families, they are terminal anyway.” Nurses make comments after a long day such as “kill me. Shoot me. etc.” Our language has power, and we may not realize the hurt someone actually feels behind their “joking” words.

Life is so so beautiful. If you don’t see it, be around those who do. Engage yourself within nature and a healthy community. There is breath in your lungs. Joy comes in the morning.

Please, don’t wish to die.

Until next shift,

Shania

Suicide resources:

suicidepreventionlifeline.org

1-800-273-8255

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615-856-8181
shania@shanialynnvo.com