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patient

I got the COVID-19…

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Speak out on behalf of the voiceless and for the rights of all who are vulnerable. -Proverbs 31:8

After working five 12-hr shifts this week, I was one of the fortunate people to receive the Pfizer COVID-19 vaccine. I choose to receive this vaccine for the return of social gatherings, hugs, concerts, game days, to protect those who are immunocompromised, and to relieve the strain on the healthcare system.

Any new medication or vaccine does have some risks and concerns. After speaking with multiple hospitalists and doing my own research, I am hopeful for better days to come.

What is special about an mRNA vaccine?

  • mRNA vaccines create the same protein (spike protein) that is on the SARS-CoV-2 in our bodies so that we can produce antibodies that will fight an infection if we are infected.
  • This differs from the flu vaccine which is an inactivated form of the virus. This is not the case with the COVID vaccine- you cannot get COVID by simply taking the vaccine.

How is this safe when developed so quickly?

  • Many people, including myself, have been hesitant to accept a vaccine that has been developed so quickly. However, I have learned that scientists have been familiar with  mRNA vaccines for years. Once COVID hit, these scientists were able to identify the spike protein on the actual virus and create that same protein into a vaccine for our protection.

How is it administered?

  • The vaccine is an intramuscular injection like the flu vaccine and is administered in 2 doses either 21 days apart (Pfizer) or 28 days apart (Moderna).

Considerations/Unknowns

  • It is unknown how long natural immunity will last for someone who has already had the COVID-19.
  • mild s/e include pain at the injection site, muscle aches, fatigue, h/a, chills, joint pain, and fever. These were more common with the second dose than the first.

What is vaccine efficacy?

  • A vaccine is shown to be effective if it reduces the chance of becoming seriously ill.
  • Pfizer has shown 95% effectiveness, meaning that 95% of people will not become seriously ill if infected with the virus. This is actually wonderful, considering the flu vaccine is at most around 50% effective.
  • it is unknown whether the vaccine reduces transmissibility- continue to wear masks!

I hope this relieves some concerns about the vaccine. I believe in the science and pray for a happier and healthier 2021.

Until next shift,

Shania

Sources:

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html

https://www.mayoclinic.org/coronavirus-covid-19

Mayo Clinic answers questions about COVID-19 vaccine

Clots, Codes, and COVID

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A 50 y/o COVID positive male is admitted to the med-Surg floor on 4L BNC. Shortly after arriving, the patient turned blue and became hypoxic. The rapid response team was called and the patient was immediately taken to get a CT scan with PE protocol to assess for a clot in the lung. The patient had to be placed on a bipap for transfer to radiology. This involved a respiratory therapist, ICU nurse, charge nurse, and a primary RN. I was instructed to carry 2 extra oxygen tanks as the patient was depleting the existing tanks rather quickly. As we arrive at radiology, the current 2 tanks are emptied, and I had to run to another department to grab additional back ups.

Once the CT was completed, we moved straight to the cardiac cath lab. There, they told the patient that it was necessary to perform a rapid sequence intubation and subsequent transfer to the ICU after all imaging was done. The pt became tearful and stated he could not breathe throughout the full 2 hour code.

Covid has been such a strange virus and we continue to learn more at each patient encounter. Prior to this admission, the patient was healthy with minimal preexisting conditions. The last night shift I worked, I happened to walk into his room to fix a beeping IV and was so excited to see this man awake, alert, and talking to me.

He told me that he had several clots throughout his entire body.. his heart, lungs, and his legs. He stated that he had coded twice in the ICU. He was covered in bruises and complaining of severe generalized pain. He was placed on a heparin drip to prevent any further clotting. I was so excited to see how “good” he looked and he was so grateful to be alive.

Covid is no joke and can change a life in seconds. This man may still be on oxygen, be quarantined in the hospital through Christmas, be covered in bruises, and suffering from generalized pain; however, he is alive. This is another humbling reminder to always count my blessings.

Until next shift,

Shania

The Corona Pool

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As cases continue to rise in the hospital, fatigue continues to settle into the organization. We have filled the ICU, expanded the ICU, and currently have nearly two full COVID floors apart from critical care.

There have been an increase in patients and a decrease in nursing staff due to also succumbing to the illness. In order to combat the increase in patient census, incentives have been put in place to encourage nurses to work overtime. Even with several nurses working five 12 hour shifts (the corona pool), we often still do not have enough staff to cater to our patients.

Caring exclusively for covid patients has brought many challenges, insights, and humbling to my practice. Patients are forced to be isolated in their dark hospital rooms for days. Staff is instructed to only go into the room when necessary, so we call them to see if they need anything. They are served meals on paper trays. They are forced to keep their doors closed. They are often transferred to a different room in the middle of the night to allow grouping of all covid cases. They are allowed absolutely no visitors, even at the end of life. One minute they can be communicating effectively on room air to the next minute on optiflow and unable to walk to the bathroom.. oxygen levels can change drastically. A multitude of patients have stated they want to die and give up fighting, then they do die. Patients have screamed and cried for nursing to help them as they are scared and can’t catch their breath even on the highest of oxygen settings, fearing an impending intubation.

Your nursing “heroes” are still here and very tired. Our own bodies are fatigued and overworked. I love my job, but never would I imagine to be in the horrific situation we are in currently. Never knowing what the next day will bring is scary. Fearing a continual expansion of critical care, caring for higher acuity patients, and watching management being forced into bedside nursing roles is scary.

But it’s all political, right?

Until next shift,

Shania

Masking is not political: Nursing in the age of COVID

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72 y/o female with h/o hypertension presents to the ED complaining of a sore throat and diarrhea. She has no known allergies, lives alone, and enjoys cooking for her family. She is diagnosed with COVID-19 (Day #1). She is asked to stay overnight in the hospital for observation and IV fluid replacement. Overnight, her O2 saturations drop and pt is placed on 2L BNC. The next day she is unable to walk to the bathroom and becomes extremely SOB on exertion. O2 is increased to 4L BNC and is placed on steroid therapy. The pt continues to decline and is now looking at rehab placement at discharge. The following night, the pt is placed on a nonrebreather plus Optiflow HFNC and is transferred to Critical Care where she will be intubated. The nurse arranges a FaceTime call with the family because they are unable to come see their grandmother/mother and the pt is declining quickly. The pt passes away that night.

Scenarios such as this happen every day in the hospital. As cases continue to rise, people continue to disregard the pandemic, refuse to wear a mask, and bet on the election to halt the so-called pandemic.

Previously healthy individuals are dying. Patients with comorbidities are dying. Elective procedures are being canceled. Jobs are being furloughed/eliminated. OB nurses and forced to work critical care. Healthcare workers are isolating from family and working overtime, while the community praises the “heroes” and can’t even wear a mask when in public.

COVID inpatients spend between 3-20+ days in the hospital. Disease progression has been seen to peak around day #7 in which the patient will make a turn for the better or a turn for the worse. Symptomatic treatment plus steroid therapy and Remdesivir has been shown to be effective for treatment. Isolation precautions are extended to 20-21 days for those being hospitalized.

Why is a pandemic and the importance of wearing a mask political? COVID continues to place a strain on the healthcare system as the frontline staff face burnout, hospitals are accepting higher acuity/patient loads, and the overall stress levels are not healthy to sustain.

The CDC explains how mask wearing helps with source control- You wear a mask to protect others and vice versa. Cloth and medical masks are not tight-fitting, therefore do little to protect the wearer. They are more effective in reducing transmission to others, expanding the importance of masking requirements for the public. N95 masks are the most effective to protect yourself and others as it filters 95% of small aerosolized particles and is fit-tested to the specific wearer.

The right to wear a mask is not a right to the individual. A majority of the people who do not wear a mask are not the people dying from the COVID-19. In order to protect the health of those around you, please wear a mask.. then everyone can be deemed a hero.

Until next shift,

Shania

If your leg hurts, don’t wish to cut it off

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A woman in her 50s was treated in a burn center and brought to our facility for continued medical treatment of her delayed healing leg. It looked like she got her lower leg stuck underneath a lawn mower, when it was actually due to a heating pad. Surgery was done to clean out the wound and remove dead tissue. External fixation was placed to ensure proper placement. After 3 months of hospitalization, the patient decided to get it amputated due to the severe pain. She was also aware that even if the leg healed, it would take extensive rehab to ever walk again.

This scenario justifies the importance of pain management and education. Pain is now seen as the 4th vital sign. We ask everyone if they are in pain and will medicate the said pain if present. Many patients immediately expect narcotics and opioids to be the only relief for their pain. Educating on nonopioid or no nonpharmacological pain management is crucial to effectively treat pain. These modalities include NSAIDS, ice/heat therapy, massage, imagery, and movement among others.

This patient had several moderate dose narcotics available as well as IV ketoralac/ Toradol. The only medication that was actually effectively for a long duration was the Toradol.

Toradol is classified as an NSAID and can only be given up to 5 days to prevent GI bleeding and kidney issues. However, with it being an anti inflammatory, this medication was greatly effective for a recently amputated leg. The patient was aware of that and only requested the Toradol for her pain. Education is key.

Aside from the pain management of this woman, her positive outlook on her situation is also what leads to positive healing. She repeatedly stated how God will bring her through any situation she faces. She was confident that this was in her plan and was determined to do anything it took to heal her body.

We actually developed a good rapport after realizing we both favor a particular pastor and both plan on attending his church after the pandemic.

It is important to not simply treat the patient, but to try and communicate with them as human beings. You never know who is in that bed.

When I was going off shift, she reminded me that if my leg was ever hurting, not to wish to cut it off.. I plan to take that advice to heart.

Until next shift,

Shania

I Owe You a Coffee

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The hospital has hired several new hospitalists during the past few months. One in particular really clicked with me. I introduced myself to her because she had several of my patients for the day, who required a lot of attention. I had to call her several times regarding discharge planning/issues, a change in antibiotics, and family concerns.

Typically, many doctors seem to get annoyed by patient/nurse concerns and don’t communicate with the nurses as much as we would like. At the end of the week, this hospitalist repeatedly thanked me for “making her first days easier” and for “telling her any issues/concerns so we can solve them.” She even offered to buy me a coffee sometime for her gratitude.

It is really nice to see true nurse-physician communication without feeling overpowered. She valued my opinion/suggestions, took her time to assess the nurse and patient needs, and treated me like we were on the same team (which we are).

Relationships like this are so important in healthcare, yet so minimal. It is so frustrating to be hesitant to call a doctor for a legitimate concern. It’s frustrating to sense that a physician feels like they have all of the power/intelligence. It is important to remember multi-disciplinary care and recognize that each member is on the same team to serve the patient.

Until next shift,

Shania

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615-856-8181
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