Sunday, November 22, 2015

Idiopathic cerebral hypertension/benign intracranial hypertension

So that's my diagnosis. Reason for it...... because I'm fat! Ha, as if I didn't already know that! It's something that I want to deal with and haven't been able to because exercising is a feat in and of itself because of the rectal fistula. When I try to exercise = sweating = increased infection rate.

So when I saw my surgeon the last time I asked about gastric bypass and was told that I wasn't fat ENOUGH! Geeze. I was told that I would be if I had secondary conditions such as diabetes, hypertension, cardiac or renal disease.... so I was excluded. So I wonder if having hypertension in your head counts?!

I had the LP done yesterday and it showed that my opening pressure was 28 => less than the 36 it was before but more than it certainly should be (normal = 10-20). It was weird having it done under fluroscopy because they do it in the supine position and then once close to/in position then they turn you to the lateral position to obtain the opening pressure and take the samples. They also took off some CSF (I was told between 35 & 40).

I instantly felt some relief from the fluid being removed which I was thankful for. Unfortunately it didn't help the hazy vision issues.

Because we now know the diagnosis, I was restarted on the med that caused my sodium to drop the last time I was on it so I'm in the hospital still to ensure that we monitor it. Well I had my blood work done today and while my sodium was fine my CO2 (I think that's the one that the Dr said was abnormal) wasn't and had dropped from 25 to 21 (normal 23-29) so while it's not in the danger range it''s stil something that we have to watch. I was told that the reason for the drop is that my kidneys coould be having difficulty coping with the medication and that if  it dropped any more then I may have to stop the medication. Don't quite know the repercussions of that one. Also, I dont know if ppl feel any different when they first start this medication but I certainly haven't.

This morning I woke up because of a nasty headache. Ugh. Then the dilaudid didn't even help and required toradol above that. Together they seemed to take away the brunt of it and I was able to go back to sleep. Today has been rough when it comes to headaches.

I also went to the opthamology appointment and had them check my eyes and then they dilated them. Oh boy was that interesting. Geeze were things blurry! But I was told that my eyes look healthy so we still have no real reason for the continueed bluriness. The Dr wants me to have a follow up appointment with an opthamologist but don't know with whom. Also - he said that if I lose just 5% of my weight that things will be drastically different - ya we'll see!

So ya, I feel so great about myself. Yes I know I'm fat. Thank you for throwing that fact in my face time and time again.

Thursday, November 19, 2015

7 days in and still no real answers

SO if you've actually been reading this blog (thank you!) you'll notice that there's been a drop in my posts even though there's things been going on in the life of Nurse Dee.

Well it all started last week (we'll say monday for shits and giggles) and I had a headache, decreased appetite and nausea (no vomitting) and been monday and wednesday I had a fever off and on - it seemed that when I had the nausea really bad that I also had the fever. The highest it got was 38.4 C/101.2 F. The other temps were <38.0 so I didn't go to the hospital. Figured I could just get over "whatever" this was.

So thursday rolls around and my husband gets fed up with me saying that I'm not feeing well and tellls me that I either need to put up or shut up.... in other words - go see a Dr or stop complaining!

So I grabbed some stuff and off we went to the hospital - no temp at the hospital but because I had had a high one the night before I was considered a SIRS alert and was seeen a bit quicker.

About 6hrs later I finally see someone - the nurse practitioner - now I'm ok with them - I know that often they will know just as much or more than regular docs but this one seemed real unsure about what to do with my symptomolgy. She calls in the MD and he makes the decision to do blood work and a CT - those come back clear and I wait some more.

When I see the Dr again he decides he wants to do a LP (lumbar puncture) which I thought would be valid given my symptoms - my neck was stiff and my vision turned hazy that day which is actually why I agreed to go in.

Anyways - he also has a call in to the neurologist (one I actually know and converse with on my unit) and he comes in JUST as he's (the ER doc) creating his sterile field and said he wants to ask some questions and proceeds to. I think he got 3 questions in when I told him I needed an emesis basin in case and I think he asked another question and a wave of nausea hit me and of course I reacted - trying to keep the stuff down - and he thought I was just being emotional about the question! Hahahaha. So I think he asked about 2 more questions and I answered by vomiting.... he was so astonished! Oh to just picture his face! He said "yep, I think that's about enough, we may want to reconsider doing the LP in her condition" Hahahahaha

They gave me some Zofran and 20 min later we did the LP - not simple and certainly painful! But we got the fluid.

Before doing it though I made sure to have him check my opening pressure (see I am learning things from school!) and that that's really important! So when he opened the first kit and it didn't have it he ensured that he found one that did.

Well good thing I pushed for that because my opening pressure was 36!!!!!!!!!!!! High normal is 20 so it's no wonder I was in soo much pain. And let me tell u pain.... after the hour of being supine/lateral, I got up to go pee - OMG the pain..... it was searing from the LP injection to my neck like someone was stabbing me or something. I could no longer look left/right or put my chin to my chest without excruciating pain - I couldn't lay flat with my legs down - when they had me do that I was in tears!

So they admitted me. They said the fluid looked clear and the results of the LP came back clear so we didn't know what was going on. Then we did a MRI/MVA where we look at the veins and artieries and such of the brain to see if there's somthing going on there. Nope - that pretty much came back clear - the neurologist said that I had a slight compression of some area that is often associated with a condition called iopathic cerebral HTN.... but he didn't see me til the Saturday and in his notes indicated that he wanted a therapeutic LP done on me to drain 40cc of fluid!!! That seems like an awful lot! The MRP refused, indicating that he wasn't confortable taking that much, neither was the anesthesia consult MD because if u take off too much,u could cause herniation and thus death unless dealt with immediately.

Now, my hospital might be huge but we do no have neurosurgery on stand-by! So if I did herniate then I would die or have severe deficits - just what I always wanted!!!

So today finally came when the same neurologist was back in house and he came to see about doing the LP - said the risk of herniation is about 1% and risk of low CSF is 5%, so I consented.

The fellow that he has on service with him is also an anasthesiologist by trade and said that she would do the tap.... and didn't bother numbing me at all!!!! Said that it can "screw up/shift the anatomy" and make it more difficult to get into the space. I think it was utter bullshit but who am I to say?!

So now they want this tap done under x-ray/fluroscopy/CT/MRI - whatever the hell it is! And who knows when that will be!

I just told my MRP (because we've known each other for 4+ yrs now) that I think it would be better to just go to the hospital that specializes in this sort of thing.... tomorrow we will see. I didn't see him tonight before he went off.

Tuesday, November 10, 2015

Here I sit waiting

I thought perhaps that I would have had an email when I got up in the morning.

Alas, nothing.

So I don't know how to decide between one position or the other if I don't have all the answers.

So I put out an email to the recruiter to find out about information that I require.

Hopefully I'll know more tomorrow.

Saturday, November 7, 2015

I thought my previous problem was a problem, now it's a real conundrum

Today I had an interview for the position that was offered to me when I applied to another position - at a different hospital.

So I showed up at the wrong hospital and when I realized it I ended up at the place late. I covered it well because the location was locked up tight and when they called me to ask if I was actually showing up I played it off that I had been circling the building trying to get in and that's why I was late. Thankfully another interviewee was also waiting along side me so it seemed like I was just simply locked out.

The interview went awesomely. As in my best yet.

The new place is as follows:

52 bed medical unit with 8 beds reserved for surgical patients
The other unit that I would be hired for is an ER overflow unit
The shift is 12 hours (what I really, really want to work!!)
The new place is closer to my house and would be easier to get dropped off/picked up from if needed
The new place is actually going to be a new unit so there's something to be said about being the one to be there for that


I would be missing out on surgical post-op patients all the time - I feel like I need that experience
I would lose my senority
I may not be making as much money (but I wouldn't have to work as many days in order to get the same amount of money)
The new place would mean that I wouldn't have to work more frequently which means I can use that time to study

Lastly - I don't know about the paeds position yet and I would technically have to start the new position on Nov. 23rd which means giving my place less than 2 wks notice (not that I work that day so I suppose it could be >2wks notice - but that's not really what I'm concerned about).... if I were to leave I don't think I would be eligible for the paeds position - which is what I would really want if I could choose.

So HELP - I don't know what to do! Each is good in their own right. So I have no idea what to do now.

Thursday, November 5, 2015

A real problem

Ok so I accepted the surgical position - supposed to start at the beginning of December...

But today a paediatric position showed up on the posting board today... and so I applied because it's really where I want to be. Like REALLY REALLY want to be.

But how do I go back on my word if I actually get hired?

I want to work in ICU - but I want to work in a NICU/PICU so having the peds experience would be really really important.


I really want an interview. I really want that position.

I guess time will tell - for now I study for my crazy hard exam I have due this week. Wish me luck!

Wednesday, November 4, 2015

What nurses should realize is this...

On my current unit we have 37 beds with 3 potential hallways for a total of 40 pts to be divided between nurses.

There is a combination of 8 & 12 hr shifts - and even 4 hr shifts for when there's a gap.

I find it surprising when people get so upset that their assignment from yesterday or the day before changes - primarily this occurs with nights and sometimes for evenings. 

Yet it's often the experienced nurses (those who have been on this unit for 5+ years) who are the ones who are complaining. As though they don't know that sometimes things change according to how many 8 and how many 12 hr shift nurses there are. Plus at 2330hrs you have to put up 2-3 more pts to have over night.

Now, often the charge nurse will "try" to give the same assignment but that's not always feasibly possible. You would think that nurses would understand this. But alas you still hear the complaints that they have to take on new patients.

OR, the charge nurse will change things up entirely and do it depending on the area that the pts are because our unit has pods (sorta) and will give you patients depending on where they're located - with no regard to how heavy a pod may be pt wise - you could feasibly have 4-5 (of your 6-7 pts) that are total care with which they are incontinent and you have to change them at least twice on your shift - it can make your back and feet hurt a lot. And these same ppl will still complain about their assignment. 

It's a lose-lose situation IMO - you can't win with these ppl. Such a shame that they clearly don't learn.

REALIZE THIS: Your assignment will ALWAYS change - expect this and just roll with it. If you don't like it, go to days, their assignment won't change for the slew of shifts that they're working.

Saturday, October 31, 2015

Start slow means crazy at the end

Why does it seem that when the shift starts off slow that the shit hits the fan at the end and you're stuck late on the unit completing charting.

But guess what... T-38 days til I get to start on the surgical/ortho unit!!!

I was talking to a nurse who floats to lots of different units and she said that she enjoys working there and it's MUCH better than my unit.

Can't wait to start!!!