Friday, March 26, 2010

I'm Tired!

I'm doing really well in school here lately; got all my work done, turned in, and what's been graded has been pretty good. I'm just so extremely tired.

I get nearly no sleep between nursing school, work, and home responsiblities. I just hope it's all worth it because I literally go 7 days a week with school and work. I haven't had a day off since the blizzard. After about 3-4 weeks, it really starts to wear on you...

My sales work suffers because I'm always preoccupied with schoolwork. My home life sucks, because according to my wife, "I'm never home to be a father." I always feel like we are on the verge of a separation over the whole thing. The only thing I do really well right now is school...

I gotta hope that everything gets better once it's done or else I'm only gonna have my job and education.

Saturday, March 20, 2010

ADE at Home

A close family member of mine was acting quite strange last night. They stated that they had had a headache that felt like it was inside their head; not in any of the typical sinus spots. They also said it hurt so bad that they were going to see the doctor if it didn't resolve.

Now as close as this person is, I should have known if they were taking any pills actively. Asking what types of medication that they were currently taking, I discovered they were taking Celexa, an SSRI (selective serotonin reuptake inhibitor) and phentermine, an appetite suppressant.

I decided to see if there were any drug-drug interactions. Turns out that phentermine shouldn't be given with any SSRI because of an increased risk for serotonin syndrome. Now these drugs were prescribed together and picked up from the same pharmacy and nobody knew anything it; nor did any system catch it.

I knew something wasn't right because I recalled SSRIs typically are excreted through bile about 80%, with 20% excreted through urine. Bile means you poop it out. Appetite suppressant means you don't poop as much. Not pooping much = more serotonin-screwing-with-agents still in the body. I try to break things down to the simplest level: believe me; it helps! Not to mention the potential for serotonin toxicity which can lead to the potentially fatal serotonin syndrome.

This family member reported:
  • Paranoia
  • Depression
  • Insomnia
  • Headache
  • Insomnolence

I obviously told this person they shouldn't take either drug for 3-4 days since the half-life of Celexa is 35h. I'm continuing to assess for signs of serotonin sydrome, but they seem to be improving.

Turns out polypharmacy can be closer than we think: I definitely think everyone should audit their medications, especially after this scary incident.

The Heart...

I've learned a ton here recently about the heart.

I'm still in the LPN year of school, so I don't get to go into major detail until this fall. What I will say is that my Human Anatomy & Physiology courses are pretty much crucial to proper understanding of how everything works.

My teacher, also a male, explained the cardiac system beautifully in terms of plumbing.. which worked out great for me since my father used to be a plumber! It also explains nicely why people are usually on more than one blood pressure medication.

Basically, there's three things the drugs affect: contractility, preload, and afterload. Basically, this means blood before the heart, blood after the heart (peripheral resistance), and how hard the heart contracts. I'll explain each in basic terms I use to understand them.

Preload mainly affects CHF patients: they got too much fluid. This fluid is trying to enter the heart during diastole (when it's not pumping) to fill the right atrium, but there's just too much in the pipes. Expect this to be treated with Lasix or HCTZ; primarily they are diurectics (removing the fluid), but the secondary effect is lowered blood pressure because it reduces the amount of fluid being pushed into the heart during diastole.

Contractility is the force of the heart's pumping. Beta adrenergic receptor antagonists (beta blockers) are what affects this. Big word: it really scared the hell out of me when i first saw it, but it's actually pretty easy concept if we break that big word apart. Adrenergic means "adrenaline". Receptors are where the chemical/hormone/enzyme lands to cause an effect of some sort. Anatagonists means "goes against". So it's an adrenaline receptor blocker... this means that all the "receptors" that adrenaline activates on the heart are reduced: for the sake of the concept let's say they are cut in half. Since the beta blocker effectively "clogs" some of the receptor sites and renders them unusable, the heart will not contract as hard, reducing workload, and reducing the amount of oxygen the heart tissue itself needs.

Afterload means after the heart. The bad thing here is peripheral resistance. Imagine a garden hose with no nozzle: the water comes out steady, but there's not a lot of force behind it. Now, stick your thumb over the nozzle: you've got a mini pressure washer on your hands. Same is true for peripheral resistance: if those arteries or veins narrow you are essentially sticking your finger over the hose. The best way to medically treat this is with any sort of vasodilator. The bigger the pipes, the easier they flow. The ones you usually see are calcium (ca+) channel blockers. Calcium is important in muscle contraction; especially smooth muscle contraction. This means that the veins and arteries dilate rather than constrict and this eases up total peripheral resistance. Of course, there is some beneficial action in the heart itself related to calcium channel blockers, but this is just my understanding of a concept and not advanced hypertensive pharmacology.

So, now when I see that patient who is on Lasix, Norvasc, and Bisoprolol, I can visualize and understand that the Lasix reduces fluid in preload, Norvasc eases the amount of force the heart contracts, and Bisoprolol dilates the periphery. In my first nursing class, seeing two or three hypertensives on a client concerned me a bit and I started wondering about polypharmacy issues; my cardiac lecture put it in perspective pretty good.

Friday, March 19, 2010

Over the Hump

Looking at my calendar I realize... I'm about over the hump!

I like to take things small. I'm not halfway to my RN, but I am about two-thirds of the way to my LPN! Here's my current schedule:
  1. Six more weeks of NUR151 - Adult Nursing
  2. Break for three weeks!! (Beer, here I come!)
  3. Six and a half weeks of Maternal-Child Nursing.
  4. Break for another week!! (Welcome back beer.)
  5. Six and a half weeks of Psychiatric Nursing.
  6. Eligibility to sit for NCLEX-LN and my Certificate of Proficiency in Nursing!

And just in case you were wondering about the beer comments... I've sworn off any and all beer and alcohol consumption while I am actively in nursing school. I think it's just better that way... don't need any more distractions than I already have.

It's nice seeing myself make progress... I just hope I can get through this class. You can see my grades are decent but not exactly superior!

Nurse Slaps Quadrapalegic!

Wow... slapping a quadrapalegic is like the most screwed up thing you can do! I know people can be obnoxious (I'm thinking of you Mr.-don't-wipe-my-arm-off-with-alcohol-before administering-my-insulin-needle), but come on!

Shocking what so-called nurses are caught doing! And here I'm struggling to get through nursing school... it makes me feel like getting through nursing school shouldn't be as hard if morons like this get through.

Link to original article:

Tuesday, March 16, 2010

Back to Reality!

Well, I'm back to school after a week-long break. This has been a weird semester: we lost nearly two weeks due to the triple blizzards, I just got off of our scheduled winter break, and I lost a clinical day due to a bomb threat.

The week prior I passed my skills check. I studied so much it was second nature and I wasn't even nearly as nervous as I usually am. I converted an IV site into an intermittant infusion cap and I calculated and hung a primary bag, a secondary medicated bag, and calculated the drip rate and set flow with a clamp controller off of gravity. No pumps. Good thing that I will know how to do this out in the bush! ;)

Yesterday was my first day back. I had a test on the respiratory and reproductive systems. Hearing these two systems, I focused my studying on respiratory because I figured the test would be respiratory-heavy. I was wrong... the test was split in half and my studying of the reproductive system was lax to say the least.

Tons of questions on BPH, continuous bladder irrigation, cystoceles, and leiomyomas... I wasn't as focused on these as I should have been. I knew what they are, how they worked, etc. but you really need to know the drugs, interventions, and what to expect, because these hard ass NCLEX-style questions are not forgiving to those looking to reach the correct answer by eliminating 3 out of 4 possible questions.

My school has a ridiculous policy about not giving out test grades until everyone has taken the test, even though the tests are Scantron and they have the results immediately. I can understand, obviously, that we can't see our actual tests, but what would a number really hurt? Test integrity would not be comprimised.

After much bugging, the class at least got our instructor to give us a range, which he shouldn't have due to departmental policy, and the class range was 62-94. This is actually not bad news because even if I got the 62, I will still be passing due to the 90% I received on exam #1. So, I maintain a passing overall grade, even in the worst case scenario.

We also learned about the sheer nastiness of the digestive tract. NG tube insertion was pretty cool and probably the most uncomfortable thing I'll ever have to do to someone (probably up there with foley insertion). You can, in fact, vomit up feces. And if you do so on my shift, I'll be vomitting right alongside you. Of course, compared to that last exam, I can't seem to decide which one I think is better! :)

Tonight, I will be going to the hospital. I am extremely happy to be done with the long-term care clinical site. Happier still to be with what I consider the better out of the two instructors. Acute care is much more appealing to me than long-term care, though in the real world, LTC offers some great (and lucrative) job opportunities. Will I sell out for an extra nickel, or will I simply stick with what I love... only time will tell.

Oh, and in February's update, I made mention of my graded nursing careplan. I got a freakin' 78% on it, and the amount of pissed that made me still can't be accurately described by the English vocabulary. That careplan was awesome. Totally awesome. And when compared to the other students (especially those in the other instructor's group), they wrote careplans of the same caliber, or even less in my opinion, than mine, yet received a much higher grade. I'm really mad, but unfortunately, grading in nursing is so incredibly subjective, I think I'll just keep my trap shut and play nice before I fail something that is "unrelated" by this instructor.

I'll post up my current grade calculations:

Still in it... not exactly setting the nursing world of academia on fire, but I'm giving nursing one hell of a shot! Oh, and that Total Theory Grade is obviously wrong; just a byproduct of the formulas used to calculate my grade.