Hypothermia

I am currently looking after a patient that is suffering of hypothermia of unknown aetiology. ?cold sepsis. When I was wrapping her up in a foil blanket I got from ICU, all I could think was "She looks like a baked potato"

Patients Vs. Patience

Today, I had an 88 year old, 52kg patient give me attitude. Apparently, trying to raise her BP was the wrong thing to do, despite me explaining the importance of not having a systolic BP of 76. 
“Why, because a text book told you so!?”. No, because you have no radial.

How to age gracefully

"What is the secret to staying young?"

I ask this question of all my older and surprisingly independent patients. I have had some expected answers and some that shocked me. 

I thought I would compile a list (of the ones that I can remember). Because, let's face it... we all want to age gracefully.

• Stay active. Every single day
• Take time out from your job
• Drink a shot of Greek Brandy every night with dinner. I have also been told on several different occasions, a shot of liqueur, or a small glass of red wine every night helps too.
• Have lots of sex
• Remain positive
• Never stop learning
• Reduce stress in your life
• Eat healthy

I endevour to update this list as I meet more new and exciting elderly patients. I love sitting and chatting with them, and learning about their lives. A lot can be learnt from them!

Nurse KC

Graduate Year: How to stay ahead of the game

                                                                                     source: sketchymedicine.com

One thing I have learned from asking experienced nurses, is ways in which you can maximize your potential to learn new things, and stay afloat. And it all comes down to asking questions.

Whether the questions are:

• What is this diagnosis?
• What is this new medication?
• Are there any practice points I need to know for these?
• Are there any side effects?

It has been drilled into us at uni, to question everything that we come across. And it's so true! 

Whether you have time at work or at home, is so important to advance your nursing care, and expand on your knowledge.... it's not all about the fun complex medical procedures.

I'll give you an example...
Today I cared for a patient with Serotonin Syndrome. Before today, I had only dealt with Serotonin Syndrome in the community, so I had no idea how to manage a sub-acute patient with this condition. Luckily for me, an ICU nurse had been one step ahead and printed out a BMJ Best Practice article on this condition. It greatly helped in identifying the diagnostic approach, the classifications of Serotonin Syndrome, the investigations needed, and the criteria the patient meets to be diagnosed with the syndrome.  

Not only knowing the presentation of a medical condition, but also how it is treated can shape you nursing care to be more patient centered. Also, it greatly aids in the identification of warning signs that things aren't right for your patient, and the things that are expected.

Understanding the treatment plan the doctors are prescribing makes for a happy nurse!

Questioning everything has advanced me a lot further than than being 'just a grad nurse'.  With time, the 'common' diagnoses in the ward will become ingrained in my memory, and google will no longer be my best friend!

For those interested, here is a link to a basic rundown of Serotonin Syndrome.

You're welcome :)

Now, go forth and study your hearts out!

Nurse KC

ANZAC

Today is one of the most important days on the Australian and New Zealand calendars. ANZAC Day.

ANZAC day is annually commemorated to mark the day in which that Australian and New Zealand Army Corps landed at Gallipoli in 1915. Dawn services are held around the country to mark respects to those who fought for our freedom (unfortunately, this year I was unable to attend, due to work commitments). Veterans and family members march in parades, their shiny and prized medals gleaming brightly, pinned to their breast. This is an amazing experience for all involved. 

In true Aussie style, an annual AFL game between Essendon and Collingwood is played out at the MCG in front of a packed crowd. During World War 1, the VFL alone lost 94 players, including 17 in the chaos of Gallipoli - six on the first day! (abc.net.au)

I identify strongly with the connection to the Australian Defence Force. I am proud to have a grandfather who fought in World War 2, and my brother currently serves in the Army, and holds a rank of corporal.

So today I say thank you to the ANZAC's who paid the ultimate sacrifice to that we could live ours. Thank you to the ANZAC's who returned to teach us about the spirit of the ANZAC's. Thank you to the ADF for keeping our country safe. 

Lest we forget.

Nurse KC

Knowledge

I stumbled upon this post Dr. Grumpy recently uploaded about knowledge. I can relate to the Medical Student that was Dr. Grumpy and Haley. There have been so many times when I was a student, and now, when I look up to senior nurses and wonder just how they can remember that much, and how it seems like second nature to them.

While I roll around the ward with my P-plates on, I must look like a foal trying to walk for the first time. Although, I am getting better at my coordination of certain things... like taking blood and not being so cack-handed.

I know that it is experience and practice that makes perfect. So here is to all the practice I will get!

Have a read of the story Dr. Grumpy shared...

Recently a patient brought his daughter, a 4th year medical student, to the appointment with him. She nervously asked me about making her imminent, and bizarre, leap from medical student to doctor. She felt like someone was going to tell her she wasn't really qualified to be a doctor, that her whole 4 years of med school were some sort of trick, and that she was really a fraud.
And... I agree. Not that she's a fraud, but that it's how I think most of us feel at that point. Actually, it's how ALL of us feel. It's just that some won't admit it. I will.
Attention medical students and residents: THIS IS NORMAL. You just don't realize it until you're actually going through it.
As a 3rd year medical student this terrified me. I was seeing REAL (OMG! REAL!) PATIENTS and had no idea what I was doing. The attendings would point out the substantial gaps in my knowledge and I'd feel like there was absolutely no way in hell I'd ever know that much.
Toward the end of my 3rd year was a rotation with Dr. Griffith, an absolutely brilliant internist. He was a nice guy, but always made me feel like I knew little, simply because he had all the answers I didn't. Seated next to him at an end-of-year lunch, someone pointed out to him that he'd now been an attending for 6 years (yeah, in retrospect, he's not that much older than me). I quietly asked him "and do you still feel like you don't know anything?" He laughed and said "I don't know anything."
And, folks, it never goes away. I've now been an attending physician for over 15 years, much longer than Dr. Griffith was at that time. And I still feel like I don't know anything.
I think the issue is that inwardly we're still the same people who went to college, made it through medical school, survived residency... but we're still ourselves. Somehow we expect that, by being given the title of "Doctor" we're suddenly endowed with a sort of medical omniscience... and it doesn't happen. I don't feel any smarter today than I did when I stepped out of grade school, or high school, or college. Even though I KNOW that through learning and training I've amassed a decent amount of medical knowledge, it's not something that any of us is consciously aware of.
In my experience, the only way any of us realize how far we've come is when we compare ourselves to someone at a previous stage in our training. When I have the occasional medical student or resident spend a few days with me, I'm amazed at how much more I know about neurology than they do, even though I don't feel any different than I did at their stage. It's only in comparison to those behind us that we realize how far we've come.
And, if they ask me if I ever feel like I don't know anything, I tell them "always."
Good luck, Haley!

Oat Bites

I found these Oat Bites on the Kristin Cavallari app that I have (yes, I am a huge fan of her... She "get's it", you know?). Anywho, I decided to give them a crack, and I am pleasantly surprised that they taste bloody amazing! And there are so many possibilities to make them healthier, or not so healthy (....chocolate and alcohol, anyone?)

Here is the recipe:

Ingredients:

1 cup rolled oats

2/3 cup unsweetened coconut flakes

1/2 cup cashew butter

1/2 cup chia seeds

1/2 cup cocoa nibs

3 tablespoon coconut oil, softened

1/3 cup honey or maple syrup

1/2 teaspoon vanilla powder

Directions:

1. Mix everything together in a medium bowl. 

2. Chill for 45 minutes.

3. Roll the mixture into balls and enjoy!

4. Store them in the fridge.

I bought the white chia seeds... only because the supermarket was sold out of the black chia seeds. I did have to hunt around for a whole foods store that sold cocoa nibs. And I substituted the vanilla powder for vanilla extract, because I had that in my cupboard. Next time I make these, I think I will make my own vanilla powder.

Let me know what you think of these! 

Nurse KC 

Photo: Kristin Cavallari app - Oat Bites