Haldol Headache

Studies have been done on the antipsychotic drug, "haloperidol" to see if it prolongs the heart's QT interval. 

What is a QT interval?  What does it do?  How is it measured?  Does the heart rate have to be slow and regular?  Where are my calipers?

Nurses aren't supposed to give haloperidol to a psychotic patient until the QT interval is calculated.  Then, after the dose is given, the QT is supposed to be re-calculated to see if there has been a change. 

Remember--haloperidol is given for PSYCHOSIS.  If a patient is tearing out his IV's and foley, ripping off his clothes and running down the hall screaming and punching nurses--how much time do I have to calculate a prolonged QT?

When the policy of calculating QT intervals came out, the number of psychotic patients plummeted to zero.  It was a medical miracle!  There were no more psychotic patients in the whole hospital.  We still had anxious patients, though.  Lorazepam could be given to calm them down.

Beware of making the cure worse than the disease.  If the right treatment is made too difficult, people will give the wrong one.

I'm giving about 3%

Today I heard a sports announcer say that a player was "Giving 110%!"

Now, I didn't major in math (I don't know what a slide ruler's for) so I could be wrong here, but isn't it impossible to get a number larger than 100 when you are calculating percentages?  The denominator is the whole (represented by 100% in percentages) and the numerator is some portion of that whole.  Right?

So, if someone in sports is giving 110%, are they bringing an extra body part with them?

Nurse's Note:  I wanted to have shirts made up for our unit that said, "ICU Nurses Give 110%!"  but my manager discouraged it.  She said that since we are calculating vasoactive drips, we need to demonstrate some basic math competence so we don't frighten the patients.

HDL Chart

Nurses have a special chart to graph happiness--the HDL chart.  "HDL" stands for, "Happiness Decibel Level".   

Here's last week's HDL chart:

When to Write Other Nurses Up

"Lateral violence" can be loosely defined as taking out your frustrations on coworkers 'cause that's the safest way to do it.  Lateral violence is not as common as it used to be, thank god. 

Sometimes new nurses ask me if they should "write up" another nurse.  Here's what I tell them:

Some things should be written up.  But what?  It can be hard to know.  If you follow a nurse and the IV tubing is unlabeled, should you "write it up"?  What if the patient doesn't have their SCD's on?  What if Zosyn was hung but the tubing was clamped so the dose didn't run in?

Should you fill out an INCIDENT REPORT?  Should you have your nurse manager paged overhead?  Should you contact the hospital CEO?

Maybe.

But, before you do any of that, ask yourself:  "Am I prepared to have this person as an enemy for the rest of my life?" 

Because THAT NURSE WILL BE YOUR ENEMY.  Make no mistake about that.  We are not creatures of logic; we are creatures of emotion.  A nurse who writes up a coworker had better be ready to never make any mistakes, because no mercy will be shown.

You can work with that other nurse for the next 43 years, and she will STILL remember it.

Label the tubing.  Put the SCD's on.  Release the clamp and let the Zosyn run in.  The next time you see that nurse, mention these omissions in a kind, instructive manner.  Make it a learning experience.

This is a 24 hour job.

Hospital Goblins

Hospitals are plagued by several goblins.  These goblins make the nurse's job difficult.

Here are a few of the more common goblins:

THE PAGER GOBLIN

When a nurse pages a doctor and gets no return call, we often hear later, "I didn't get that page".  The Pager Goblin has been at work!

THE TRANSPORT GOBLIN

This goblin is most commonly seen right at shift change. The off going nurse says, "Oh!  This intubated patient needs to be taken for an MRI scan of the chest/abdomen/pelvis!  I didn't see that order.  Can you take them?"

THE TANGLED LINE GOBLIN

This goblin comes into the patient's room and knots the monitor cables, IV tubing, foley, flexiseal, CRRT lines and balloon pump catheter into a ball.  The nurse untangles the mess, but the goblin sneaks in and weaves them together again.

THE MISSING LAB GOBLIN

A nurse draws a patient's blood, puts it into a tube, labels it and sends it to the lab.  Then, the nurse waits.  And waits.  And waits...

Time passes.  The polar ice caps recede.  A new president is elected.  Mars is colonized.

Finally, the nurse calls the lab to check on when--or if--the result might be posted.  The lab technician says cheerfully, "We didn't get that sample!"

This is the Missing Lab Goblin at work.

Step-Parenting

I think the hardest job on Earth is step-parenting. 

This is not exactly breaking news.  The authors of Snow White and Cinderella knew it centuries ago. 

Part of the difficulty of step-parenting lies in the vagueness of the job description.  Are you supposed to be a parent?  Or just a friend?  An adult friend?  (What is an adult friend, exactly?)  Should you try to be a pal, like a popularity contest?  Or more like a teacher?  How much--if any--authority do you have?  

I love my step-daughters and we get along well.  But, nine years ago we adopted two eight-year-old girls from an orphanage in Russia.  They were from the opposite side of the planet from us.  If you get a globe and put one finger on their hometown and one on mine, you can suspend the globe in the air.

They spoke no English and had experienced massive loss, BUT--parenting them has been a stroll through a flower garden in May compared to parenting step-children.

Why should this be true?

Most relationships go like this:  Boy meets Girl

Let's call them, "Tom" and, "Sylvia"...

What's important in this relationship dynamic?  

It's how Tom feels about Sylvia...

And how Sylvia feels about Tom.

This is love in it's simplest, easiest form

Relationships are tough, though.  Think how many fail.  All relationships face daunting odds.

But, if both Tom and Sylvia have children...

The relationship dynamic looks more like this:

How Susie feels about Kate

And how Anna feels about Tom.

How Anna feels about Kate and how Kate feels about Tom...

How Tom feels about Anna and how Anna feels about Susie and how Susie feels about Sylvia and how Kate feels about Erin and how Susie feels about Anna and how Erin feels about Susie and how Kate feels about Tom and how Erin feels about Anna and how Sylvia feels about Kate and how Erin feels about Anna...

All these arrows lead to stress...

Mayhem ensues...

It's tough being a step-parent.

(I didn't draw the arrows that go out to Tom's and Sylvia's parents, brothers, sisters, cousins, nieces, nephews, aunts, uncles, grandparents and friends or the children's other parents.  I wanted to, but Google doesn't allow that large of a post in one blog)

The Plav-Ex Man

I've learned that anything can be delivered these days.  I knew that groceries, horse wormer paste and furniture could be delivered right to your door...but, did you know that you can also have prescription drugs delivered?  Now you don't have to worry with those little pill boxes that say, Mon Tues Wed on their flip tops.

 Every day, your front doorbell rings, and Viola!  The Plav-Ex man is there!

Add caption