I was assessing a teenager who had, a number of years ago, had all thier fingers/thumbs amputated at the knuckle. I knew this from looking at the patient notes, and also from looking at his hands and the scarring - he had no fingers.
Part way through the assessment, after taking the history, I went to take his physical observations, including his pulse. I went into autopilot, started unfolding my pulse-oximeter cable and said...
"Can I borrow a finger please"
I was mortified. The patient didn't have a sense of humour and didn't make a joke out of it to save me (Darn him! I thought later I should have said "Ah, it looks like we've already had them" but I don't think he was the laughing kind).
Instead I fumbled my way through with...
"Or, we could use a toe..." (I later read more of his notes and discovered he'd had a partial foot amputations too)
"Or I could just stop being so lazy and do a manual pulse. That's the problem with these machines, you get so used to using them that you become lazy and use them even when you don't have to"
Ramble. Ramble. Just keep on digging Angela.
Tuesday, March 27, 2007
Tuesday, March 20, 2007
Monday, March 19, 2007
Demanding day
I've had a couple of interesting shifts. Yesterday was tiring, both emotionally and physically and I came home feeling rather weary. It wasn't a bad day; I learned a lot but it was demanding.
We had a 13 year old epileptic who hadn't had a seizure in 4 years and had been off her medication for a year. She had a seizure on a tube station yesterday. A lovely family, she was very upset and worried that this would be the start of her having regular seizures and needing medication again. Her mother was being optimistic for her, but I knew she was very shaken by the incident. Initially she had thought she was alone on the station which must have been frightening for her, but some passers by stopped to help. Her mother said how nice and friendly we were, and I think they were both feeling much better about things by the time they left the department.
Last week I held a 5 week old baby for a lumbar puncture, I'd only seen one before and it was my first time holding, with another nurse to give me a hand. Last night the last 25 minutes of my shift were spent holding a 4 month old, my first solo hold as the department was pretty busy. It took 3 attempts, the fist 2 by an inexperienced doctor and the 3rd by her supervising doctor. It was physically very demanding to hold the baby in that position for that length of time and the baby was obviously very distressed and it is very difficult to comfort when you're having to wrap your arms around the head/neck and legs/back to hold them in a curved position. Mum wasn't present, and when we handed him back was very understanding and calm which made it easier, but I came away feeling exhausted, physically and mentally.
We had a toddler who had squirted persil washing liquid in her eyes and needed irrigation. That was another interesting one to watch. It involved swaddling the kicking, screaming child and laying her on a bed with her head slightly tipped over the edge, and running 500mls of Normal Saline into her eyes which we needed to prise open. It is incredible how strongly a person cold hold their eyes closed. It isn't painful, but it is unpleasant, the nurse was explaining she'd had to to do it to a doctor recently who had got blood in her eye and she really struggled with it, so it's much harder on a child who is too young to understand and comply.
We had an incredibly brave 9 year old who had fallen off a scooter and hurt his elbow. When he came in it was swollen and deformed. The assessment nurse called me over to ask what I thought, it was kinda like "No.. that's definitely not quite right, something is going on there" but it was hard to precisely explain. After a while it swelled more and became clearer. He ended up having broken his elbow bone, and bother his radius and ulnar and was going to need orthopaedic surgery to fix it.
The other great case we had was a 5 year old who came in with a petechial rash and a purpuric rash, a great example as I had seen neither before. The purpuric rash is the one commonly associated with meningitis. The child had meningitic symptoms but was very well, obviously it couldn't be ruled out so tests were being run for that. Another differential diagnosis was Henoch-Schonlein purpura Henoch-Schonlein Purpura (HSP). Petechial spots are caused by minor bleeding under the skin, broken capillary blood vessels, I have noticed them on myself occasionally after I've been carrying a heavy bag over my shoulder or my wrist, they are sometimes seen on the face after excessive coughing.
Well this has been a bit of a long ramble. One other thing before I finish. In my second year I worked on a respiratory ward and really enjoyed it. I was told at the time that when I was qualified if I wanted a job the Sister would be happy to have me. I spoke to one of the Sisters yesterday who had mentored me at the time and she said she couldn't guarantee anything but thought they were still under their quota for nurses and that I should email the senior sister and let her know I'm still interested. I've done that today, so as the Swedes say I shall be holding my thumbs.
We had a 13 year old epileptic who hadn't had a seizure in 4 years and had been off her medication for a year. She had a seizure on a tube station yesterday. A lovely family, she was very upset and worried that this would be the start of her having regular seizures and needing medication again. Her mother was being optimistic for her, but I knew she was very shaken by the incident. Initially she had thought she was alone on the station which must have been frightening for her, but some passers by stopped to help. Her mother said how nice and friendly we were, and I think they were both feeling much better about things by the time they left the department.
Last week I held a 5 week old baby for a lumbar puncture, I'd only seen one before and it was my first time holding, with another nurse to give me a hand. Last night the last 25 minutes of my shift were spent holding a 4 month old, my first solo hold as the department was pretty busy. It took 3 attempts, the fist 2 by an inexperienced doctor and the 3rd by her supervising doctor. It was physically very demanding to hold the baby in that position for that length of time and the baby was obviously very distressed and it is very difficult to comfort when you're having to wrap your arms around the head/neck and legs/back to hold them in a curved position. Mum wasn't present, and when we handed him back was very understanding and calm which made it easier, but I came away feeling exhausted, physically and mentally.
We had a toddler who had squirted persil washing liquid in her eyes and needed irrigation. That was another interesting one to watch. It involved swaddling the kicking, screaming child and laying her on a bed with her head slightly tipped over the edge, and running 500mls of Normal Saline into her eyes which we needed to prise open. It is incredible how strongly a person cold hold their eyes closed. It isn't painful, but it is unpleasant, the nurse was explaining she'd had to to do it to a doctor recently who had got blood in her eye and she really struggled with it, so it's much harder on a child who is too young to understand and comply.
We had an incredibly brave 9 year old who had fallen off a scooter and hurt his elbow. When he came in it was swollen and deformed. The assessment nurse called me over to ask what I thought, it was kinda like "No.. that's definitely not quite right, something is going on there" but it was hard to precisely explain. After a while it swelled more and became clearer. He ended up having broken his elbow bone, and bother his radius and ulnar and was going to need orthopaedic surgery to fix it.
The other great case we had was a 5 year old who came in with a petechial rash and a purpuric rash, a great example as I had seen neither before. The purpuric rash is the one commonly associated with meningitis. The child had meningitic symptoms but was very well, obviously it couldn't be ruled out so tests were being run for that. Another differential diagnosis was Henoch-Schonlein purpura Henoch-Schonlein Purpura (HSP). Petechial spots are caused by minor bleeding under the skin, broken capillary blood vessels, I have noticed them on myself occasionally after I've been carrying a heavy bag over my shoulder or my wrist, they are sometimes seen on the face after excessive coughing.
Well this has been a bit of a long ramble. One other thing before I finish. In my second year I worked on a respiratory ward and really enjoyed it. I was told at the time that when I was qualified if I wanted a job the Sister would be happy to have me. I spoke to one of the Sisters yesterday who had mentored me at the time and she said she couldn't guarantee anything but thought they were still under their quota for nurses and that I should email the senior sister and let her know I'm still interested. I've done that today, so as the Swedes say I shall be holding my thumbs.
Thursday, March 15, 2007
Some good ones.
We've had some good ones recently.
Possibly thebest worst reason for bringing your child to A&E. A 13 year old was brought in by his parents because he'd put something into his ear... three years ago. Why did they wait so long to come in? He'd only just told them. He had no history of ear problems and unsurprisingly there was nothing still left in his ear.
We had a 15 year old brought in from school yesterday by LAS because he was vomiting. Turns out he'd smoked some cannabis on the way to school. He was looking pretty rough and feeling quite sorry for himself. Guess he won't be doing that again in a hurry.
A 2 month old was brought in because he hadn't slept in the last 3 days, at all. (Yeah, right.) So presumably the parents haven't slept in the last 3 days either? Or have at least taken it in shifts so can observe their son's lack of sleep.
We have a television in the waiting room that we can play children's films on, one of the Registrars was walking through and suggested that we should change the channel as "My daughter is a prostitute" on Jeremy Kyle might not be the most appropriate viewing! Sometimes I'm surprised at what makes day time television and what is shown after the watershed.
Possibly the
We had a 15 year old brought in from school yesterday by LAS because he was vomiting. Turns out he'd smoked some cannabis on the way to school. He was looking pretty rough and feeling quite sorry for himself. Guess he won't be doing that again in a hurry.
A 2 month old was brought in because he hadn't slept in the last 3 days, at all. (Yeah, right.) So presumably the parents haven't slept in the last 3 days either? Or have at least taken it in shifts so can observe their son's lack of sleep.
We have a television in the waiting room that we can play children's films on, one of the Registrars was walking through and suggested that we should change the channel as "My daughter is a prostitute" on Jeremy Kyle might not be the most appropriate viewing! Sometimes I'm surprised at what makes day time television and what is shown after the watershed.
Tuesday, March 06, 2007
Almost there
I feel that I should post as I have neglected my blog for so long!
My placement is going really well, I have only 4 and a half weeks left but have discovered I need to make up another 6 shifts that I owe. I have very nearly finished my Portfolio essay and now it feels the end is in sight! By the end of April I should have all my work submitted and my hours done.
I'm trying to think if we've had any interesting cases recently. There was a little boy who had swallowed a 5pence coin yesterday, his younger brother had put it in the back of his mouth and whilst his mum tried to remove it he swallowed it! We used a metal detector to locate it, but as this method is currently being audited we had to confirm with x-ray. It was in his stomach and not causing any problems so nature is left to take its course. Fortunatly it was only a 5pence piece and not a 50 pence!
We had an unpleasant child yesterday, about 4 years old, who decided to hit me in the face and knock my (new) glasses onto the floor and then kicked me. He wasn't frightened, in pain or struggling to get away, just a naughty little boy who refused to apologise and smiled everytime he was told off. Mum assured us he didn't get away with it at home (yeah right) as he continued trying to hit and kick me as I fitted his collar and cuff (a foamy sling for soft tissue injuries).
The NMC is visiting our clinical area next week to audit the student placement experience/education and I've been asked to work that day, they're also auditing a clinical area I've worked in previously. It will be easy to provide a good report for my current area, they're brilliant, but not so easy for the other. It was a children's hospice that had recently lost its funding, there were a lot of redundancies being made and the service was very under used because of financial problems, it meant there was often nothing to do on the placement as there were few or no patients. I did learn some things, but most of my time was spent doing nothing at all, I think with funding it had the potential to be a very good clinical area.
My placement is going really well, I have only 4 and a half weeks left but have discovered I need to make up another 6 shifts that I owe. I have very nearly finished my Portfolio essay and now it feels the end is in sight! By the end of April I should have all my work submitted and my hours done.
I'm trying to think if we've had any interesting cases recently. There was a little boy who had swallowed a 5pence coin yesterday, his younger brother had put it in the back of his mouth and whilst his mum tried to remove it he swallowed it! We used a metal detector to locate it, but as this method is currently being audited we had to confirm with x-ray. It was in his stomach and not causing any problems so nature is left to take its course. Fortunatly it was only a 5pence piece and not a 50 pence!
We had an unpleasant child yesterday, about 4 years old, who decided to hit me in the face and knock my (new) glasses onto the floor and then kicked me. He wasn't frightened, in pain or struggling to get away, just a naughty little boy who refused to apologise and smiled everytime he was told off. Mum assured us he didn't get away with it at home (yeah right) as he continued trying to hit and kick me as I fitted his collar and cuff (a foamy sling for soft tissue injuries).
The NMC is visiting our clinical area next week to audit the student placement experience/education and I've been asked to work that day, they're also auditing a clinical area I've worked in previously. It will be easy to provide a good report for my current area, they're brilliant, but not so easy for the other. It was a children's hospice that had recently lost its funding, there were a lot of redundancies being made and the service was very under used because of financial problems, it meant there was often nothing to do on the placement as there were few or no patients. I did learn some things, but most of my time was spent doing nothing at all, I think with funding it had the potential to be a very good clinical area.
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