April 11, 2012

I slept all day so I’m not feeling as tired as I have been the past few shifts. I am currently still looking for a job and have received a few responses just saying they are looking for more experience which I can understand, but if I need experience to get hired then how am I supposed to get that needed experience if no one will hire me? It is very frustrating sometimes but I am glad at least I have my CNA license so I am qualified for a job in the medical field.

Tonight the ED (emergency department) has been fairly busy. A man came in having seizures that was going to be admitted to the hospital for that reason, but the RN noticed that the patient had a fever. So before the patient was transported to the ICU, the doctor wanted to make sure he didn’t have meningitis (can cause a fever) so they intubated (placement of a flexible tube into the trachea to either assist the patient to breath or to keep the air way open) him and then did a spinal tap to be able to test for meningitis.

A lumbar puncture (also called a spinal tap) is a procedure to collect and look at the fluid (cerebrospinal fluid, or CSF) surrounding the brain and spinal cord. During a lumbar puncture, a needle is carefully inserted into the spinal canal low in the back (lumbar area). Samples of CSF are collected. The samples are studied for color, blood cell counts, protein, glucose, and other substances. Some of the sample may be put into a special culture cup to see if any infection, such as bacteria or fungi, grows. The pressure of the CSF also is measured during the procedure. (http://www.webmd.com/brain/lumbar-puncture)

I also spent some time in the Labor and Delivery department learning about a complication that can happen during a pregnancy called PIH or preeclampsia. The most common signs/symptoms or preeclampsia are hypertension (high blood pressure), high protein in the urine due to the preeclampsia affecting the kidneys, vision changes, and a headache that doesn’t go away.. In some more severe cases the liver is affected causing pain on the right side of the belly making the diagnosis change from preeclampsia to HELP syndrome (hemolysis, elevated liver enzymes, and low platelet count). The baby must be observed closely to make sure that the baby is still receiving the proper oxygen and blood flow through the uterus. Another concern is that once the mother has progressed to the point they have HELP syndrome, their platelet count is so low that their blood cant clot and if the mother was to have a c-section or a vaginal birth, there would be major concerns of how much the mother will bleed and will the doctors be able to stop it. The only cure for HELP and preeclampsia is delivery of the baby.

After having a mastectomy (the removal of partial or completely one breast, done to treat breast cancer) you will be missing some if not all of the lymph nodes on that side of your body. Lymph nodes contribute to blood return to the heart, so most times if a patient has had a mastectomy you would not try to put an I.V. in the arm on the side the mastectomy took place due to the risk of the blood/fluids being able to travel back to the heart. When the fluids and blood can’t properly travel back to the heart it causes swelling (edema) of the arm and for some mastectomy patients the edema can be permanent. A patient came in to the ED with this scenario and their veins in the arm on the side of the body that had not had the mastectomy were very fragile and would blowout before the nurses could start an I.V. The last option was to start a line in the vein of the patient’s foot which did prove to be successful. The nurses were then able to begin hydrating the patient with fluids and complete the proper blood work.