Monday, October 29, 2012

Ever Wonder.....

Ever been through a chart and see these funny diagrams 
the Doc writes in his progress note?

It took me awhile to ask what the heck these were,
and I finally have an answer.
Now you know too!

Friday, October 26, 2012

"H" Stands For Human

  Dear Patient,

   Thank you for choosing our hospital for your medical emergency, we are glad that you think so highly of us that you would bring your family member here. I feel the need at this time to point out to you that while we are indeed a hospital and have an Emergency Dept, we specialize only in treating the human members of your family. While we do understand that canines are a very important part of any family, regret to inform you that we are unable to treat the four legged member of your family at this time.

  While our doctors are indeed very skilled at treating humans, I am afraid they are rather under trained in the treatment of canines, and would further suggest that you would really not want one of them to attend to your four legged family member since I am very sure that they would have no idea of what they were doing and could potentially cause greater harm to Fido.

  I would further suggest that standing at the Triage window and arguing with the nurse there will only cause further delay in the treatment of your beloved canine and that you should, without any further delay, should take him to the nearest 24 hour animal clinic if he is indeed having a medical emergency. The nearest emergency clinic is two blocks north of our location.

  Please be assured that we do understand that veterinarian bills are very expensive and that it is a great hardship for you to cover the cost of treatment for Fido,however I regret to inform you that Medicare would not accept charges for Fido's care even if we agreed to treat him. Yes I do understand that he IS a family member to you, but the Federal Government does not at this time cover any animals medical treatment, please feel free to raise this issue with your local government officials.

  Once again thank you for choosing Local Hospital for your healthcare needs.


   Kitty, RN


Wednesday, October 17, 2012

Mini Turkey Pot Pies

  Things have been busy around here, last week I picked up an extra shift at the last minute. On top of that the weather has been getting cooler so I have had more of an urge to cook now that turning on the oven does not mean turning my kitchen into an inferno.

  I have had a ton of leftover turkey in the fridge, we roasted a 14 pound bird on Columbus Day in celebration of Canadian Thanksgiving and spending the last 13 years with the same great guy. I already made soup and even fed the entire unit, so I was looking for some thing more involved. 

  I decided on turkey pot pie, but with only two of us eating it would be a huge waste to make a giant one and all the recipes that I looked at made pies that would feed a small army. 

Then it hit me, if we make mini fruit pies of all kinds, 
why not mini turkey pot pies? 
It worked under the same principle, right?

  The only catch in this plan is that I truly suck at making pie pastry, and I mean I really suck at it. For some reason my pie pastry always comes out tough, hard and tasting like salt dough, I bought some pre-made pie dough from the store but that seemed so wrong. So I sat down to do some research and found this recipe, All Butter Really Flaky Pie Dough  from one of my favorite food blogs The Smitten Kitchen. The recipe comes with step by step picture instructions on how to get the perfect all butter pie crust, so I whipped up a batch and made a couple test pies that turned out perfect! The pastry is light, flaky and oh so buttery which compliments the rich creamy gravy of the pot pies. This recipe makes about 8 pot pies with some filling left over for another round, however there were no pot pies left at the end of the night, just one adoring husband.

Mini Turkey Pot Pies

(Recipe adapted from Left Over Turkey Pot Pie by The Pioneer Woman)

1 pie crust (All Butter Really Flaky Pie Dough from Smitten Kitchen)
1/4 stick butter
1/4 cup diced onion
1/4 cup diced carrot
1/4 cup diced celery
1/4 cup chopped mushrooms
1 cup leftover turkey, light and dark, diced or shredded (or both!)
3 tablespoons flour
1 cup leftover gravy thinned with some hot water (you can use chicken broth instead)
splash of white wine (optional)
splash of heavy cream
Frozen peas
Fresh thyme, chopped (dry thyme is fine too)
Fresh Italian Parsley, chopped
Garlic Powder
Salt and Pepper to taste

Make All Butter Really Flaky Pie Dough from Smitten Kitchen wrap the dough and put in the fridge to chill while you make the filling.

Preheat oven to 400 degrees.

Melt butter in a skillet add onion, carrots, and celery, and cook until translucent.Add turkey and stir. Sprinkle flour over mixture and stir. Cook over medium heat for a couple of minutes, stirring constantly. Pour in thinned gravy, stirring constantly. Splash in wine (you can leave this out if you’d like but it tastes SO good.) Pour in cream and add frozen peas.Bring to a simmer and allow mixture to cook and thicken for a few minutes. Add salt, pepper and garlic powder to taste. Toss in parsley and fresh or dried thyme to taste. Do one final taste at the end and add what you like to make it taste right. Be sure not to under season.

Butter the inside of 6 muffins tins

Roll out crust so that it’s about 1/8 inch thick and cut into 3 1/2 inch rounds.Scoop a heaping table spoon into the center of one round, place a second round on top and pinch the edges closed all the way around.
All ready for the oven!

Place mini pie into buttered muffin tinCut vents in the top of the crust.Bake for 15 - 20 minutes or until the pastry is very golden and the filling is bubbly.
The vents are REALLY important.

Allow to cool for a little bit before serving,
that filling will be volcanic!
Serve with a big salad and pour out the rest of that bottle of wine you opened making the sauce.  

Sunday, October 14, 2012

Friday, October 12, 2012

The Things Left in the ER

  Worked the other night in the ER, it was a typical night of babies with runny noses, tummy aches and bug bites. So I wasn't overly surprised to hear from one of our visitors that they were bitten by a spider, nor was I surprised that they had captured the spider and brought it in a bottle for us to see so we could determine whether it was the poisonous kind. Turns out that it was a wolf spider, a pretty harmless spider that would leave you with a bite that would hurt but with no danger to the patient. PA No-Bullshit was on and he had them in and out in less than an hour much to our delight.

 A few minutes after they left I hear a shriek from the room and go running, I see the housekeeper pointing in horror to a water bottle that had been tossed on the floor and had rolled under the bed. The bottle containing the, still live, spider. 

  Now seriously, first off who the heck just leaves their junk lying around for someone else to clean up? And secondly who the heck just leaves a live spider in a bottle on the floor for someone else to clean up?

I wonder about people like that...and what their homes must look like.

No spiders were harmed in this ER visit.
The spider was released alive and well into
it's natural habitat, outside the hospital.

Monday, October 8, 2012

IV Insertion Tips

  A couple of days ago a reader asked me for some tips on IV insertion, unfortunately I was in the middle of a three day stretch and I wasn't able to get a post up in time. It got me thinking though and I began going over all the things that I have learned in the last few months that have made putting in an IV much easier for me. 

  So here is what I could think of, I hope it helps.

Feel, don't look.  
  I know every instructor has said this and it makes about zero sense, but trust me, this is one time in nursing that your eyes can lie to you. It makes sense that every new nurse (and even some seasoned ones) will go for an easily visible vein, but often these veins are very close to the surface and will blow easily, deeper veins are often stronger, less fragile veins.  
  Palpate veins with your fingers tips and feel around for a springy feeling vein. It will feel vaguely like  pressing down on an under inflated balloon, it will "bounce" a little under your fingers. Avoid "mushy" or soft feeling veins, these can be more delicate and blow easier. Select the largest vein you can find, they are way harder to miss, you can use a nice large catheter and they are less likely to "go bad". No point in putting in an IV that only lasts a few hours. 

  Once you have a found a nice big, bouncy vein follow it up about an inch or two and make sure it feels pretty much the same all the way up. A hardened area can indicate a valve or sclerotic area that will not allow the catheter to advance. If you find one of these area's be patient and follow the vein further up or down until you find a nice stretch of clean vein.

Hold on!
  Now that you found that vein, anchor that sucker!  You went through all the time to find it now make sure it doesn't run away when you try to poke it. I hear a lot of people say that a patient has veins that roll, all veins do roll to a certain extent so hold em down!

 Everyone does it a little differently
For really roll-y veins try stabilizing
between two fingers.
Spread your fingers wide and hold the skin 
very taut.

Anchor the base of the vein close to your puncture site.
Apply pressure and pull your thumb towards yourself
pulling the skin taut

  The key to anchoring a vein is to apply pressure,  so don't be shy about pushing down on your patient and to pull their skin nice and tight. Apologize and let them know the discomfort will only be for a few seconds, it's a way better option than having to poke them a second time. 

Don't go deep!
  It's tempting to puncture the vein at a 30 to 45 degree angle, especially if you have drawn blood a lot, then drop your angle and attempt to advance the catheter, don't do it!  Going in on a steeper angle than 15 or 20 degrees increases your chance of going straight through the vein, and I find that when I drop my angle after a flash I flub the insertion almost 50% of the time.

  An IV nurse I work with gave me these tips, go in at an angle that is only slightly steeper than parallel with the vein and then check for your flash. If you don't have one advance slightly at a slightly steeper angle.  As she put it veins aren't that deep and your aren't drilling for oil.

Don't be shy

  OK so you got a great flash, but as you advanced the catheter you lose it. Sound familiar? It happened to me over an over again until my friend the IV Nurse commented that I am "bashful" in threading the catheter.

  What she meant is that when I was advancing the catheter I would do so slowly because I was worried about losing my IV. Problem was that my caution was what was causing me to lose my IV sticks. She reminded me that advancing a catheter quickly would not cause any damage.

  What I learned to do it insert the IV and check for a flash, 
then wait and see how well the flash chamber is filling. 
When I see that the chamber is nearly full, 
 I am sure the IV is in the vein.
Now in one smooth quick motion I advance the catheter.

  I know it sounds way too simple but honestly it has worked like a charm every time. Oh yes and don't worry, if there is a valve or sclerotic area that you did not find prior to inserting the catheter won't advance, promise.

And remember....
If you don't get it the first, second or even third time
it's OK.
Don't beat yourself up about it, 
stop and think about what you learned from the experience.
Then let it go.

 none of us were born with these skills.
We all have had to learn them

Sunday, October 7, 2012

Sunday Funnies

                                                                                                     Source: via Chanda on Pinterest

                                                          Too true!