A Novel Idea

When Patients Read What Their Doctors Write

Feeling Frustrated

Don’t you hate it when you have unsatisfying visits? Like when there is no clear diagnosis or you just feel inadequate as a health care provider?

I had two of those yesterday.

Continue

A Good Day

I finally had a couple of good days here at the clinic. I was busy with patients and got to keep up with my skills doing some procedures. We were down on providers so I got the opportunity to triage some kids. The first kids I triaged were school-aged siblings. Whenever siblings come in sick, it’s often viral. I usually ask who got sick first and go from there. Never let a parent talk about both kids at the same time- you will get confused. So I do a full history for one kid, then the other. Both seemed fine, but the older brother had a stomach ache so I did a urine test. The dip showed some trace glucose and protein. Now I’ve heard that trace protein during illness is common, but I had not heard of glucose in the urine meaning the same thing. The pediatrician saw him and his fingerstick was fine, so that was a lesson learned.
I also saw a 12 mth old with 3 days of high fever with a temp of 103 in clinic. Parents get very nervous about fever, but it’s no big deal. Fever is just the body doing its job. The problem is having a nonverbal patient with fever and no other symptoms. I wanted to blame the fever on a virus, but without cough, vomiting, diarrhea, or rash, the diagnosis becomes harder. If this was the ER, we might immediately do a urine cath, blood work, and possibly a lumbar puncture to find the source of infection. However, working in outpatient is more forgiving. You can bring the patient back the next day and keep a close watch on them. In her case, she was well hydrated with good energy, so waiting another day was a good option. I was thinking this looked like Roseola. Roseola is tricky because the patient initially presents with high fever and no other symptoms. After 4-5 days the fever breaks and they get a full body rash. I called the next day and the fever had broken, but no rash. Looks like another case of mysterious teething-baby virus. It’s amazing how little we know.
I also got to help out in the lab doing blood draws. Before starting this job I didn’t know how to do blood draws or urine caths. I was lucky to have a great teacher- a long-time medical assistant with crazy skill. I had an obese teenager that needed a blood draw and I could feel a deep vein in the antecubital fossa. I’m usually more comfortable with the superficial veins, but I took on the challenge and got it! It’s the small successes like that, that keep me going.

Nurse Recognition

6 Reasons Why Nurses are the Unsung Heroes of the ER

Summer Slump

So I’m on Summer Break from NP school and upping my hours at work. I love my job and coworkers, and am so happy to take a break from school, so why do I feel so miserable?
I have a problem that I always need to be doing something new. I am not one to stay in the same job for a decade (or even more than 1 year for that matter) nor am I one to enjoy a slow day in the office. I am a NURSE! I want to be seeing patients, constantly solving new problems, and be challenged on a daily basis. Nursing is great in that you don’t know what new disease you’re going to learn about or if you save a life that day. However, it also sucks when we’re in a Summer Slump, the kids aren’t sick, and I am stuck calling insurance and billing departments to get a kid coverage for a procedure. WHY ME???
I got transfered 3 times, with each department not wanting to take responsibility for the patient or problem. “Im sorry we only take care of encounters before May 3rd”. “I’m sorry, the procedure has to have been completed and denied before we can help you.”
We are not even the providers ordering the procedure! Why am I going out of my way to help? Oh yeah, because no one else seems to care.
Does anyone have a urine cath, blood draw, or suture removal for me to do? I’ll bet that I could complete the procedure, come back, and still be on hold.

Blisters on shoulder- A Case Study

I saw a rash similar in appearance to the one above and at first assumed it was a 2nd degree blistered burn. That is until I found out more history and looked closer at the vesicles.

An 11 year old female presents for blisters on R shoulder on a Thursday.

Continue

RN Interview Tips

I was just helping my friend prepare for an interview for her first RN job. So I thought I’d share the same pointers with you all.

Along with the standard interview questions, the RN interview usually involves clinical scenarios and prioritization questions. It’s impossible to read up on every possible scenario, though catching up on those NCLEX questions could help. Most scenarios you can answer in the same way.

Continue