July 26, 2012

Almost done...

From 55 assignments down to 1 remaining:  one last test in the Texas class.  

I got an A in the US government class, which honestly surprised me since the final was a 140 question bear.  I'm still stunned that I got 130 right, since I had about 30 questions that I had marked as uncertain and planned to go back to.  But I decided that it wouldn't really make much of a difference since I was willing to settle for a B (only needed to get 80 right for that), and didn't go back to them and just hit Submit.

I'm glad I didn't change any answers...I had most of them right.

The Texas class should also be a A.  This last test is only worth 12.5% of the final grade and I'm sitting on a 95 as it is.  I'd have to really tank it.  Fortunately, it's not a cumulative test.  So that one will take place on Sunday morning.

I'm so glad this is almost over.

Prenatal appointment tomorrow.  Not sure what to expect other than we'll be scheduling most of the genetic testing.  Probably no ultrasound this time around, though I don't know.  Now that I'm officially in the high-risk category thanks to being quite a bit over 35, they may do things differently than they did the first time around.

July 21, 2012

I caved

After having a house free of checked-out library books for the past several days, I finally caved.  I took out a few books today.  One is about high-risk pregnancy, the second is about pregnancy over 35.

The third is the Diary of Samuel Pepys.  Score!

Now that the term paper is over and all I have left are 4 tests (three regular, one final), I feel like I can finally get to reading fun stuff for a few weeks.  I have a whole Kindle-full of books waiting for some love, as well as a whole bunch around the house...except that I didn't have the Diary of Samuel Pepys.   Now I do, at least for a few weeks.  After I take one of the four tests today (the other will be tomorrow, then Thursday, then next Sunday), I may crack it open.

I also ordered a whole lot of yarn from my yarn dealer...er, favorite online store:  KnitPicks.  After I finish the baby blanket for my now two-month old nephew, I have to start one for my own baby.   Plus booties, hats, sweaters, and all the other baby stuff.  Eight-plus weeks now...still feeling tired and sore but otherwise fine.  Weight is fairly stable, only up one pound since I found out.  Pants still fit, though my play-doh belly looks a bit doughier because what's underneath is pushing it out.  It may also be time to start shopping for new brassieres because my cups are starting to runneth over.

I can still keep up with the LVNs in running to a code, though.   And I never feel the fatigue at work.  I'm not sure at what point I'll call a time-out for maternity leave.  I'd like to work as long as I can, but again, I'm going to defer to the doctor's recommendations.

Next week is the start of the prenatal testing.  I admit, I feel like I'm tempting fate by working on baby gear so early.  I know that even at my age--which really isn't that old if you think about it--the odds are very much in my favor of having a healthy pregnancy.   The risk of miscarriage is pretty low now and once I cross week 13, will be lower still.  Granted, the CVS and amnio carry a risk of miscarriage but it's very small.  And to be honest, I'd rather know what I could be facing and so take that risk.

My little one is very excited about the baby.  Every time I pick him up from childcare, he introduces me to whichever staff member he sees and tells them that there is a baby in my belly that will come out in February.  He will tell anyone and everyone he sees about it:  at school, at the store, in the museum, while at the park...at the rate he is going, there are probably villages in Mexico that know about the baby by now.

July 18, 2012

Term Paper Day

I have the day off (picking up a princess shift later), so I'm working on my term paper.  During the week I've been taking advantage of my lunch break and downtime at work (ha!) to get the other assignments for the week done, so all I have to do for the next three days is work on this lovely paper.  And since I work tomorrow and Friday, most of the paper has to get done today.

So the bulk of the first draft is done.  I have to research one more section and write an intro, both of which I'll try to get in before work today...otherwise after work.   If I can get that done, then the next two days can be spent revising, which won't be too bad.

I have to admit that I'm getting really good at APA.  I only had to look at the guidebook a couple of times.

July 15, 2012

The work week went well.  I fell back into inpatient fairly easily...only one late day because it was chaotic.  I spent four hours being harangued by a female patient who was not a happy camper.  But I chose to throw myself at the grenade...because if I hadn't, she would have went off and a code would have been called.  Better she had someone to focus her frustrations on--me--since even though she was shouting and verbally abusive, at least I was keeping her relatively deescalated.  And she did apologize frequently.

The doctor complimented me on my performance.  One of the other nurses--fairly new grad--was amazed that I kept calm and didn't lose it myself.  I told them it's what I'm here for.

I can't say I keep it together that well for every patient.   Some patients can do far less and make me struggle to keep control.  But I guess that was my daily miracle.

The next two weeks will be spent wrapping up the politics classes.  Remember when I posted the number of assignments I had to do for both classes (53 at first, turned out to be 55)?  I'm now down to 11.  There are 6 remaining for the regular politics class including a comprehensive final exam.  And 5 remaining for the Texas class including a paper due on Friday that I really need to start tonight.  I never thought I'd start seeing white at the bottom of my iCal's task list.

The ultrasound went well.  Got to hear and see the heartbeat, which was nice.  There's only one in there, thank God--I don't think I could handle twins at this point.  Blood testing started and next appointment set up for a couple of weeks.  Feeling less asymptomatic:  I've been more sore and tired lately, plus I've started having nausea.  Guess this pregnancy won't be as morning-sickness free as the last one was.

July 9, 2012

Back to the grind...

The mini-vacation of sorts went well.  We helped my sister and her family get settled into the area.  I've been away from inpatient for almost two weeks, so tomorrow is going to be a little rough as I get back into the swing of things.  But it should be fine.  And it'll be nice to get away from outpatient for a while as there's some drama a-brewing...no, I'm not directly involved, but I am one of the ones caught in the middle of it.  Oh well.

Everyone is excited about the baby...so much so that I've been yelled at several times to not lift things, carry my older nephew, not stay up late, not work too hard or otherwise tax myself.   They're all rooting for a girl, especially since the first three grandchildren are boys.  Myself...I don't know what I want.  I admit that taking care of a boy would be a lot easier as it's what I know and what the other half (having grown up without sisters) knows.  But I don't really have much say in that matter, do I?

Anyhow, Wednesday morning is the first official appointment and ultrasound photograph session.   Wednesday afternoon is a training class.  So I'm just going to show up to the appointment in scrubs.

Of course, the big question came up...what am I going to do about work?   Other half is worried about me working inpatient while pregnant.  Family is worried even more and expects me to do the barefoot and pregnant routine at home for the next several months.

I explained that working in psych is actually far safer than a lot of specialties.  Even the psych ED is far safer than a regular ED.  A psych environment is more controlled, the staff are well-trained in deescalation and crisis, there is security and law enforcement up the wazoo, we don't wait for situations to explode before we act, and it's not like any random cartoon character can walk into the psych environment with a gun.  Whereas in an ED or a regular hospital floor...

Also, I wouldn't be one of the ones in the front of a code response.  That's what we did with the last couple of pregnant coworkers that we had:  they carried on their duties but should a code be called they were placed in the second or third line.  We'd even give the injections for them if they wanted.

Does this mean psych is 100% safe?  Absolutely not.  There's danger there, especially if one isn't aware of their surroundings and patient population...as well as if one is foolish enough to believe that in such a controlled environment there is no potential for danger.  We may take away their weapons and contraband, true...but that doesn't mean they can't get creative with what they do have.

So long story short:  I plan to work until the doctor tells me I can't, and I don't plan to do anything stupid that could put me and the sprog at risk for injury.  Other half knows and understands.  Family knows...understanding is another matter.  Right now, I am trying to cut it back to 3 days a week max for inpatient, and 4 days a week total inpatient/outpatient.  I'll see how the pregnancy progresses.

Neither workplace knows yet.  They will know after the genetic testing is done, or if I end up in a situation and they need to know about it.  Until then, I carry on as usual.

I will admit that the time away from work--as well as the shifting hormones--made me wonder if I should switch to medical right now and work on that year's medical experience so I can get it over with.    I toyed with a quick refresher class, then picking up a PT or per-diem job in LTAC.  But I don't think I'll do it.  After the refresher class, my pregnancy will probably be more noticeable.  While they technically can't discriminate against me because of it...it does make the non-pregnant candidate look a lot more desirable.  Plus, I like the flexibility of agency right now:  if I go PT or PD somewhere, I will lose that.  And I'd like to work at least PT, since I really won't get a good experience in medical pulling a couple of shifts a month.

And I want to finish this damn BSN first!!!!

July 4, 2012

Electrolytes and EDs and EDs

Happy Independence Day if you celebrate it, Happy Wednesday if you don't.

People, even other nurses, don't realize the severe physiological damage that an eating disorder can do.  They know the basics:  too thin isn't good, too fat isn't good.  And that's all they think there is to it.  They don't realize the stress that eating disorders can put on the body.

Electrolyte imbalances are a big one.   I remember sitting in Med/Surg 1 learning about electrolyte imbalances, thinking that they would be one of these things that I'd probably never use but had to learn anyway.  I did very well in it...perhaps it was hinting at my future specialty.

A lot of patients like to fluid-load in lieu of eating:  they drink massive amounts of water or soda (popular with the bulimics since the bubbles apparently aid in vomiting).  The problem is that fluid-loading results in dilutional hyponatremia, which causes decreased levels of consciousness and can even be fatal.  Remember the woman who died after participating in that "Hold Your Wee for a Wii?" contest?  Dilutional hyponatremia in action.

Then there's the kalemias:  hypo and hyper.  Hypokalemia from vomiting or diuretic use.  Hyperkalemia because patients decide to take supplemental potassium to counterbalance their vomiting or diuretic use.  Both screw with the heart and result in dysrhythmias.  If I had a quarter for every normal EKG that I've seen in a new admit...well, I could get a cup of coffee.  But that's the extent of it.

Hypomagnesemia from a poor diet...or perhaps it's the very common co-occurring alcohol addiction?  Either way, heart issues and muscle spasms.

Hypophosphatemia occurs when people starve themselves for extended periods and then start gorging on food...a.k.a. refeeding syndrome.  Can occur when you're trying to restart an anorexic/restricter back on a regular diet:  their system is so depleted that to take on a normal diet just shocks it.

And here you are thinking you don't use any medical knowledge in psych.  Silly you.

In other news...I went to the ED on Monday after work.  I had severe shoulder pain that woke me up in the middle of the night and would not let me get back to sleep.  It didn't respond to Tylenol, heat or massage.  So I slogged though work all day and was going to go home and take some cyclobenzaprine until I remembered one thing from Mother/Baby nursing classes:  shoulder pain could mean ectopic pregnancy and internal bleeding.  So after work I called my doctor who had me go to the ED.

Several hours of testing and waiting later...no ectopic pregnancy.  The embryo landed in the uterus, is on schedule as far as size, and had a heart rate of 124.  So the diagnosis is shoulder pain of unknown origin...best words I heard all night.

I did find it disturbing that not once did they make any attempt towards pain relief...in fact, only one person ever followed up on it.  I did tell them about the pain, but it was 5 hours into the ordeal that a LVN offered me something for it.  She asked what I wanted and I told her Tylenol.  I was offered stronger stuff but I told him that I don't do narcotics.

Side note:  if you show up to the ED wearing scrubs, it's kind of obvious you're a health care provider of some sort.  All of nurses I had asked where I worked.  I told them I worked as a psych RN.  All of them said, "I could never do that."  Which was kind of gratifying to hear.

So after a long night, I went home and had that Flexeril...which did help a bit.  Two days later, the pain is finally easing up.

The brighter side:  now that we had that heartbeat, we were able to tell the little one the good news.  The little one was so excited he's started telling strangers at the airport about the baby that his Mommy is having.  So we let him tell my family when they arrived...and they are overjoyed.  We haven't told his family yet because they weren't home when we called.

And that's about all we're telling for now...we're going to wait until all the genetic testing is done and things are good to go before we go really public with it.  The first appointment is still next week.

July 1, 2012

Better than I thought

I have two course maps on my desktop:  one that has me graduating in mid-May 2013, and one that has me graduating in late-June 2013.   Oddly enough, both course maps leave me with a big gap from mid-December to the start of March...I'm due in February.  It's comforting to know that at the end of my pregnancy I'm not going to be struggling with the discomforts of the last months and the discomforts of classes at the same time.

Should the sprog arrive early...I possibly may be able to graduate in May:  after the baby is born, I have Research in March and Capstone in April.  Considering that I won't be working but pretty much at home with the new little one, it's possible.  Should sprog arrive on time...I guess it's still possible to roll into Research, though it'd be hard on me.  Should sprog be late...well, back to the course map blackboard.

While it has me graduating later, the other course map is actually disqualified since its April class is Leadership...and it's this class that requires me to shadow a nurse administrator.  That's something I'd rather not do immediately post-partum.

If I continue to aim to graduate in May, I will have to push the addictions certification until Fall 2013.  I'm not that much of a miracle worker to double-up on courses and study for that test this fall.

Again, this is all subject to change...but it's nice to know that my plans may not be derailed as badly as I thought.

Of course, when/how I'm going to return to work after the baby is a whole other story that I'm still working on.

Almost a week off...not quite

Monday and Tuesday in outpatient, Wednesday off, Thursday tentatively working but if I do work I can get off early.  No inpatient this week or over the weekend.  Not too bad.

I was approached by my nurse manager about getting involved in a unit practice council...after some internal debate, I decided to accept.  I figure it'd be good for the resume, it's additional hours, they're administrative hours (no patient care!), and it would help me when the time comes for me to ask someone in management if I can shadow them for that class in community nursing.

My two politics classes are about half-way over.  So far so good on both.  After they're done I'm going to have to look at my coursemap and see how it's going to have to change to accommodate the pregnancy.  I really hate pushing back--YET AGAIN--my graduation date, but I don't think I'll really have a choice.  Maybe if I keep saying it to myself I'll get used to it.