Monday and Tuesday were my first clinical days this semester. I was in the Surgical Intensive Care Unit (SICU) or more commonly known as SI. I was paired with the same nurse both days. He looked and acted exactly like Joey Gladstone from Full House. He was a great teacher and was patient with me as I knew very little outside of CNA work in an ICU, but boy did his weird imitation voices and stupid jokes get annoying. I was able to do a lot of things on my own which was fun. I assessed the patient and he taught me how to interpret an ECG. We found that my patient was in Type 1 atrial fibrillation, but he was asymptomatic so there was no need to be too worried. My supervising nurse also let me push many things IV, including a drug called Digoxin. Digoxin is one of the scariest drugs because it has the narrowest therapeutic range for a drug. Meaning, I have to give a patient .25 mg/1ml...but if I give him 2 ml...it would kill him. So medical errors with this drug won't fly. Joey Gladstone handed me the ampule and syringe and I drew up the correct amount. I remembered from class that your are supposed to push the drug through the IV over at least 2 minutes and up to 5 minutes. I asked "Gladstone" how he thought I should push the med, and he said "Oh as fast as you want. Don't matter." "UHHHHHH what?? Won't that kill him? I'm pretty sure it's 5 minutes." He rolled his eyes and looked up the correct administration in the computer, and shortly after responded, "Oh yaaaaa...it says here 5 minutes. Ok whatever...do it over 5 minutes then" Jeez man...You trying to make make me kill someone??
Early that day I was drawing up some Zofran from a bottle. When I pulled out the syringe, the bottle spurted out the med into my eye. At this time I was alone in the room with this post-Korean War Vet and he just started laughing at me. But it wasn't funny!! I just got a medication in my eye on the first day in an ICU!! I told my nurse supervisor and he responded, "Oh you'll be fine. I had a nursing student accidentally squirt a vasodilator in her eye. The capillaries in her eye absorbed the med right away and her blood pressure dropped rapidly, she dropped to the floor passed out, and her eye was so swollen. You're fine." The more I hear stories about nursing students, the more I fear for my mistakes in the future!
On a somewhat different note than nursing school, I went to the dermatologist today to get this funky pigmentation checked on my fingernail. The reason I thought to have this checked out in the first place was because I saw a picture of the same thing I had in one of my pathophysiology books. It said "brown linear pigmentations on light skinned people can be a sign of melanoma, especially with individuals with family history of melanoma." Ding ding ding...that fits me to a T. In December, I had a PA look at it and he only looked at it for about 15 seconds and said, 'Oh I usually only see this in African Americans, but if you want peace of mind we can do a really painful nail biopsy where they peel the skin back and cut out most of your nail bed. But I don't think this is anything to worry about."
My Mom (who had melanoma in her 30s or early 40s) asked her dermatologist about this issue that I had, and highly recommended I get to a fully certified dermatologist because it is such an unusual symptom. I made another appointment for today to get a second opinion so I could not worry about this anymore. I had done even more research leading up to this appointment and read online about people who never got this type of thing checked and had to have this whole finger amputated. Ah!!! I told the dermatologist today my history and why I wanted a second opinion, and I loved this dermatologist. He was very serious and listened to all of my fears and looked at my nails under these lights for a good few minutes, compared to the 15 seconds that the PA took to look at them. The dermatologist responded the same way my mom's dermatologist responded. He said he didn't feel comfortable letting me go without getting a biopsy, and referred me to a dermatology surgeon of some sort that is going to perform the biopsy.
*For the faint of heart, you might not want to read this next section.* The nail biopsy will most likely entail pulling back my cuticle and possibly cutting back up to a quarter of an inch of skin in order for them to scrape out a lot of my nail bed so they can test me for melanoma. Half of my nail will likely be cut out. At best, they will try to cut out just a portion of the base of my nail, which I am hoping that is all they will have to do.
In conclusion, I still feel great. Yes, this sucks. Yes, this is going to be extremely painful and as Sarah suggested, I am going to see if I can get some pain meds. But I am just relieved that I will figure all this out soon and I am happy that one of my hypochondriac worries has proven not to be so irrational.
2 comments:
Digoxin is the drug that Allison was on for the first two years of life for her heart condition. I was constantly afraid that I would give her an extra dose by not remembering I had already given her a dose!
If you get Uncle Joey again, you should just do the "Oh come on now, cut it out!" Practice the hand gestures so it's just right. And maybe throw in a Bullwinkle impression for funsies.
And a big thanks to Moomy for not killing me with the Digoxin. Phew!
Post a Comment