Acuity

Over the last few months, I've been a little.... (not sure if 'bored' is the correct word, but..)bored with some of the low acuity that I've been assigned. (Acuity- Medical definition- the level of severity of an illness. This is one of the parameters considered in patient classification systems that are designed to serve as guidelines for allocation of nursing staff, to justify staffing decisions, and to aid in long-range projection of staffing and budget. The Medical Dictionary) So I have been requesting high acuity assignments from the charge nurses, so that they are accustomed to me working with more critical patients and will (hopefully) automatically assign me to them. I have been assigned some really great patients as a result of this plan. Recently, I've taken care of an infant with a thorocostomy or chest tube. The chest tube is placed to drain either air or fluid from around an infant's lungs and remove the pressure that is restricting the lungs from achieving full expansion.
The chest tube drains into a collection chamber that is attached to suction or sealed. And the drainage is measured (if there is any).
I have also had a patient on a High Frequency Oscillating Ventilator (HFOV) which is a ventilator (breathing machine) that gives breaths at a greatly increased rate. The usual breathing rate for a conventional ventilator is 40-60 breaths per minute- while the oscillator give 400-600 breaths per minute. This can be useful in several different cases. The HFOV is gentler on the lungs (for the most part) and helps decreased Carbon Dioxide (Co2). The oscillator looks like a very old machine, it's a little crazy how we depend on such old equipment. But it works!

Our conventional ventilators are a little more up-to-date looking though.

Don't You Just Hold Babies All Day Long?

I found this on a tumblr blog named #WhatShouldWeCallNICUNursing

"'Don't you just like, I don't know..... hold babies all day long?'
Yes.

I hold a baby when I hand him to his mother for the first time, three weeks after his birth date.

I hold a baby when teaching a new mother how to breastfeed her child.

I hold a baby when morphine and walking the halls twenty-four hours a day are the only things that will quiet him down while he's withdrawing from the illegal drugs his mother took.

I hold a baby's arm still when my fellow nurse inserts an IV.

I hold a baby's head still while we bag oxygenated air back into his tiny lungs.

I hold a baby when he has no family to hold him.

I hold a baby when he takes his last breaths because his parents didn't make it to the hospital in time.

I hold a baby when I'm placing his lifeless, tiny hands in plaster to make a keepsake for his parents.... because there is no baby too hold anymore.

Yes.

I hold babies all day long."

What I Do Now

In the years since I last posted, I have been rather busy. My last post involved my trip home from the college I attended in a large city, somewhere in the Midwest. Since then, I have attended a couple of other colleges and have obtained my degree. I graduated from University in December of 2013 with a Bachelor of Science with a Major in Nursing and have been working for a year now.

This post will be a departure from my previous posts where I reviewed books. And, I may not return to reviewing books at all in my later posts (if I ever actually write them). I am using these posts as a way to look back from where I started in the beginning of my career and to see how I grow as a nurse.
As I mentioned, I graduated in December of 2013 with my BSN and I was hired by one of the major medical centers in my (not impressively-large) city in the Northwest. I work in the Neonatal Intensive Care Unit, commonly referred to as the NICU ("Nick-you"), which is the ICU for infants. I explained what I did this week to someone and I realized how little people know about such a specific and access-limited area. So, I'll explain what exactly the NICU is and does... Well, as best as I can.

The NICU is where infants who are just born or were born in the last 30 days are admitted for treatment. Infants who are older are no longer in the "neonatal" period (which means "new baby") and would be admitted to pediatrics. The NICU I work in is a Level III, which means that we can treat infants born as low as 22 weeks gestation -before they've hit the 6th month of pregnancy. We are not up to a level IV NICU- which means that we send infant with complicated cardiac issues to other hospitals, where they will receive surgerical correction or other treatments. We also do not perform other specific types of surgery- e.g. complicated eye surgery. We are not ECMO-certified, which is what makes us a Level III, versus a Level IV. ECMO is essentially heart and lung bypass; it is a machine that oxygenates and filters the blood and pumps it to the body, thereby bypassing the heart and lungs.
A Level II NICU cares for Infants born at greater than 32 weeks gestation and without respiratory support greater than oxygen through a nasal cannula. So as a Level III, we can have infants on the ventilator (with breathing tube) or CPAP ("continuous positive airway pressure- pressurized oxygen that assists in keeping the infant's lungs open), and there are many degrees and modes of respiratory support that we provide. I could explain, but then it would become rather technical and since my (one) reader is probably not a respiratory therapist (RT), it wouldn't be very helpful or interesting.

Many people are most interested in our premature infants or "preemies", especially those that are what we call "micro-preemies"- they are born before 26 & 27 weeks gestation and weigh-in under one and a half pounds. They appear very fragile, and they can be both more resilient than they appear and more delicate than you think.

There are a huge list of complications that these patients can experience and I'll probably discuss them as I (hopefully) continue to post. But that is brief overview of the NICU I work in. In the last year of working there, I have grown and improved immeasurably. I love my job! Working with the parents, Neonatologists, Neonatal Nurse Practitioners, RTs, and other RNs to help babies get better is the best job that I can imagine. I'm so glad that I was hired where I was, and that I got the chance as new nurse to work in such a difficult and complicated place!

Well..... It's been quite a long time! Nearly a year. I promised myself when I started this blog that I would be more faithful to post regularly. That's out the window. But, I have joined a site that may force me to blog more, in order to be able to read their books. So, I see my future posts coming more frequently at the very least (although with the amount I've blogged, any post at all would be a vast improvement!)

As I just mentioned, I have joined a site, it is called NetGalley & it allows people to download DRM copies of pre-published books in order to review them. Unfortunately, I cannot simply write a short review and send it directly to the publisher =( ... I have to publish it on my blog. So in order to keep my subscription, I have to provide a link to my published review. So, for you, (my few & far between, readers) I will be publishing many more posts... I hope this pleases you ;-) I found this site through a favorite blog of mine TheNeverendingShelf.com, this blog is constantly filled with reviews of unpublished books that make me want to read the book... I've found dozens of new books by reading this blog, and if you enjoy books as much as I do, (doubtful....) you'll love this blog! Go visit & improve your collection of "want-to-read" books. =)

Sincerely, (& with great hope for the improvement of future posts),

Home again

Well, I've arrived safely home. After being taken to the airport by T's 1 and 2, I was checking in my luggage for the flight home when the clerk requested my license. A few minutes of frantic searching failed to reveal the elusive identification. He accepted other I.D. in the form of my college student card, but warned me that the airline officials would not be so readily persuadable. Taking this warning to heart, I spent the next ten minutes digging through my purse and bags for the license, without luck despite my appellation. With trembling heart and failing knees, I approached the formidable officials to explain my predicament. They accredited my explanations and my three other forms of identification (a credit card, a college I.D., and my state childcare license). This was a great relief, and after successfully threading my way through the security checkpoints, I called my mother to relay the relief I felt. :) (Later I found my Driver's License in a purse that I had put in my "check-in" bag, which was of great relief to everyone.)



I had planned to relax on my first day home, but I learned while in the airport that my aunt and uncle were moving to Arkansas to pastor. This was a shock to me, for he had never been a preacher and this was rather sudden. Of course, I learned that my mother had known for months, and had thought that she had already informed me of this interesting development. So, Thursday was spent packing all of my aunt's knick-knacks and "priceless" mementos of her grandchildren (this, of course, means the ten year-old birthday cards and Christmas tree decorations that were falling apart). So Thursday was spent in that way, with Friday being not much better.



A couple's wedding was planned for Friday evening, and being the wonderful person I am, I attended with a glad heart and merry smile..... (yeah, whatever) and found it a rather interesting experience as all wedding are (to females). The reception was the highlight of the wedding, with many delectable foods served. Included in the dishes were such things as venison steak, chicken jambalaya, elk meat, and some macaroni salads. But the best of the food, was the chocolate fountain, served with fruits and pretzels. After the reception, the wedding party had to rush to the church to remove the decorations and clean the church for the deadline of nine. This left the kitchen of the reception, a total disaster. Because my mother was a server for the meal, she was already in the kitchen. She and Miss Laurel (my teacher for all of my home school years) felt obligated to assist in the clean-up, and so, by extension, all of their children were obligated as well. For several hours, all of the teens washed pots and pans, dished food into containers, and bleached counter tops and ovens. Many of the helpers teased me about the "welcome-home reception" in which I was currently participating (washing the large pots). We all left at midnight, making our weary way home.



Saturday was the graduation of one of my best friends, and one of my pastor's grandsons. My family was enlisted in the reception committee, and after setting up we barely made it to the graduation. Arriving in time to make it through the doors before they locked them for the procession, we found seats with the rest of our group. Several speeches later, the triumphant graduates walked back down the aisle, and we made our way to the reception at the park. The potluck was good, and I was able to borrow AVT's camera and brand-new lens for some experimentation. (He told me I need to start getting into photography, which from him is a great compliment, as usually he just makes fun of my attempts......maybe it was the improvements I made by experimentation with T1's camera) He took several pictures of me with his monstrosity he calls his camera, and they are quite amusing....I'll have to get them from him sometime.



Sunday was an honorary service for the Noble Hunts for their fifty years of service in ministry. Returning home, we prepared the Sunday dinner, and I cooked! yay! The rest of the day was spent in relaxation and attending the night service.



Monday we relaxed and read our books, including my dad, who rarely finds time to read. Dad and I read Emilie Loring and Mother read a christian thriller. It was very peaceful, and we enjoyed it. K was at a friend's house playing games all day and grilling hamburgers and having fun. Bre spent the day on the computer and finishing her Bible classes for the year. I was somewhat disappointed not to be able to go jet-skiing and boating as per our normal custom, but the day turned out well in spite of that disappointment. :)
Until next time,

Anne McCaffrey

One of my favorite authors is Anne McCaffrey, known for her award winning "Chronicles of Pern" series. She is a Fantasy/ Science Fiction writer, and as such she is superb.


The first book I ever read of Anne McCaffrey was not her well known Pern series, but the Acorna series. Included in this series are the books following: Acorna, Acorna's Quest, Acorna's People, Acorna's People, Acorna's World, Acorna's Search, Acorna's Rebels, Acorna's Triumph, and the connected series called Acorna's Children includes First Invasion, Second Wave, and Third Watch.


Synopsis: A young child is found in an escape pod in deep space by three bachelor space miners. The child has some oddities; she has a opalescent horn growing from her forehead, hoof-like feet, and three fingers with only one joint. The miners raise her with a few interesting mishaps, but eventually she grows into a very gentle and loving young lady. She frees child slaves from the factories of Kezdet and is adopted by a wealthy gentleman who believes that she is a "ki-lin" or descendant of the ancient, legendary unicorns. Eventually, Acorna's family finds her, and she discovers that she is a "Linyaari", an alien race that is being exterminated by insectoid aliens. Acorna, with the help of her adopted benefactor and future life-mate, discovers a way to stop the massacre. After several adventures involving time travel, Acorna settles down in the rehabilitated home world of the Linyaari, and has a child whose adventures furnish the story line of the "Acorna's Children" series.


Also written by Anne McCaffrey, is the Talent series. Included in this series are the following books in a set of two "mini-series": in the Pegasus series are To Ride Pegasus, Pegasus in Flight, and Pegasus in Space. In the Rowan series are The Rowan, Damia, Damia's Children, Lyon's Pride, and The Tower and the Hive.


Synopsis (Pegasus): A few years into the future, parapsychic abilities are finally proven scientifically. After years of work, the many people with these abilities, called Talents, are accepted as useful contributors to society. With the help of strong teleporters, space can finally be habited by humans with little cost. These books chronicle the adventures of Peter Reidinger the first "Prime", a Talent of the highest ability known. Peter began the Federated Teleport and Telepath company, which loans its services to anyone who needs the help of any Talent. Peter is a quadriplegic who learns to transport himself by his talent.



Synopsis (Rowan): After a disaster on Callisto, one of Jupiter's moons and a domed habitation, a piercing mental scream is heard by anyone with the least degree of Talent. The source of the scream is found to be a young girl of about two years of age. Taking the name of the mining village near where she is found, the Rowan is trained to become the Prime for Callisto. This book follows her search for a cure to her incredible loneliness, finally found in the love of Jeff Raven, a Prime from the outer reaches of the known universe. This series tells of the adventures of the Rowan-Raven descendants and their battles against an encroaching alien threat that seeks to destroy the human civilization.



The Chronicles of Pern are the best known of any of Anne McCaffrey's writtings. These begin with a suprising propensity for fantasy, instead of her usual futuristic science fiction. Eventually though, the reader discovers that Pern was an Earth colony that was severed from communication with Earth. When the Pernese discover an Artificially Intelligent computer, their way of life drastically improves.

Poetry of Martha Snell Nicholson

Probably one of my all-time favorite poets is Martha Snell Nicholson. She is able to speak plainly about her Christian faith, and is able to capture many of my feelings/fears accurately on paper, when I am so often unable to do so. Some blog I was reading lately informed me that April is Poetry Month...or something to that effect, so I thought that I should at least post some of my very favorite poems. So I hope you enjoy!

My Advocate (I performed this poem for my church one Sunday evening, as a dramatic monologue.)

I sinned. And straightway, post-haste, Satan flew
Before the presence of the Most High God,
And made a railing accusation there.
He said, "This soul, this thing of clay and sod
Has sinned. 'Tis true that he has named Thy name,
But I demand his death, for Thou hast said,
'The soul that sinneth, it shall die.' Shall not
Thy sentence be fulfilled? Is justice dead?
Send now this wretched sinner to his doom.
What other thing can righteous Ruler do?"
And thus he did accuse me day and night,
And every word he spoke, O God, was true!

Then quickly One rose up from God's right hand,
Before Whose glory angels veiled their eyes.
He spoke, "Each jot and tittle of the law
Must be fulfilled: the guilty sinner dies.
But wait.......Suppose this guilt were all transferred
To ME and that I paid his penalty.
Behold My hands, My side, My feet. One day
I was made sin for him, and died that he
Might be presented faultless, at Thy throne."
And Satan fled away. Full well he knew
That he could not prevail against such love,
For every word my dear Lord spoke was true!


Treasures

One by one He took them from me,
All the things I valued most,
Until I was empty-handed;
Every glittering toy was lost.

And I walked earth's highways, grieving.
In my rags and poverty.
Till I heard His voice inviting,
"Lift your empty hands to Me!"

So I held my hands toward heaven,
And He filled them with a store
Of His own transcendent riches,
Till they could contain no more.

And at last I comprehended
With my stupid mind and dull,
That God COULD not pour His riches
Into hands already full!


His Plan for Me
When I stand at the judgment seat of Christ
And He shows me His plan for me,
The Plan of my life as it might have been
Had He had His way, and I see

How I blocked Him here,
and I checked Him there,
And I would not yield my will --
Will there be grief in my Savior's eyes,
Grief, though He loves me still?

He would have me rich,
and I stand there poor,
Stripped of all but His grace,
While memory runs like a hunted thing
Down the paths I cannot retrace.

Then my desolate heart will well-nigh break
With the tears that I cannot shed;
I shall cover my face with my empty hands,
I shall bow my uncrowned head...

Lord of the years that are left to me,
I give them to Thy hand;
Take me and break me,
mould me to The pattern Thou hast planned!


These poems are definitely how I feel. I long for Christ to mold me into His Pattern. I want His Will for my life! As the speaker said this morning in chapel, "I just want MORE of Him!s" that is so true for me! I just want more of Him.