Morbid Curiosity

This last week I did a one-day rotation with a Hospice Nurse. Hospice care is "any form of medical care or treatment that concentrates on reducing the severity of the symptoms of a disease or slows its progress rather than providing a cure" (Wikipedia).

Our first visit of the day was to a patient who had passed on just one hour before our arrival.

I had never seen a dead person up close before.

She was in her 70's, a dignified looking woman who was clean and well-cared for. Her passing was peaceful, while she was sleeping, with her family nearby. Advanced breast cancer was the official cause of death.

In death her mouth slacked open like a trap door, as if her soul had escaped from that orifice.

After consoling the family, the Hospice nurse began the woman's post-mortem bath. I held up this woman's legs and turned her side-to-side while the nurse lovingly, gently washed her entire body.

She was still warm. A little air escaped her mouth when I turned her, making a groaning noise.

We dressed her in her favorite pajamas and the Nurse arranged her body just so: arms nestled in her lap, legs straight, head propped up on pillows. She looked as if she might be just resting, ready for someone to visit.

Then we waited with the family for the mortuary to arrive. They were eating fried chicken in the living room and some were crying while they ate. The smell of grease from the fried chicken mingled with images of this dead woman in her bed; it was surreal.

The mortuary workers came and took her away. Then we left.

I was impressed with the professionalism and respect that the Hospice Nurse had for this woman and her family. The family was grateful for her and for the gift of Hospice: A dignified, supported death at home.

To learn more about Hospice, Death and Dying visit Death Maiden.

I'm Alive

Hello my Poor Dear Readers, who I have left stranded for over a month.

I want to assure you all that I am alive and well, as well as half-way through my 4th and last semester of nursing school.

I do not have an earth-shattering reason why I didn't post for you, I simply have been overwhelmed with the job of completing this last semester.

I wish you all well until the next post,

Student Nurse

Burnt

This week I had a very needy patient who greatly tested my patience.

And as one of my friends said about me, "You have the patience of Job."

But something just snapped inside me this week. When she put on her call light "to get something for my dry lips," the 5th non-emergent call within that hour, a part of me wanted to tell her to shut the *%*!^ up and deal with it.

Of course I didn't. I got her petroleum jelly and she smiled this angelic, manipulating smile, saying, "Oh, Student Nurse, thank you so much."

I don't know exactly why I snapped this last week; chalk it up to the stomach-churning stress of a barbaric nursing school experience combined with less-than supportive hospital staff.

Whatever the reason, it bothers me. For a moment, I had that same look in my eyes that you see in badly burnt out nurses, those ones everyone hopes they never turn into.

I hope I can find a part of myself that is still idealistic and naive after this whole ordeal is over in February.

The Answer and Beach Time

Yes indeed dear readers, my patient described in You're the Sleuth, Installment Two had a Cipro allergy. Props to those who guessed correctly.

Some nice pictures from a quick vacation to a misty beach in late September...

You're the Sleuth, Installment Two

At clinical yesterday, my patient displayed interesting symptoms that left everybody guessing. Test your clinical knowledge with this scenario:

A 52 year old female has breast cancer and is 1 day post-masectomy of the left breast. Three lymph nodes were removed during the surgery. So far her recovery is uneventful except for complaints of "itching like crazy" on her left arm, right flank and head.

She asks you to check for a rash because "it feels so bad there must be something like a rash there." You see no rash, only redness where she has scratched the skin.

Her arms and hands are edematous (swollen) bilaterally, with the left side more swollen than the right.

This patient has not received any opiates (including morphine) for the past 24 hours. She is receiving Tylenol (Acetaminophen) PO for pain, Benadryl (Diphenhydramine) PO to relieve itching, and Cipro (Ciprofloxacin) PO to prevent a post-op infection.

What are your first impressions as to what could cause these symptoms?

Stop now to formulate your hypotheses.

Later in the shift the patient applies warm water to the itching area and states that this partially relieves the itching.

Thirty minutes later you observe a rash of fine papules on the patients hand and arm that looks like this:


What has caused these symptoms? What are the priority nursing interventions? What orders do you anticipate from the doctor?

Leave your comments and stay tuned to find out what happened. I will post the answer tomorrow!