Pediatric Dosing

I am still not a Peds' Nurse.
Thank gods for them.

It used to be the only things I knew about peds' fevers are the dosages are weird, they can get Reye's and Kawasakis. That's about it.

Now I know that they can't go to daycare, they just want to be held and its usually because of a tooth.

Hey Tylenol, how about you just label your syringes with weight as well as dosages? This way I'm not doing sleep deprived math holding a screaming baby while trying to remember what overdose in infants looks like just in case.

See, this could be so awesome.

I bet you'd even be able to sell more...



I can't tell if being a nurse and a new mom is a good or a bad thing.
On one hand when the doctor reported that my son was bleeding a lot post-circumcision, I didn't really care. On the other, when ever he coughs or sounds congested I panic that he's got epiglottitis and I start planning the fastest route to the hospital.


Good thing I don't live far.

Certainties in life.

Look at him, with his smug little face. 

Well, sir. I believe you are wrong. 

As an ICU Nurse, I don't deny that death is certain. I have seen many people post-pone it. I have seen  families avoid it. I have seen countless co-workers battle it. 

However, even if we "keep 'em alive until 7:45." it will catch up to you eventually. 

I also don't deny that taxes are certain. Although, I'm starting to see a bit more grey area on this one. My husband is an accountant attempting to get a job as a tax auditor. You'd think this would incline me to boast the veracity of Benny's certainties, however... My husband forgot to file his own taxes a few years ago...

So many people advised against filing back-taxes...

So many...

I'm looking at you H&R Block. 

   

So where exactly do I find fault with Mr. Franklin?

He's so sure that nothing else can be certain. 

I posit another theory. 

Change.

Now, while Goodreads attributes this quote to Hilary Clinton most other sources credit EH Carr. 

It also happens to be the title of an article about Coronary Bypass trends published in 1998.

Unfortunately, I am not going to address any of those subjects in this post. Today. 

Today I am going to talk about some changes.

Mostly, how I've changed.

Again. 

I have had a lot of things shift on me. Not, terribly recently, but recent enough. I hope to resume our little one-sided chats, however. There will appear to be some continuity issues for the purists. 

I am back, and because of my assertion that change is also certain, be aware that changes have occurred.

The important ones:

I have three cats (Pistachio, Rydia, Cricket)

I am married to an accountant (technically, still a student)

I work in Neurotrauma ICU (with backgrounds in ER, Cardiovascular ICU and Education)

I'm pregnant

Feeling positive!

  

Today's Accomplishment is...

I was going to ramble a bit about Susan Komen and Planned Parenthood, but that was quickly turned around.

Now what?

Oh yea. I ran a 15k today (about 9miles)

I PLACED 2nd!

Wahoo. Was not expecting that. It was great. All of this work now feels validated. 1 month into the New Year and I've already met a goal of placing in a race. Sweet. Now I can smooth sail the rest of the time.

I did however cause a bit of an issue at the Awards Ceremony.

Sadly, this want not the first time this has happened...

It's nice to get this sort of validation. From my thesis work I'm learning the importance of instant feedback to my generation (Millennials FTW!) Now, society is not exactly set up for instant gratification or feedback (unless you've been sucked into facebook et al.)

This is exactly why I try not to get too involved in social media. Life does not happen instantly. It takes a long time to become good at something, or learn most things of value.

Running is like that.

It took me 1hour and 34 minutes, but it felt really good.

If only it could be faster...

My how we've grown

For once it's not sideways...
I've been laying on the floor for about 30minutes re-reading some of my old blogs. Interesting to see where life has taken me in a year.

I've still got half a year on this
EMR business and by the time thats over I'll have my MSN in education.

Who knows what I'll be doing professionally.

I've got a half-marathon in 4 weeks and plans for a triathlon in 9months.

I think I'll make a concentrated effort at a well researched post tomorrow.

Probably something about Womens Heart Health. (National "wear something red day")

Be ready for it.

CME

For the those lucky people who don't have to know what CME is, it is Continuing Medical Education. I listen to some podcasts that give me the option for free CME, Medscape sends me free CME quizzes, and I can go through my works' web portal for free CME but I really feel that I should get CMEs simply by sitting on my couch while these beautiful people I live with study.
Really, every nurse should live with med-students. One really gets a good idea of the hell they go through. The HESI was nothing.
Keep on keeping on doctors.

However, I'm still going to call you a 1 am if you forgot to write orders.

Testing

Testing the blogger app, because... Maybe we're doing this thing again.
Photo of cat, the Internet loves cats.

The Complexities of Simplicity

Meh.

Happy Halloween.

I've been working at making life simpler, then harder, then simpler again.

Bah.

I gave up on social media for a month. Did not really change much in my life. True, I am not in "contact" with as many people as often. (Those "facebook friends" that you have not seen since highschool.) Not a great loss.

I did not really blog. Someone had to have noticed. I think it was my Dad. Because of this I also did not spend as much time on the internet "researching" things. Maybe I was a bit more boring of a person.

I tried not to play on my phone when in the room with other people. This was probably the worst effect. I was not playing games on my phone, but everyone else was. So I was just sitting there trying to make conversation with people too busy flinging birds at pigs.

What this did do however, was make everything on my phone harder to use.

This is why and how I became a Socially Awkward Penguin.

Turns out if you do not have a facebook account, you pretty much do not exist and signing into THE INTERNET is near impossible.

So much for all that.

I posted all this to say.

I get a new phone today.

Maybe I'm back online.

Just when I thought about ending it all...

Just when I had some serious thoughts about giving up on my blog I get this gem.

The Potential Use of "Blogs" in Nursing Education

I'm my homework for today, I'm researching the different uses of technology in nursing education.

Tweets and Blogs are at the top of the list!

How crazy. I guess I'd simply never thought about it, but instructing students to utilize a blog for reflective assignments beats sitting through post-conference any day.

Schon addresses three steps in reflection.

1. Knowing in action

2.Reflection in action

3. Reflection on action

Knowing in action is the knowledge the student brings with them.

Reflection in action is the thinking that goes on while they are using their knowledge

Reflection on action is the thinking that happens after they've completed their task.

For example.

The student brings with them the technical knowledge of how to initiate a peripheral IV (and all the anxiety that comes with it.) Then he/she gets the opportunity to practice and while they are performing the task they are thinking about how it functions. After this activity is over the student reflects on how it went, what went wrong, what could have gone better, etc...

I have to go now, so more later, but turns out blogging is a future wave for nursing students.

I probably better keep my skills up.

Warning to my future students, follow my blog or fail.

My, how meta we are today.

Currently studying learning styles, learning intelligences, and learning strategies.
This entire Master's thing is so much fun.

Most of us know about the different types of learners. We've used it as an excuse for years as to why we didn't do as well as (insert THAT GUY here) on the exam.
"If only my teacher knew I was a VISUAL learner!" we wail in anguish as they ramble on indefinitely without a graph, picture, or powerpoint in sight.
Then there are the poor Kinesthetic learners who are convinced the entire education system is out to get them. 50 minutes of sitting still, "taking notes" then 10minutes to run across campus only to sit for 50 more minutes. When will it be lab day when I can actually DO something? Oh wait. This class doesn't have a lab component. Well, I'm boned.
Auditory learners, you poor kids. What's the point of a 50 page reading? I could read that book all day and still have no idea what the general topic is.

Sigh everyone is out to get us. All of us. Worthless educational program, not understanding MY needs. Only after my monies...

Have a bit of fun. Take one of the "Multiple Intelligences" test.
I liked this one, it's a self scoring excel spreadsheet (complete with graph for all you visual -spatial learners!)

I really was not that surprised with my results. I've always known I'm a left-leaning brain. I can do right-sided things, but it takes some work around. A bit of synestheia helps too. I scored the same on almost every category with the exception of musical/rhythmic (got none) and intrapersonal (much higher.)

After discussing the styles of learning, we moved on to strategies for learning.
They listed three.
Concept Maps
Mental Imagery
Storytelling

For those nurse's out there I don't have to explain Concept Maps. They're pretty much the pillars of nursing education. Draw a bunch of pictures to represent your patient and what's wrong with them and all the things we will do to fix them (don't forget to include how they feel about it!)

Mental Imagery dealt with that initial "gut" understanding or visualization of an idea. Those pictures you automatically associate with words. Triggered by language or music. It allows people to see the "big picture." Based on socialization and indoctrination if you ask me. How do I know when I say "tiger" if you're thinking of a Bengal or White tiger?

Storytelling- Acting out the scenario. This is the part of your CPR class when they tell you you've found a 40 year old unconscious on the golf course. "Hey! Are you ok? You, call 911. You, get the AED." Etc. Or, for example, when I was a baby nurse and freaking out about all the little things (IV starts, etc.) I wrote myself a little short story involving a new grad and the zombie-apocalypse while she was working a night-shift. Really helped me with my triage skills. ;)


Then it ended saying that another method of storytelling is blogging about your learning experience.
Whee.

All the while I was envisioning myself in my dream job, using all these skills to develop the most awesome educational materials ever.
Ah, the power of daydreams.

The Pleasure of Finding Things Out

This is a fantastic book.

I'm a bit of a scientist-stalker and one of my favorites is Richard Feynman. (Who doesn't like this guy?)

I'm reading along in this book and it's got loads of practical advice.

Here's an excerpt I particularly liked and wanted to share.

Link to the story here.

It really gets my attention that it actually doesn't matter all the naming conventions and idiosyncrasies about an object you could name. If you don't know anything about how it works, or why then you truly don't know the object.

For instance, pretty much everyone has that "friend" that they know really well. You know what they like and don't like and how they react to tapioca, but you never can quite remember their name. Do you know them? If you know about their family and favorite book and what they want to do this weekend or where they want to go on vacation do you know them? Or do you know the person you were just introduced to?

Learning different languages really puts things in perspective. There are so many ways to name yellow. How do you describe it?

In another Feynman book (Quantum Man by Laurence Krauss.) He challenges us to explain left and right to an alien. It's very complicated. Try to figure it out.

"The prize is the pleasure of finding the thing out." That's the short version of his answer to winning a Nobel Prize in physics. How many people do you know that after achieving something of that magnitude would blow it off so easily? How much better do you think everything could be if people were more focused on doing things because they're interested as opposed to doing them for the rewards?

I don't run to lose weight, or beat a certain speed. I run because it's fun. Some days its not fun, its frustrating. Other days its a blast and I can hardly wait for the chance. The pleasure I get from running isn't all the goal setting and achieving or medals and PRs. The pleasure is in getting out there and discovering what my body can and won't do.

Zumba?

Two things I learned from Zumba.

Know where YOUR water bottle is and wear socks.

I accompanied a co-worker to a free, work-sponsored zumba class. If I wasn't the only white-girl there at least I was the only one under the age of 40. It's interesting to be talking to someone about their grandchildren then have them explain to you how to "pop and lock-it."

Zumba is a combination of all those ridiculous moves you combined when you were 13 and rocking out in your bedroom to your cassette tapes. I ended up failing my arms and legs around for an hour while burning approximately 10 calories a minute.

Techincally, it's salsa, samba, bollywood, and belly-dance. However, to me it's more like the hokey-pokey with squat-lunges, and "little kicks."

Really wished I grabbed a pair of socks though..

It's still too hot outside to enjoy the porch.

It's almost too hot outside to enjoy the couch...

I've been thinking, might I need to revamp this blog? I technically don't work IN the ER anymore. I don't have patient interaction, I don't see my former co-workers, I don't really DO nursing in the traditional sense.

I spend most of my time researching things, making presentations, having conference calls. True it's about Nursing Informatics and technology.

However, this blog tends to be my rantings and ravings as it is.

I downloaded the iTunes University classes Principles of Management. I figured if I have to be the project leader for the ED I might as well learn how to do it right. Now, where to fit THAT in?

I've only listened to one class so all I can tell you is a bunch of theorists and studies that have been done on human behavior.

I should probably get dressed before I go to work.

I might be out of dress code in a dressing gown...

MorningCat

Let me introduce you to someone.

His name is Morning Cat.

He's snuggly, sleepy, purrs and is quite a bit insistent.
Morning Cat gets up between 530-630 and requires attention. Doesn't matter from who or what kind. Positive or negative. Morning Cat enjoys snuggling just as much as being hurled at the wall because godsdamnit this is the first day ive gotten to sleep in in months!
Places MorningCat likes to be. My head, my back, under my arm, walking on my stomach. It's ok if you want to keep sleeping, Morning Cat will rub his head against your hand or face receiving all the pets he wants regardless of your state of consciousness. He will also step on you and kneed your face with a bit of clawing and a few "sweet" mews.

However Morning Cat morphs into Bastard Cat by 7am...
He then remains in this form until 530am the next morning.

I've spent the last two weeks traveling.

One for work and one for fun.

Little blogging and lots to do.

Work is mostly sitting around in meetings wondering what I'm doing there (in a cosmic and literal sense) and when it will be over.

I was beginning to feel like Bean in Ender's Shadow.

Lots of food everywhere.

I also made this form for the Cerner interview process based on my observation of their employees.

Is the applicant young, attractive, and well-spoken?

-Yes= Hire immediately

-No= Offer a warm handshake.

It seems like those are the basic requirements for their employees. Closely followed by being tech-savvy and cordial.

There were a lot of cookies around that office though. I wonder how they keep all that up?

Just found this little gem on the internet. Like all things on the internet, could this be for realz?

It's supposedly a memo (few years old) posted by the Cerner CEO, chewing his middle management out for poor productivity.

Must have gotten that straightened out, these people were great to work with.

I guess David wasn't joking about the beatings though...

Cerner even has their own "facebook" (complete with iPhone app.) Crazy world in it's own. Our building was an old Casino on the Missouri River. It was quite fancy and a little weird to have meetings in.

The buffet was good (as previously stated.)

Also, on the mention of Facebook. I've deleted myself, removed as much as I could, contacted the Admins and submitted a request to be deleted.

I'm through with social media (well...sort of.)

Facebook was going to get me in trouble (again) eventually (again) and I decided I'm done with it. Not interested enough in most people's lives. This way if I really want "social interaction" I'll actually talk to someone, not look at pictures of their dog without their knowledge.

Besides all that pseudo-friendship probably isn't good for society.

This way I can spend more time blogging!!

If you want to contact me you'll have to email, call, text, or write me.

Ha.

Ode to a Kindle

I should really, no really be doing something else right now.

I mean honestly, when you have to purchase receipt paper rolls to create your weekend to-do lists, you really shouldn't be dinking around the internet. I blame this on my parents.

Weekends were more like Workends at my house, but we all loved it. There's no way to excape it either. It was always a "Hurry up! We need to relax!"

Anyway. I've kind of broken that mold a bit. Here I sit, Saturday morning. After sleeping in until 7am. I snuggled with a cat. Made a cup of coffee, wrote in my journal, then... picked up my Kindle.

A pageless turn, a weightless thing

How could I so swiftly discard my others?

Speakers yes, but no backlit screen

It lays on a table, not bookcase with brothers.

It feels so light, yet heavy with knowledge

So simple to transport, and hard to escape

I acquire new adventures must faster at current

Visit endless worlds, with hardly the baggage

If my arms grow weary, I switch it to landscape

Buy, trade, and share? Books even for rent.

I like it. Its easy to carry and find new books without having to GO anywhere. I'll probably read tons more now that I have one. No longer confined to what the library has, or what is a decent price at the bookstore.

I don't really like acquiring things. You always have to store things, and keep up with them, etc. I never seem to want to read the books I have on my shelf, because they're always there. There's no sense of urgency. I rarely read library books I get because I don't want them to get damaged when I carry them around.

I do see the negatives of a Kindle though.

The snoop factor is gone.

When people come to my house, they can't really snoop through my books. Potential conversations are lost. Also, when reading in public no one can see what you're reading. Good and a bad thing. But then again, potential conversations are lost. No one is going to be like, hey that person is reading a book I've read. Maybe we're similar enough to have a pleasant moment. Nope. Moment gone.

Also. I'm spending a lot more money on books now. The nice thing is, Kindle books are much cheaper...

The Constant Struggler

Ha HA!

I'm back.

A few days ago I had a dream in which I was the lead researcher for the Harley Davidson Institute of Neurotrama Research.

This does not exist.

Except in my head and on my whiteboard.

Today marks one week of me doing absolutely nothing at work. This is an exaggeration of course, but it feels that way. Going from working an understaffed ER to reading computer manuals is a bit of a change of pace. Considering that I finished reading them all last wednesday and we still have about a week of scheduled "study time" I've been doing various other things.

I think today I'll make a presentation about Diffusion of Innovation as discussed by Rogers.

It's applicable to the instigation of computerized charting at the hospital.

Besides, I've run out of internet...

It happened again. I hit my responsibility spiral and crashed out of control.

This one was interesting. I tried introducing some "color" to my clothing palette. This was a bad idea. There's a reason I need to keep things remarkably simple. If not I make them incredibly complex and it rapidly gets out of control.

I'm reading Running and Philosophy: A Marathon for the Mind there's a bit where Kevin Kinghorn writes about "Single Decision Makers" He likens them to Anscombe's intentional actions. Where you can give an explanation as to why we do them. I found this describes me a bit too well.

For example.

I decide to go running every morning (this month it's every other day.) That's the decision. Every subequent action that follows are intentional actions. I put out my shirt and shorts, find my shoes, set my alarm, make sure my phone is charged, and fill my water bottle before going to bed.

In contrast, there's another sort known as the constant struggler. My roommate for example. She's decided to exercise everyday, but where I decide to do it and go into autopilot. She makes a decision every step. What time of day should I exercise? What clothing should I wear?Depending on what exercises I'm going to do. Should I cardio first or second? Which muscle group today? How long should I wait after eating? What will I refuel with?

I don't choose what shorts or shirt to wear. I don't (typically) change my time of day. I don't "mix up" my routine (except monthly.) I've decided on something and that's how it is until the review period is over and I can re-evaluate.

I do things like this for a month. Review the data collected and see what I need to alter.

Here's the unfortunate bit that seems to have taken a while to get to. I decided to add color to my closet. Once I did this I couldn't get up and put clothes on. I had to make multiple decisions every time I wanted to get dressed. Would this underwear show through? Was it too hot for this shirt? Are these pants clean? What socks do you wear with this? AURGH!

It was very difficult.

I gave up yesterday.

I'm wearing scrubs and a white t-shirt.

Business casual is so overrated.

Things are simpler when you don't have to think about it.

This is one of the main reasons I'm a vegetarian. There's usually about one good thing per menu when I go out to eat. I don't have to decide if I feel like chicken or steak. I can always have pasta!

Carbivore out.

Snip Snip

So, when I friend of mine made the post that she bought $66 worth of items for $0.94 I sort of sat up and took notice.

I was raised to be a good steward of money. Really more as a bragging point than anything. Oh yea, and so we could go on living our lifestyle.

My Dad once bought a suit at JC Penney's for around $3. I found a pair of puma trainers for $10. Paying full price seems like such a rip off. Every time a sale goes on, John comments, "So THAT's what the real price is."

On to the extreme couponing phase.

I don't have television access except at the gym so I stay relatively 3months to a year behind on trends and whatnot. Turns out there's now a show teaching people how to save money by using coupons. I feel I learned this is Home Economics (of course, being homeschooled cleaning the bathroom was considered home economics...) This sharp change in the economy is teaching people to be a little more careful in their planning. There are a few sacrifices to be made however.

Is this something I think I need to look into?

You must develop a strategic plan.

Turns out you can't really skim the grocery adds for what's cheapest anymore. I could never do that to begin with. I already set aside a portion of my weekend to flip through cookbooks with my roommate (Sarah) and decide on recipes for the week, who will cook what night and the overall health of the foods we are choosing (it's fun to live with scientists.) These decisions are all copied onto this What to Eat pad and checked against the pantry for what we need. The missing items are checked on this All Out of List and off we go with our "Green Bags" to Kroger, Sam's, or (if it's just me) WholeFoods and the Farmer's Market.

I am a terrible person at the grocery store. I hope you never have to see me. Not only do I have terrible control over the MONSTER-SIZED carts (just can't get leverage if you can barely see over) I also read the labels for EVERYTHING, bring my own bags, use coupons, self-checkout, purchase alcohol (while looking like a 12 year old), buy insane amounts of fresh produce, check unit prices on items located in different isles (or even different stores.) Sometimes, I even get on Amazon while in the store to see if it's cheaper to have it mailed to me within two days.

Do I really want to add the crazyness of getting weekly emails, printing, snipping, planning, etc. Just to save a few bucks?

Here's the sad kicker...

All this time I've been thinking about this (thinking includes creating a coupon email account and signing up for a bunch of online coupon sites, reading the ehow, and watching some tip videos on youtube.) I keep coming up with one repeating idea that I can't seem to shake and really reveals my personality.

Why?

What's the overall net gain?

A few extra bucks?

Is all this work worth it?

I already spend a great amount of time recording and analyzing my diet to keep kcal and sodium low while maintaining protein levels separate from animal proteins. (not as hard as people seem to think) Do I really want to add an additional level of crazy?

Then I think, what will I do with the money.

Anything I need I already have. I could probably live comfortably 2-3 months without buying another item (if I ration the food properly.) Things I want I either purchase or talk myself out of. School bills have been part of the planned budget since highschool and therefore are well foreseen. Emergency money is placed well out of reach.

Hmmm,

Here we go.

I'll find a charity/organization/or cause and donate the remainder of my planned grocery budget to them after 1 month of couponing.

Suggestions would be appreciated.

If you think you're infected...

So here's what happened.

Friday evening I developed a rash across my abdomen, by Saturday it was spreading up my neck, and it covered me by Sunday. Monday when I went to see my Doctor it was in my ears and my mouth. Monday afternoon I had a fever.

I had erupted in pseudovesicular pustules all over my body.

They think I had a severe allergic reaction to sunscreen. So bad it became systemic. I've been on steroids for 4 days now, and it looks like I'm overcoming chicken pox.

I still have a few open sores so work is frowned upon as well.

I was eaten up.

Now it's time to embrace the paste.

This is how you get ants...

Well, here's to having written something yesterday and forgetting to submit it.

Oops.

We have ants.

The 2D character sketch from Archer was pretty much the conversation held in my house...

But we also have a plan.

I come home around midnight when I get off work and I find my "big board" (<-reason why we have it.) covered in a very specific strategy to "Starve the Bastards!"

Incidentally, I had a very ant-related dream that night in which I did panic.

Now I find this scary business.

Ant-zombies.

The scientists found that at solar noon, when the Sun is at its strongest, the fungus synchronised ant behavior, forcing infected ants to bite the main vein on the underside of a leaf. The multiplying fungal cells in the ant's head cause fibres within the muscles that open and close the ant's mandibles to become detached, causing "lock jaw," which makes an infected ant unable to release the leaf, even after death. A few days later, the fungus grows through the ant's head a fruiting body, a stroma, which releases spores to be picked up by another wandering ant

Jeez. Thanks Science Daily.

Now I have the decision. Do I want fungus in my house or ants?

Here's a zombie movie potential.

Them and 28 Days Later.

If only I had a little ant doll...

What's with the candypan?

Here I sit at Starbucks, freezing bits of me off that I didn't even know I had, but hey, Frappuchinos are half-price!

Supposedly, I'm working on my Ethics in Nursing paper. Last paper for this semester, once it's done, I'm done.

Meh.

I've made the cover page so far.

I've been such an oscillator of moods recently. I became visibly upset over getting lost on my way to a wedding today. So upset, in fact, I gave up and decided to go home. Now, every thing is just peachy. I'm trying to decided if this is a problem or simply life and I need to figure a way to chill out.

I really think it's just life. One can not be happy all the time, nor should one expect to be. I don't need medication or hormone therapy, I just have moods. Right now, I'm cold.

SO. Onto the interest of the day.

It's between 1430- 1500 at work and everyday I try to pass around the ED with a bedpan full of chocolate. Nothing gross like that. They're all neatly packaged and I hand them out to people.

So, why the bedpan?

Here's why.

Everyone knows a little bribery goes a long way but Alice Isen has isolated even more. She reviewed some studies with doctors, candy, and correct diagnoses.

A little positive influence helps doctors come to correct diagnoses faster and more accurately.

In addition, if I can't be skinny at least I can make my co-w0rkers fat!