Sleep.. nah..

Well it’s 0515 am here and I am watching the dementor’s go after Harry and Sirius after narrowly surviving a warewolf attack — so to some of you that means I have been up sipping tea for nearly two hours already, to everyone else in my sleepless state tonight I am on the third Harry Potter movie ‘Prisoner of Azkaban’

I could argue that it is the best of all the movies, despite alot of the book being cut as is the start of all the books being made into movies, however a great series to have on in the background. A debate for another day…

So I’ve worked 6 of the last 9 days and I am drained, on all levels. Perhaps this super-moon is having effects on me as well, glad it was a day in ER today and not a night shift. After an exhausting week the choice to buy Miss Vickies S&V chips and open a beer after weeks of clean eating has done it. However I know I am not the only one who has hit an emotional precipice this week,

Source

SNL has been always been hit or miss with the comedy but Kate aka Hillary and Alec aka Donald has been great to watch and this was an amazing way to address the post election week and tribute to a great Canadian musical legend.

Well shall we talk a little nursing since we’re here… hmm.. ok. I have had access to increasingly acute patient’s more recently. And one in particular.

I’ve mentioned before about the increased attempt at suicide we see in this facility.

For those looking for some related reading — Roberts, N., Nicholas, A., & Repetti, L. (2016). Clinical Characteristics and Outcome of Emergency Department Referrals for Suicidal First Nation Children and Adolescents from Northern Ontario: Preliminary Report. International Journal of School and Cognitive Psychology. https://doi.org/10.4172/2469-9837.1000180

What I have seen is a large number of adolescents and adults who choose ingesting pills, and behind that are those who attempt or succeed with hanging. This is my personal observation and of course there are those who either succeed in their attempt or who are too sick for the facility in SL.

On more than on occasion I have seen an adolescent who took not only acetaminophen which seems to be in everyone’s bathroom cabinet but also medication used to treat diabetes.

Let me break it down for my non nursing readers – diabetes is a chronic illness that requires daily medication to process the glucose in what we consume into energy our bodies can use to function. With me so far — it takes our pancreas to be stimulated to release insulin for this glucose the be processed and diabetes in the dysfunction of the pancreas to produce insulin. So what happens next, well unprocessed glucose from what we consume then circulates in our blood, causing an increased blood sugar and complications go on from there. There are a variety of medications a person with diabetes could take to normalize this function. It is very serious when a non- diabetic takes even few, let alone a handful or bottle of these medications.

Prior to my taking over this patient – she had been formed (meaning required to stay in hospital for a psych consult, because of attempt at harming self). Her mother had escorted her down and we had already begun to keep her circulating blood sugar within a normal range (between 4.0 – 7.0). On arrival it was 2.7 – low but perhaps not low enough for an adolescent to feel really ill. Treatment consisted of regular bloodwork and fingerpokes to monitor her blood sugar and other electrolytes.

So while “nursing” the mental state of this patient I was also responsible for maintaining two IV lines, the first a continuous glucose (D10) infusion and luckily for this patient the antidote for the anti-hyperglycemic med.

Learned this weekend.  Gliclazide can be counter balanced by Octreotide.

Octreotide is not a drug I have not used often in my nursing career. When I have it was related to the management of bleeding in the GI tract, so it took a bit of reading to figure this one out. Now I know that Octreotide mimics the actions of one of our natural hormones, somatostatin, and one action of that hormone is to stimulate the pancreas to not release insulin — remember my patient is not a diabetic so this process does occur naturally.

So a person ingests multiple tablets that reduce blood sugar, so we give glucose through IV to try to maintain a normal range. Poison Control – had recommended that we have to monitor this patient for upto 72 hours because of the number of tablets ingested. So not to effect the normal function of her pancreas and hormones we balanced the glucose fluid to the Gliclazide in her system.

The patient had no idea how serious her actions were. Through my shift she was seen by mental health counselling and the physician lifted her formed status, as she agreed to stay and get her needed medical treatment. After 30 hours of treatment, she admitted to feeling better and actually asked about being discharged. The chat we had then, I hope, really illustrated the seriousness of her actions.

So now I think I may finish my cup of tea and try to get some sleep. I’m looking forward to having the day off so lounging in my sweats and pulling my book back out seems like a good plan for the day.

Close enough.. anyway hope you all have a great week and to those I haven’t talked to recently we need to make plans for December when I get home! So msg me!

Make sure you’re all caught up on my posts Click HERE

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