S8s the narcotics (drugs of addiction)

S4D’s the sedatives (Potential for abuse)

2. What are the 5 Rights of safe medication admin?

Right patient, right med, right time, right dose, right route

3. When do the 3 checks happen in meds preparation, and what are they?

i. When ur about to administer meds, Check the Meds Packet against the Pt’s Meds Chart

ii. Check again as Meds are removed from packet (right dose, right blister pack)

iii.  Check 3rd time as u put the Meds away

4. What is an “adverse drug event”?

= an injury to a Pt caused by a med error, e.g. drug given to wrong Pt, or wrong drug given to Pt, or drugs given despite contrainidications.

= the most common adverse event in Hosp, aside from surgical mistakes

5. Just say you were administering 25mg oxycontin to a Pt but the only tablets left were 50mg. Would you:

a. give the Pt the whole tablet

b. break the tablet in half, give half to the Pt and eat the other half

c. break the tablet in half, give half to the Pt, and sell the other half at the local Westfield

d. break the tablet in half, give half to the Pt, destroy the remainder by flushing it down the toilet, have another RN witness this, and record it as destroyed in the register (both to sign)

RHEUMATOID ARTHRITIS

6. What happens inside joints that are affected by RA?

RA is an autoimmune disease in which the body’s defence system starts to attack the synovial membrane. The synovial membrane becomes inflamed. This is a problem for the articular cartilage because the cartilage doesnt have any real circulation of its own and so it sort of relies on the synovial membrane to bring nutrients etc which diffuse across to it. Pannus (granular tissue) forms at the edges of the cartilage and gradually replaces it all, causing joint stiffness. The joint space gets smaller and eventually the joint might fuse (bones stick together). The edges of the bones not covered by cartilage begin to wear away. Yow!

7. My neighbour Judy is a 40 year old piano teacher. Her finger joints are stiff and they are red, hot, and swollen. They look shiny. She admits she hasn’t been feeling all that well lately. She thought she had a virus 2 months ago, but since then she has lost 7kg. She has an itchy rash on her stomach, she feels tired and unwell, and when I take her temp. it is 38.9 C. Judy says her fingers are sore from playing the piano too much. How likely is this?

Not very likely. It sounds like she might have RA, as her condition is more systemic and not just localized to her fingers. Also, her small joints are affected on each hand. She is also female, 40, thin, and unwell. All these are pointers to RA.

8. What tests would you expect a Dr to order for Judy?

hands Xray, joint WBC count, ESR, rheumatoid factor test, and maybe a DNA test for the gene for Human Leucocyte Antigen production

About rheumatoid factor - if you have RA, that means your IgG antibodies go nuts and start attacking your own tissues rather than foreign invaders. A test for rheumatoid factor is counting how many of your IgG antibodies have crossed to the dark side.

9. What would u expect to see on Judy’s fingers Xray?

narrowed joint spaces, maybe fused bones

10. What is an ESR and what does it mean if your ESR is raised?

I dont know. Anybody? Anybody?

11. Your Dad is 50 years old and he’s getting pretty chubby from working too much at his computer. One night after a large dinner of steak and red wine, your Dad wakes up with a really, really sore R big toe. He hops down the hallway to the living room where you are hanging out. He hasn’t injured his toe exercising, and he’s otherwise well. What’s wrong with your Dad’s foot?

He most likely has gout. Gout most commonly onsets in obese middle aged men >40, and commonly affects the big toe.  It is extremely painful. It can be brought on by eating red meat too often. Gout can certainly happen to women but the age of onset is later. Alcohol abuse is also a risk factor. Maybe Dad should cut down on the red wine!

12 The Dr tells your dad that it’s gout, and he gives him some meds. Dad wants you to explain what causes gout…

Gout is caused by wonky metabolism of Purine (no idea what that is - just think of Pura milk, then make it into Purine - which could be the expelled waste of Pura milk - ha ha) which causes your blood to have a too high level of uric acid. Your body responds to the uric acid with an inflammation response to try and attack it and get rid of it. Unfortunately, uric acid precipitates in your joints as crystals, and then your inflammatory pac-mans attack inside your joints, which is VERY painful.

13. Later that evening, you notice that your Dad’s arm has quite a lot of tiny white nodules under the skin. Is this related to the gout, or has Dad got a mysterious rash?

a. It’s a rash unrelated to the gout, and you don’t want to know where he got it

b. It’s nodules called ‘tophi’, which are uric acid deposits under the skin

c. It’s a fungal infection called ‘fungi’

d. It’s suncream absorbed by Dad’s skin when he put too much on

14. Mr Singh is a 75yo man who comes to your local GP’s clinic with a sore R hip. He walks with a stick which he bought 6 months ago. Mr Singh used to be a marathon junky, but now he is elderly and overweight (120kg, 170cm). He says his hip is getting more painful and he can hear it creaking when he walks. It is stiff and sore in the mornings for <1hr. It gets worse with exercise. He has no other health problems. What is Mr Singh’s problem?

OA, because: he’s elderly, it’s a major joint that’s affected, he’s overweight, he’s otherwise generally well, his morning stiffness lasts <1hr; the joint pain gets worse with exercise, you can hear crepitus when he moves it, and the joint damage may be a result of many years of marathon running.

15. What happens inside a joint suffering from OA?

Chondrocytes (bone cells) turn evil and start to overgrow. The hyaline cartilage gets roughened and then worn away. The chondrocytes continue to multiply and cause bony overgrowth (osteophytes) at the edges of the joint, which sometimes break off (”joint mice”) and float around in the synovial fluid, causing pain and crepitus. What triggers chondrocytes to grow out of control? Genetic factors, trauma, chronic overuse - lots of factors.

16. What is an arthroplasty?

a. A nose job

b. An operation to scrape out the osteophytes in a joint

c. Surgery by a plastic surgeon on a joint

d. The replacement of a joint via surgery

17. What are the 4 main areas of nursing care that a Pt needs after a THR surgery?

i. Prevention of Infection (e.g., via surgical wound, the wound drain, or IDC)

ii. Prevention of acute pain, and monitoring of pain analgesia & side effects

iii. Exercises to regain joint mobility but avoid movements that might dislocate the hip joint

iv. Prevention of DVTs via assessment for DVT signs, leg exercises, Ted stockings etc

18. As luck would have it, you are working as an undergrad nurse in rehab and you are looking after Mr Singh after a THR. You have to help him get dressed. Are you going to:

a. Get him to put his knees together (adduct his legs)

b. Get him to bring his knees up to his chest

c. Move his legs apart wider than his hips (abduct his legs)

d. Absolutely NONE  of the above! Keep his legs about knee-width apart and don’t raise his knees above his hips

Yippee!!! My exams and essays are over, at least. Never has anyone crammed so much info into such a small skull in so little time!!!

Never has anyone used so much of their pre-existing general knowledge to make such intelligent guesses on multiple choice questions, when they didnt know the real answer!!!

The good news is…I can take your pulse, your temp., your BP, I can listen to your chest, assess your breathing, do mouth to mouth if youve stopped breathing entirely (enough with the cheeky comments, you boys), I can hook you up for an ECG and read it and know if you’re having a cardiac arrest, I can give you a nebuliser if youre having an asthma attack, AND I’ll know what drugs you should be getting during any or all of these events, just in case the Dr is having a spaz and has forgotten what to do.

And while Im busy saving your life, will you be wondering what marks I got on my exams?

Jeez, I bloody hope not!

Ive worked a bit with people with disabilities in the past. I think we’re allowed to call them disabled. When I was a kid it used to be OK to say ‘retarded’ about a person with an intellectual disability. And a person with cerebral palsy was spastic. Remember that? Then words like ‘retarded’ and ’spastic’ got made taboo. Spastic got replaced by ‘cerebral palsy’, which is fair enough. Retarded, on the other hand, was replaced by ‘developmentally delayed’.

That is not only hard to say, but it also kind of implies that the person is just running a bit late and will be here eventually with the rest of us. “I’ve just been delayed for your dinner party, but I will be there.” Believe me, some developmentally delayed people are never, ever going to catch up, no matter how optimistic you want to be. I think after a while someone realized that, because then it got changed to ’special needs’. I used to be a ‘carer’, and my ‘clients’ had ’special needs’. And special needs is a euphemism of course. You could say my Dad has special needs - when he goes on a Qantas flight, his special need is to have the low-fat airline dinner. However, with ’special needs’ clients, we are NOT talking about a special dinner every so often. We are talking major care: help to eat and talk and move and keep clean and maybe even breathe. And that could be 24 hours a day.

Let’s talk about the word ’special’. Does the word special mean ‘different, unique, and rare’? It does to me. When I say ‘you are very special’ to someone I love, that means, you are unique and I treasure you. And it implies something positive. And rare.

Now, I think someone finally figured out that calling disabled people ’special needs’ people was not only a misnomer it was possibly also a bit cruel. Because now after about 25 years we are once again able to say they have a disability. Phew!!!

And now I am going to talk about Differently Abled, because that is a term that I truly like. In all my work with people with brain injuries and various sorts of disabilities, I have met some extraordinary people who I can quite honestly say were outstandingly able. They might have had a disability in one area, but made up for it by compensating in other areas. Take John for example. John was a 47 year old man who owned his own printing company. He was very successful, and he loved cars. He had a garage full of different sorts of cars, including a very rare old model T Ford. One day for no reason at all an artery burst in John’s brain, which pretty much wrecked his vision, and gave him a limp. John’s wife didn’t think John was going to be successful anymore, and that wasn’t sexy to her, so she left. Now, you might be thinking, that would pretty much wreck his life. But it didn’t.

When I met John he lived in a beautiful apartment with a waterfront. He was still the managing director of his business and he had hired other guys he trusted and liked to do the work he couldn’t do anymore. He had a bit of a Pied-Piper personality and he knew it, so he capitalized on that. Anytime he wanted to go out in one of his cars, someone from his gang at work would just show up and do the driving for him. Wherever he went, it as party city. And the business continues to do just fine.

WOO-HOO!!!!
Now, I come to the part about my sons’ friend called Ben. And this is the funniest, best Differently Abled story I know. Ben was born with only one hand. He is right handed, but his right hand just isn’t there. It is a stump with a vestigial thumb. Ben is very smart at maths. And, he is very creative. He likes to draw and put together comic magazines and get other kids to draw for his magazines too. One day Ben came over to our house with a video camera. The kids came up with an idea for a movie and they set about making it. Ben was the one with heaps of great ideas about how to set up the scenes so they would tell a story. He also had cool ideas like making the character ‘invisible’ by turning the camera off and getting the person to leave the scene, but then have someone else continue to pretend to bump into them. (This kid is great.)

But, best of all, at one point the character played by Ben got attacked with a sword, and his hand got chopped off (just like when Luke Skywalker’s hand got lopped off with a light sabre in Return of the Jedi). Suddenly there is a close up of Ben’s stumpy right hand, with tomato sauce dripping from it, and he’s going “ohhh, my hand!”
A ready-made stunt hand!

Now, that is what I call a creative use of one’s disability! BEN….

Do these look like terrorists to you?

Devils, yes, perhaps…

Boys Like Their Toys

It’s pretty widely agreed that all little boys like to play with guns.

Some people try to stop kids from playing with toy guns in the fear it might make ‘em violent. Nah! It stops them whacking each other with sticks!

Since I like to encourage the kids to take an active interest in things, my guys have quite a few plastic guns. They got laser guns. Then they graduated on to cap guns. They have computer games like Medal of Honour in which you can take part in real-life battles from various wars in history. And to make sure they know that real-life war is NOT a game, I let them watch really gory war movies like Saving Private Ryan.

Was I taking it a little bit too far when I ordered, off the Net, some BB guns for my little darlings?

Sydney Airport Customs authority thought so.

And I think NSW Police might think so as well (cousin Chris, you didnt hear that!)

I have just today received a registered slap on the wrist from Customs telling me that my illegal firearms have been seized. If I want my guns, I have to go get a license and a permit to import and THEN go pick’em up.

In their mercy, they are going to let me off this time, but I have been added to a List of illegal importers and if I do it again, I shall feel the full weight of the Law upon my puny self.

My reaction to this is………

Jerome says:

“We went to Kuringai National Park. We walked down to the Basin. I loved it because we found crabs in the sand and there was ochre everywhere. The Aboriginal carvings were my favorite. They were fantastic. I saw an upside-down kangaroo, and a man holding a fish and a banana, and I saw people.”

Mummy says:”We walked almost 6km (4 miles). Gran and I saw quite a few amazing birds, such as parrots, honey eaters and wattle birds. We had a picnic. Then we walked back up the hill. After that, we were hot.”

When I have something to Rant about,

‘cos it’s all just TOO MUCH

I am going to put it here:

11/6/07

Rock vs Hard Place

I have exams in 2 days . I have two papers due tomorrow but Im not so worried about them. Oh, but there’s an essay I haven’t even begun yet. I used to do so well at studying. Now I have exams coming up and I wont even have time to study for them. Heck, it’s lucky they’re multiple choice, at least I’ll get 25% right.

The reason why I cant study is because no matter what, I have a house to run and kids to feed. The pressure is building in my head. While I am working I hear voices saying Mum where are my socks, or Mum did you do the laundry, or Mum what about my dance practice with Zoe, or Mum can you untie my shoelaces because theyre stuck. I also hear: Mum, the rain’s coming in through the roof, and Mum the yard’s a mess, and Mum I have to be at Band practice 5 minutes ago; I hear Mum the cat’s done a poo in the hall.

The holidays are coming. But I won’t be having a break! That’s because I have to catch up on work that I missed through being sick earlier.

This is my life: <= This little person is me.

SCENE 1
Haz-Why can’t we go to (friend) Alex’s place?
Me-Look if you want the truth, we’re not going to Alex’s place because
Alex’s mum is away, and Alex’s Dad fancies me. I’m not going over there
while the Mum is away because I don’t want to be alone in the house with the Dad; it
could get embarrassing. I don’t want trouble.
Haz-(weary sigh) Yes, I knew he fancied you.
Me- Did you? How?
Haz- The way he looks and you and stuff. Some people, when they see
someone hot, they look at them a lot. Me, when I see somebody hot, I DON’T
look at them.
Me- Why’s that baby?
Haz- Well, I’m only 10 and that’s too young to be choosing a partner for
the rest of your life. I’m just not ready for a relationship yet. So I look
away.
….WHAT THE………..!???? WHAT EVER HAPPENED TO GOOD OLD GIRL GERMS’?

SCENE 2
Jumbo- Mum the best costume for this dance I’m doing at school would be a
leather jacket
Me- That sounds pretty cool
Jumbo- Leather gets a bit hot when you’re dancing though
Me-Does it honey?
Jumbo- Yes. Look, maybe you should get me a leather jacket that is, like,
100% cotton.
Me-100% cotton!
Jumbo- Yes. Just get me a leather jacket that’s about 100% cotton, or close
to it as you can get
……..JEEZ, I’M ON THE CASE NOW………..

SCENE 3
Isabella (nerdy girl) - You shouldn’t go calling people names that you don’t
understand
Jumbo - I called you a nerd. Of course I understand what a nerd is
Isabella- No, a nerd is someone who sits in front of a computer all day
Jumbo- That’s a computer nerd. I called you a nerd, which is not the same
Isabella- I don’t play on a computer all day
Jumbo- Look, a nerd is someone that has bad social skills, and likes to do
maths. They’re smart in some ways, and they’re also bad at some things, like
social skills. And that’s how you are.
………SOCK IT TO ‘EM, Jumbo……..

SCENE 4
Haz- Why are you being rested? (on sidelines at rugby match)
Liam (annoying loser kid) - (moaning) I am soooo sick
Haz- You’re not sick, you just don’t wanna play the game
Liam- I am SO sick, I have a cold.
Haz- That’s just an excuse. Jeez, I have a cold, plus gastro, plus I have
lice, plus we have worms in our family. But I can still play footy.
…….AHEM, I THINK THAT WAS TOO MUCH INFO, HAZZA………….

Welcome to our world. This blog is about the life & times of a single mum (me) and my boys Jumbo 8 and Hazza 10, who are in primary school. We live in Sydney, Australia. We have fun, we have a lot of laughs, and we’re a bit crazy (well, certifiably crazy in my case - although it’s probably not too late for the kids). Being a single parent is tough and it’s sometimes hard to know how to steer this ship and steer it right. I’m sure all parents can relate to this: nobody gives you a manual when they’re born, so you’re left secretly wondering at times what on earth you’re doing, and whether at some point someone is going to point to you and say, “Ha! You’re not really an adult! You don’t know what you’re doing!!!” This is my blog about these topics and more…
Read and Enjoy, and please leave a comment