Nursing One Day At A Time

3rd year Student Veterinary Nurse. Time to share the secrets behind the every day lives of a nurse and give you a glimpse into the mind of an emotional breakdown of a student ;)

[djelliott]

Let’s get eaten in Africa

So.....

I’m going to Africa!!! End of April I will be flying to the one place that I’ve always wanted to go. I’m volunteering at Shamwari Conservation Reserve :D Going with two amazing friends (also nurses). I do not think it has sunk in yet, but what a way to end all the studying!     

[djelliott]

Swamped

I’m not sure if it is because we are coming to the end of the course or simply because there is a lot to do at the moment, but I feel like I’m drowning in everything I need to do at the moment. 

I have 4 assignments to complete: 2 for end of March and 2 for end of May (these are to get me onto the BSc year). 

There’s 3 exams to study for and I really do not know where to start. 

We have presentations to present, CVs to write, questionnaires to fill out. 

When does it stop!? 

It feels like I’m endlessly doing something and all I want to do is nothing. I don’t get to sleep properly because my brain is still trying to organise how I’m going to get everything done before it is too late. 

Can you imagine if I have come this far just to fail these exams?     

[stickyfrogs]

Why is the hand empty? Where are our treaties……..?? By Gumby and Voigt

[puppypu]

http://puppypu.tumblr.com/

[distinguishedbaloney]

[djelliott]

So I finally did it! My Nursing Progress Log (NPL) is finally finished. No more running around looking for cases to complete tasks. No more agonising hours of logging cases. Now I just have 2 more exams and 2 more assignments until I am qualified!!! Eek!

[beben-eleben]

I have 3 moods:

skips every song in my playlist

lets the music play without interruption

plays the same song on repeat for days

[djelliott]

Feeling of a failure

Feel like an idiot right now. So much that I have actually been sitting in the dark for the last half an hour crying. I am a very quiet person. I struggle a lot with conversation and fitting in. So you have to understand I've pushed myself very far by doing placement at the QMH. I am way out of my comfort zone. So today I tried to push myself further. I thought I would be useful. So the op had finished and I started to take the suction and diathermy apart and gather everything on the trolley ready to take down to sterilisation. Halfway through my deed my clinical coach comes running in to tell me to stop. The op was an orthopaedic and had been taken down to radiography to make sure the bone plate was actually in place. So there was a possibility it could be coming back again to have it redone and I had just contaminated their only orthopaedic kit. Well you can imagine how I feel. My clinical coach proceeded to walk away from me at this point and I'm glad she did because my eyes water when I get embarrassed and angry at myself. I know you guys all think: "well it's an easy mistake you shouldn't be so hard on yourself!" But I am a nearly qualified nurse and I'm making stupid mistakes like that. It really throws my confidence and makes me think I can't do this. That I've screwed my life up by studying for the wrong career. I made the same mistake when I was a first year and I promised myself I wouldn't do it again. But I still make those mistakes again and again. Now I know it is going to throw my confidence. I'm going to be quiet and reserved. I probably won't get my NPL done even thou I only have 4 tasks left because that's the type of person I am. I let things wobble me and then I'm screwed. On the plus side I made the vet students laugh this morning. I put on a pair of medium scrub bottoms and they nearly fell down. So I swapped for a pair of small and couldn't get them over my thighs....medium it was ;)

[getyourveton]

So if I ever ask you: which breed is susceptible for this or that type of cancer, you can’t go wrong with boxers.

my pathology professor (via getyourveton)

[helpfulhintsforrvns]

EXTRAHEPATIC BILIARY TRACT OBSTRUCTION (EHBO)

What is EHBO?

In both dogs and cats Bile is produced in the Liver, it is secreted from the  Bile Canaliculi (small ducts within the Liver) into larger ducts before it then enters the  Bile duct and comes to be stored in the Gallbladder. From here the Bile drains through the Common Bile Duct which then empties into the Duodenum (The first part of the Small Intestine). 

EHBO is the blockage of normal Bile flow from the Liver to the Intestinal Tract.

What causes EHBO?

Pancreatitis 

Edema from perioperative handling of the Pancreas

Gallstones

Pancreatic, Bile Duct and Intestinal Neoplasia

What are the clinical signs of EHBO?

Clinical symptoms of EHBO are often nonspecific and can be the same as other abdominal conditions, in addition the signs can wax and wane and therefore patients are often not presented to a vet until icterus develops.

Decreased Appetite

Vomiting

Diahorrea

Lethargy

Pyrexia

Abdominal Pain

Dehydration

Icterus i.e Jaundice (Yellow discolouration to the mucus membranes, skins and sclera) usually present within 24hrs. 

How is EHBO diagnosed?

Blood Work - When the Bile Duct is obstructed serum levels of Bilirubin will be increased, and due to this the Liver enzymes (ALT & ALP) will also be increased. In severe cases the kidney values (UREA & CREA) will also be elevated and clotting times prolonged.

Radiographs - Useful in identifying stones within the biliary system and other abdominal disorders that could be contributing to the EHBO.  

Ultrasound - Abdominal ultrasound is a recommended diagnostic technique in all cases when the patient is suspected of either bile duct obstruction or disease of the Gallbladder.

How is EHBO treated?

The main aim = Confirm diagnosis, establish a patent biliary system and minimise post-operative complications. 

EHBO is almost always treated by surgical intervention which involves either removing the obstruction or bypassing it completely. Biliary-enteric anastomoses (cholecystoenterostomy) or rerouting bile from the Gallbladder to the Small Intestine will establish patency of the bile duct and help resolve clinical symptoms. 

What is the prognosis?

To ensure the outcome is positive early detection and quick resolution is needed as other metabolic issues can arise the longer a obstruction is present. Survival rates following surgery can be anywhere from 40-70%. 

[helpfulhintsforrvns]

DIAPHRAGMATIC HERNIA

The diaphragm is a large muscle which forms a barrier between the thoracic cavity containing the heart and lungs and the abdominal cavity containing many of the vital organs and structures. It is essential for efficient respiration.

THE TWO TYPES OF DIAPHRAGMATIC HERNIA

Acquired 

An acquired diaphragmatic hernia occurs when the diaphragm ruptures usually due to some kind of blunt trauma (cats falling out of trees or off of fences and dogs involved int RTCs) to the abdomen. The force of the blow against the abdomen forces the abdominal organs up onto the diaphragm causing it to tear or rupture. Once a rupture has occurred the structures such as the intestines, liver and stomach can freely move up into the thoracic cavity compressing the lungs and causing difficulty in breathing.

Congenital

An congenital diaphragmatic hernia occurs not from trauma but from the muscle failing to form correctly during development. These are very rare but from recorded cases it can be seen that Weinmerarner’s and German Shepard’s have a prevalence.

CLINICAL SIGNS

Dyspnoea (Difficulty in breathing)

Cyanosis (Blue tinge to the Mucus Membranes)

Extreme Pain Symptoms (In cases involving strangulated gut)

Vomiting

Diahorrea 

Anorexia

DIAGNOSIS AND TREATMENT

Immediate X-rays of the abdominal and thoracic cavities are needed to diagnose an diaphragmatic hernia. The patient is likely to be in shock therefore stabilisation with IVFT, pain relief and oxygen therapy should be administer to ensure the patient is supported enough for surgical intervention, the only effective treatment option. 

[catsdogsgifs]

http://catsdogsgifs.tumblr.com/

[catsdogsgifs]

http://catsdogsgifs.tumblr.com/

[djelliott]

First week as a theatre nurse at the QMH and I found out I look like and umpa lumpa :') thought I would hate it but it's actually okay :) 4 tasks to go on that NPL guys! There's a light at the end of the tunnel!!

[aosladies]

AoS Ladies Appreciation Weeks ♀ Day Six: Raina in Season One

“I have no allegiance to Hydra, Centipede, Cybertek, you. I was only ever interested in…” “Evolution.“ […] “Exactly. I was saddened to learn you weren’t Clairvoyant. I had a question I didn’t get to ask, but now…” “Now the truth is written on the back of my eyes. So go ahead, Flowers. Ask. “                                             “What will I become?” 

[djelliott]

When you've had a long day at work but decide to go hang out with a head of a dog in the Clinical Skills Centre to practice some nasogastric tube placement.

[djelliott]

A poor excuse for a blogger

Hey :) I know it's been a while, but settling into life at the hospital was hard and I've settled for the fact I am not made for 12 and 1/2 hour shifts! I've had really good days and really shit days. It has been really interesting, but being quiet hasn't really made me stand out. It's annoying when you know you need to be better but something is always holding you back for no reason. My highlights have been: -Getting to see an actual megaoesphagus case and being able to try out the elevation chair when feeding him. -Feeding tubes. I don't know why but it's so relaxing just sitting with a patient for a long time giving them a feed. -Helping out in endoscopy. -Meeting Ben the quiet lab (yes I said quiet) and watching him become more comfortable with everyone and playing with us. -Placing a U-cath successfully first time and making myself look like I have at least a bit of talent ;) The list could go on. Tomorrow I plan on getting my endoscope tasks signed off which will mean I only have 5 more tasks left on my NPL :O I am so excited! :D Nearly there guys!