ellievsbear
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Sweet Seals For You, Always
@theartofmadeline
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oozey mess
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izzy's playlists!
PUT YOUR BEARD IN MY MOUTH
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Noah Kahan
Cosmic Funnies
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TVSTRANGERTHINGS
Janaina Medeiros
Aqua Utopia｜海の底で記憶を紡ぐ
tumblr dot com
Product Placement
macklin celebrini has autism
Origami Around
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@thatlonelyintrovert
Okay but like, toothless was not domesticated. Hiccup didn’t tame him, he befriended him. That’s the whole point. Toothless is not hiccups pet, he’s hiccups best friend. They learned to communicate and understand each other, i could write a whole essay about how they are equal in that relationship. They’re best friends.
Turn based sex. Take as long as you need to think of a strategy.
HINT: his pussy is weak to fire magic.
Pepper spray his pussy
Do not.
The best thing for me, as an ex- Starbucks employee, is the horror that genuinely is the milk delivery when it’s only you and one other shift member. Though, I did end up learning how to carry six individual gallons of milk at once.
Also that change from Customer Service ™®© voice back to normal to informal joking-threats is amazing
Yeah the whiplash from “Hi welcome to starbucks how can I help you! :)” to “I’LL FUCK YOUR WIFE” killed me.
MILK.
DELIVERY.
Almost pissed myself laughing reading this addition holy shit
I Will Not Apologize
Happy Pride, ya'll.
$3 download (includes version where you can color in your own Pride flag. Limited restrictions, mostly don't be a fascist or major company: https://ko-fi.com/s/ac6c284e8c
Prints: https://www.inprnt.com/gallery/mxmorgan/
Shirts: https://mxmorgan.threadless.com/mens/t-shirt/regular
I laughed so fucking hard at this
love is the most important thing ever
not just romance . just having love in ur heart
my favourite cousins (rtte edition)
I have mixed thoughts on sex work. I love sex, but I hate work!
“Yeah, we hate seeing you work too!”
how does this post keep getting better
This sounded too good to be true, so I did a little bit of fact checking.
Mike Ilitch did in fact pay Rosa Parks' rent for years, but it wasn't because she was laid off. She needed a safer place to live after she was assaulted in her own home at the age of 81. He paid her rent from that point onward, for the rest of her life.
The more you know 🌈⭐
Those who knew Mike Ilitch, the Little Caesars founder and Detroit Tigers owner who died last Friday, have spent the past few days fondly re
When you fact check and it turns out even better than the original story.
reblog if you’ve read fanfictions that are more professional, better written than some actual novels. I’m trying to see something
“Am I getting Ocean’s-ed 11-ed on my own f***ing show?!”
At the gate for my flight home from visiting friends and there's a woman here with a service Shiba Inu. No pics because he has a Do Not Disturb vest and taking pics of strangers is illegal but I need to stress how ON DUTY this animal is. Ears up. Eyes doing Lazer scans of everything. Examining everyone who passes within 10ft like a security guard. Ass planted on her feet. I have never seen a dog with such intense chivalric guardian energy before. He has tiny eyebrows and they are FURROWED with concentration.
Man behind me having unhinged phone conversation. There is an internationally famous dairy in the area I was visiting and he was commissioned by the lady on the other end of the phone to collect specific cheeses from there. The lady is very high strung about the type and condition of the cheese.
The man does not know from cheese. The man "ain't never seen no cheese but orange before" and "I showed ya list to the cheese lady so if it's wrong it's her fault ok?"
I am 80% sure she sent him there for a really specific bleu cheese, 40% sure he does not have the very specific bleu cheese, and 100% sure he's done with her shit.
Our flight is delayed.
He does not have the cheeses in a cooler, just a regular backpack.
I need to emphasize that there is no cooler bag in the backpack. He has Jansport backpack that is jam-packed with cheeses. There is apparently $405 dollars worth of cheeses in that backpack, which I know because he has been trying to get the lady to venmo him the expense, which she has failed to do. It is unclear whether his relation to the lady is romantic, familial or what, but I'm leaning towards "what".
Two more people have joined us. One is a very elegant man with a perfect manicure in a tailored business suit, the other is a neon-haired person of indeterminate gender wearing a fox kirigumi. The Shiba Inu has been staring at the latter for three minutes now.
Uh oh.
Cheese man has been demanding payment because apparently he went like six hours out of his way and paid with his own money and between the cheese and price of gas, he is pretty sure he does not have enough money in his account for an Uber home.
The lady is FLABBERGASTED that he is demanding payment at all, as she was under the impression he was doing this for her out of the goodness of his heart.
He's not having it. He's insisting she told him she would pay him back- he would have gotten her maybe one cheese somewhere closer to his business in the area out of love, but he went out of his way because she agreed to pay him costs+ extra to cover it.
HE RECORDED THE CONVERSATION IN WHICH SHE PROMISED TO PAY FOR THE CHEESE, SHE'S THAT MUCH OF A FLAKE.
I am about to offer this man cash for some of these cheeses because our flight is now more delayed.
"YOU ALWAYS DO THIS! YOU ALWAYS DO THIS AND I FALL FOR IT EVERY TIME! NO! NO! FUCK YOU! IF YOU'RE NOT GONNA PAY ME, YOU DON'T GET FANCY CHEESE."
"OR ELSE WHAT?"
"I'm gonna-? THE BABY SHOWER? MONICA CAN'T EVEN HAVE THIS CHEESE SHE'S PREGNANT!"
"The cheese lady asked if it was for someone because the mushrooms or whatever in the cheese are dangerous for the baby or something?? You wanna poison Monica?"
"WHY WOULD I LIE ABOUT THAT?"
"YEAH OF COURSE I GOT THE CHEESE, THATS WHY I DON'T GOT MONEY FOR UBER!"
"YEAH, GO TELL! GO TELL MOMMA I STOPPED YOUR STUPID ASS FROM KILLING MONICA OR THE BABY! FUCK!"
*hangs up phone*
*head in hands, borderline hyperventilating*
The man in the three piece suit is in the chair next to him. He waits a moment, then reaches into his carryon and pulls out an entire bottle of wine with the TSA pre check sticker on it, and taps cheese guy on the shoulder.
"If your friend doesn't want it, would you be amenable to having it right now?"
Naturally, I have volunteered my box of wheat thins and offered to buy one of the harder cheeses which should be fine if it makes it home.
Meanwhile, Kirigumi has noticed that the Shiba Inu is staring at her and is correctly intimidated.
Pigeon attempts to court falcon
For all those in the notes - peregrine falcons hunt by dive-bombing their prey; this falcon however is currently stationary and cannot dive-bomb much of anything. In this moment, the pigeon is safe. The falcon however may not recover from the embarrassment.
I can't tell if that's a giant pigeon or a tiny falcon
Tiny falcon
If there’s one thing I feel I can unambiguously brag about, it’s that I’m great with patients who are in pain crises. I’m tenacious and stubborn about lowering 10/10 pain to something more manageable. I got a patient in “25 out of 10” pain at start of shift down to a 4 by midnight and it only took opioids, Tylenol, muscle relaxants, ice packs, warm blankets, fresh coffee, repositioning, an abdominal binder I scrounged up, a phone call to the surgeon to get lidocaine patches ordered, and some serious chit chatting with the patient while we waited for all that to kick in. We didn’t end up needing IV medication, we didn’t have to increase opioids, we didn’t need to add any medication that would potentially delay discharge, and the majority of what I did is all stuff she can also do at home so it’s a sustainable pain management plan. This is my absolute favorite thing with nursing, I love love love managing pain, I know I talk about it a lot but it’s the most satisfying thing in the world. I love watching someone emerge from a horrendous haze of pain until they feel like a person again. Also I’m scheduling this to post well after my shift is done so that I don’t jinx anything, also while I was writing this post I had to take a quick break for two hours half way through because someone started having a seizure. My job is wild. I used to be a barista.
@irrellavant oops you activated my trap card of asking about something I care about, please enjoy this monologue. Also it’s not comprehensive, can’t stress that enough, this is a just a lil long tumblr post made by a just some nurse who isn’t a palliative care expert and is also writing this on her cell phone on break. Some of this stuff is gonna be pretty obvious! I just would feel remiss if I left it out. And also please anyone who has pain or addresses pain, please feel free to add on. I'm always looking for new ideas and new insights, especially from the patient side so please please do chime in if you like. Okay SO
For me, the biggest thing is conveying to the patient that you care that they are in pain and that you are trying to make it better. I remember I had a patient who was in horrible pain all night, we never got it down, we never got her comfortable, but at the end of the night she thanked me so sweetly for trying and she said that knowing I was taking her pain seriously helped her feel better even if it didn't make her hurt less. Just because someone is in pain, it doesn't mean they have to suffer, if that makes sense. I think one of the worst things about pain in the hospital is the feeling that you've been abandoned to experience it. Someone gives you a pill (or not even that) and says "okay bye" then you go back to writhing in agony. I make sure that before I leave the room of a patient who is still in a pain crisis, that I let them know what the plan is and what the next step is. "You just got 5 mg of oxycodone, which will take up to an hour to take full peak effect. If your pain doesn't get better after that hour, I can give you another dose" or "I'm going to go page your doctor to see if I can get you an additional dose" or "I need to step away right now, but I'll be back in 20 minutes to see how you're doing and if the heating pad is helping." I tell the patient "we're gonna try X, which should do Y, but if it doesn't, the next step is Z” and then I make sure to follow up with them.
I also try to be honest. I never promise that they'll be pain-free, just that we'll keep trying. We aim for small but achievable goals. If it's acute pain, like you just had a surgery or something, I try to contextualize it for the patient. "We're not gonna get you pain-free ten hours post surgery, but we can get you more comfortable than you are right now." Patients are usually fine with being a six outta ten pain if they’ve been otherwise sitting at a nine. Since I’m night shift, I often tell them my goal is for them to get at least a couple hours of sleep and ask them how that sounds.
Then pharmacologically, I look at the meds I do and don't got. If a patient is having incisional pain, lidocaine patches on either side can be great for just numbing the area up. If the patient can get oxy every 6 hours but routinely gets very painful again just three hours after taking the med, then maybe the dose or the timing is not right. Maybe under prns we've got so many opioids and not a single NSAID, and there's not a contraindication. Maybe their pain is caused by muscle spasms, in which case a muscle relaxer could be a great addition. Maybe the pain is nerve pain that would respond much better to gabapentin instead. Or maybe you need IV dilaudid to quickly get the breakthrough pain down to a manageable level so that the other meds have a fighting chance to do anything. If meds aren’t available, these are things you can page the doc about and discuss with them.
I'm also a big fan of around the clock medications for patients that have had poor pain control. Ask patients if they want to be woken up for pain meds (again, patients that have been that painful usually say yes). Explain how it's easier to keep the pain low than it is to play catch up after pain spikes. Pain control works best when you avoid the spikes in the first place. There's no point getting someone out of a pain crisis if you then withdraw all your cares until they're in a pain crisis again.
I also try plenty of non-pharmacological methods of lowering pain or enhancing comfort. (Sometimes you can't lower pain! Sometimes all you can do is enhance comfort!) Does the patient have a topical cream that helps with pain? Could it be applied while gently stretching the muscles and really going to town with a foot massage? Has the patient just thrown up and would like a bed bath to feel clean again? Would they benefit from heat? Or ice? Or warm blanket? Ice and then on top of that a warm blanket? Do they want some pudding? Do they need a little candy from the nurse station candy drawer? If their lower back hurts from being in bed so long, can we get them out of bed? Even if it's three am and we need to lift them with a Hoyer to their recliner, that might still be the best intervention. I had a patient where the only thing that helped her hip pain was going on walks so over the night we went on a bunch of walks. Worked better than any meds.
What about conversation? Do they need someone to cry with? Do they want to talk about pets or their diagnosis or the bizarre TLC show that's playing on the TV? A lot of this is feeling out conversation, and I don't have great advice for that besides if you make yourself obviously available and interested in people, they tend to open up to you.
Also I’m a big fan of asking if there’s anything I can do while we wait for the meds to kick in. That’s usually when I do a bunch of those non-pharm interventions, because it’s efficient (we are in fact waiting for the meds to kick in) and it makes the waiting less miserable. I think it also makes the waiting feel less helpless. We aren’t just waiting an hour for the dilaudid to do something, we’re also tucking you in with a warm blanket and giving you the finest jello I could scrounge up.
And obviously, I ask the patient if the pain they're currently feeling is uncommon for them, either in the type of pain or the intensity. This is good for general assessment stuff and to figure out if the pain itself is the problem to be managed or if there's something new causing the pain. If the cause of the pain can be managed, that's my priority with pain medication as a supportive therapy because like if you're a paraplegic and suddenly you're complaining of an intense pounding miserable headache, giving tylenol isn't the right intervention when what I should be doing is assessing for autonomic dysreflexia.
And I ask them about the type of pain they're having and if they know what works for them to manage it. Plenty of chronic pain patients can tell you what is and isn't effective. Maybe at home they're on 50 mg of oxycodone a day, but right now in the hospital they're only prescribed 40 mg. Or hell, they're still getting 50 mg but they're here because they’re sick so their baseline level of opioids isn't gonna be enough because that's to manage their every day pain and not their new super hell hospital pain. Or they know aspercreme works like a dream on their legs but not on their back. Or patients know that ibuprofen works better for them for this type of pain than a fentanyl patch does, or they don't want to take dilaudid because it makes them nauseated, in which case you can try premedicating them with an antiemetic.
Also when your shift is done, write down all the stuff that worked to control pain in your nursing note so there’s a record of it in case someone needs to do it again.
If there’s one thing that I have found successful though, and I know this might sound cheesy, but it is CARING and showing the patient that you care. You care that they are in pain, you are working with them to get them more comfortable, if something doesn’t work you will keep trying, because pain sucks and you care that they are in pain. Even when you have to leave their room, you let them know that you will come back. They aren’t left totally alone to suffer. Again, sometimes you can’t decrease pain but you can increase comfort. I believe there is genuine comfort in knowing that someone is trying very hard on your behalf to make you feel better, even if they don’t make you feel better.
I’ve had chronic pain for 16 years, and this is most reaffirming perspective on pain I’ve ever heard from a healthcare worker. Thank you for caring and doing everything you do; it seems like such little things but to those with chronic pain, it means the world.
OP I love you
