A pink frothy mess

13 Apr

My heart is failing and
Your fluid and my air
become together
A pink frothy mess.

I drown in your pink sea.

Acute pulmonary love edema.

Do you want to be the oxygen, or do you want to be the blood, or do you want to be oxygenated blood?
I wrote this poem before and put it here somewhere a few years ago, I just chopped it down a little bit. The lungs filled with water, and the crooked heart is my art above. I miss drawing, but I do not have the software corelDRAW anymore, so my days of being a fake artist are over. Besides my art work is not that great.
I can write fake love poems like the one above to go with fake art, but the thing is I better get studying. I test next Wednesday.
So the first time I experienced this acute pulmonary edema working on telemetry revealed some facts to me. I had learned about this in school probably, maybe not. What happened was that my patient during 0800 assessments appeared anxious, but was saturating fine according to the pulse ox and the blood pressure was high normal, although I noticed the diastolic seemed high, but not >1o0. His lungs sounded totally clear. He was a big guy sitting up with 3 pillows in the bed. He did not have massive edema or anything like that. I figured he would need some XANEX in the future.
Xanex is not what the patient needed. By the time 1200 assessments came around, the patient was labored, short of breath, with a respiratory rate around high 20s per minute. You see tissues all over the floor with ping tinged sputum, and wonder: Where the hell have I been for 4 hours?  The blood pressure was 200/110, and rales, tachycardia, and the patient was cool. The patient was desaturating to the 80s.  The patient was starving for air, you know that look in the eyes. That look from the patient, is like some kind of fear, that I do not want to ever feel. And then they want to talk and tell you about how they can’t breath, and we tell them, don’t talk, we already know, we are going to try to fix this right now.
I said, Uh-Oh this is not right. The work to breathe appeared so hard, people like that can not carry on with that workout forever. Ya know, the abdomen is swelling up and collapsing down hard with each breath. It really is a strange sight. The patient was given, oxygen, morphine, lasix, and hydralazine and guess what? It worked! And worked quicker than I thought it would. The patient was stabilized and stayed on telemetry.
Oh hell. I can not draw or write poems. Here are some pulmonary questions like the test questions. The answers are highlighted in blue.
1. The patient is 1 day post op from AAA repair. She develops atrial fibrillation with subjective dyspnea. The heart rate is 121 with normotension. What pulmonary complication might this be from?
a. Pneumonia
b. ARDS
c. Shock lung
d. Pulmonary embolism.
2.The patient is recovering from a right lower lobe lobectomy by VATS procedure. There is significant subcutaneous emphysema in her upper chest and neck area. As her nurse should recognize that which of the following is the highest priority?
a. Maintaining the airway
b. Assuring patency of the chest tube
c. Administering oxygen at 2 liters nasal cannula
d. Suction the airway as needed.
*apparently the emphysema travels upward by chemical nature and can put pressure on the airway. I have only felt those rice crispies once.
3. How does a D Dimer lab test help to diagnose pulmonary embolism?
a. positive test indicates PE
b. A negative test rules out PE
c. A positive test rule out PE
d. A negative test indicates PE
*That is right people, I made it bold blue for a reason. Elevated D Dimer does not mean PE!  Stop freaking out over the elevated D Dimer please.
4. The  patient was admitted for an acute stroke. The patient is alert but has left-sided weakness and is having difficulty swallowing. This morning the patient is short of breath and has rales in all lung fields. The most likely cause of this distress is
a. PE
b. Aspiration
c. Heart failure
d. Neurogenic pulmonary edema
* Swallow evaluation please, happens all the time. Stop feeding the acute stroke orally till the patient can swallow properly. ughhh
5.  The patient comes to the emergency department with an exacerbation of COPD. The patient is hypoxic and hypercapneic. The patient does not want to be intubated and does not want mechanical ventilation. What criteria are necessary to initiate bi-level postive-pressure ventilation (BiPAP)?
a. Must be able to slow down the breathing and not fight the machine
b. Must be able to maintain his own airway
c. Must be less than 75 years old.
d. Must quit smoking first
* And not be puking into the BiPAP mask. Also less than 48 hours.
6. Nursing interventions to decrease the rate of hospital acquired pneumonia include
a. Placing gastric tubes through the nose
b. Brushing the patients teeth
c. Administering systemic antibiotics
d. Keeping the patient NPO
*yeah oral care
I will inhale the rest of the pulmonary section tomorrow. I got lazy today.
I am going to dream about pink frothy messes sans respiratory distress.

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