Archive | May, 2008

Pulseless Electrical Activity

27 May


The potassium level.

Any possible aspiration.

The test results.

The second time,

My hands shook less.


A bronze color blue.



Chest compressions



Maintaing Chest



Rhythm Checks.

200 to 360 joules.


A gray, ashen, dry blue.

ashy, cadaverous, lurid, wan, waxen, blue.

It was the second Code Blue situation that I have been in.

This time it was not my patient.

The first code blue: the code team arrived and worked in what seemed

a weird chaotic unison. I stood in the corner and answered questions about the clinical situation. This time I recorded. Everything went according to the recommendations some as I learned, but the patient still came to demise. I went home that night feeling sorry for the primary nurse and wondering how it is that I do my job and maintain my life. I watched a soul leave someones body. I witnessed that bronze blue to dry dead blue and just left the room and went back to check on my own patients in a continuous assessment that lasts for twelve hours. I am supposed to go home and be normal.

Private Duty Nurse

21 May

Private Duty Nurse.

I have been a private duty nurse for a loved one.

It is emotionally challenging.

An arduous affair.

A great effort.

With love.

How am I going to go to work in the morning?

It is nursing at the most primal level.

Of first importance.


Pain control.


20 May

I am not sure why it bothers some nurses to care for patients whose wishes are no resuscitation: no chest compressions, no intubation, no medications.

I think that part of being a nurse is helping those who are dying to be comfortable and at peace with their life and their end. I have no problem with death, it is a part of life.

Giving report though to the  next nurse about the code status of DNR always seems to put them on edge or it touches a raw nerve or something. This just reminds me that it takes special nurses to care for the dying patient. The opposite of where I work on telemetry where the goal is adrenaline and maybe 1 out of 48 on the floor in a DNR status.

No poetry tonight.

19 May

I am just so tired. I am so tired that I think if I lay in bed I will not be able to sleep.

I need a good sleep.

No poetry tonight.


14 May

I am so happy that I have reached my goal of over two hundred dollars towards the National Kidney Foundations Annual kidney walk!   🙂   I will walking two miles!

I appreciate all of those who have contributed to this cause.

Please see the link above for more information about Kidney disease and those at risk. As nurses it is really something to think about; especially concerning medications and diagnostics: to think about the body as a whole. Do not forget those kidneys! There are a few ways to protect the renal system before that procedure!  Just thinking about it……


Notes on Morality

13 May

This is Lawrence Kohlberg and I am studying his stages of morality amongst other things. Read on for a moral dilemma….

In class we heard a story about a man named Heinz, a capitalist druggist and a sick dying wife.

The druggist had the new drug that could save the wife but wanted $4000 for it.

The husband Heinz only had $2000.

Should he or should he not steal the drug?

Or better question is what sort of reasoning would lead him to steal or not steal the drug.

To answer that question one can apply Kohlberg’s 3 levels of moral reasoning and of course there are 2 stages inside each leve.

Level I–Preconventional Morality

This describes either punishment and obedience in stage one, a child learns how bad something is by how severe the punishment; therefore a preconventional thinker would worry over the punishment and then form the answer to the question. This is a form of external formulation.

In stage 2–hedonism, gaining rewards to satisfy the self and that is the reasoning behind following the rules.

Level II–Conventional Morality

Internalized moral values set by other people such as peers, parents, authorities. The child does things to maintain social order and to win approval for such behaviours.

Stage 3–Good girl/boy morality. Other peoples feelings matter and the right thing is what pleases others.

Stage 4–Maintaining social order and Authority. “Do your duty and respect the law” That is what is important to maintian social order, that is what is right.

Level III–Postconventional Morality

The individual can have a perspective of others as well as their own societys views. What is right and what is legal may be different.

Stage 5–Morality of Contract, Individual Rights and Democratically accepted law. There is an understanding of why laws are laws, the social contract the reasoning behind the order. Social welfare is maximized.

Stage 6–Morality of Individual Principle of Concience. This is the highest level or stage of moral reasoning.

The thinker is a formal operator able to think theoretically about the “what ifs”, it is complex and costly as internal reasoning may differ from the law. There is universal orientation. Less than 20% of people have achieved this level of reasoning!

And NOW my answer that follows the big lecture above.

Yes. I would steal from the druggist.
It seems like a simple enough decision to me, but the reasoning is not as simple and that is the why part of development not the description.
Thinking theoretically, asking the “what ifs” the complex and often costly price to pay of a formal operator…What if I stole the drug? The worst that would happen (thinking like a behaviorist) would be that I would go to jail, pay a fine to save my wife!
And then universal orientation…and here is a good scenario…I will steal the drug, save my wife, take some to another chemist to make another batch to sell at a reasonable price to others. This is after all attempts to purchase the drug through legal terms and contracts. I do believe that life saving treatments especially medications should be available to all, to everyone. (Think about how many people with HIV/AIDs are out there not getting the proper medications to halter their disease or ease their pain, due to lack of funds, education or insurance.)
Yes stealing is wrong we all know that. You can not however put a price on life which is exactly what the id in that druggist did. (he never knew because he never got that far along in moral development.)
I have decided from within to steal the drug. I made my own moral choice based on universal thoughts and beliefs–for the good of all mankind and turning the tables.
What if it really were my loved one? Whose blood is worth more? Are we not all the same chemical compounds? Postconventional thinking.

AV Block

12 May

I am not having a dysrhythmia

I have a condition that is caused

By a delay

From the SA

To the AV node

In the end

the electricity goes through


When I see you.

There is no blockage.

I have incomplete heart block.