Reviews Today

❤❤❤This case had a T12 burst fracture s/p jumping off bridge ...OUCH!!! had an incomplete spinal cord injury..but luckily now walking without assistance. Just wearing AFO for now. I tell you when it is not yet ur time it is NOT. She is one lucky S-----

❤❤❤

utilization review

So now I have a new job been on this for about 9 months. It is different from what iv'e been doing in the last 15 years as a RN. this job is home based which I love. Basically reviews clinical information from MDos, Imaging facilities in order to approve radiology procedures: CT scans, MRI, MPIs. Eventually I will add pain management to my specialty, but not right now Id like to concentrate on Radiology first.

It is interesting how this job works. It's like making sure the procedures are ordered appropriately and that it is really needed by the patient as the clinicals presented. And it can be tricky because if they give inaccurate  clinical information the request can be either sent to Medical review or gets denied. So the person giving the clinical information plays a critical role since as a reviewer I cannot suggest anything.

It is also entertaining to listen to the callers as they give information. I can tell which doctors really did a thorough examination and those that simply wants to scan and diagnose that way. There are also callers who are very detailed and have the information ready and there are those that will say " i dont have the chart with me so I dont know"...well guess what..these callers that doesnt care to even try to gather information I have no qualms about sending them to review. On the hand, i have no hesitation placing astudy to urgent status and approving it because it is really needed.

From here on I will posting my thoughts regarding this area of nursing.

Admitted a 93 y/o male with hip fracture, been sitting on the BSC for the last hour trying so hard to have a BM, when asked when was the last time he had a  BM, he replied I always have bm 3x a day, and I havent had one since yesterday morning. After that I don't know if I want to live this old..
Enters the wife with early stage of alzheimers...she looks really upset, "we've been waiting for 2 HOURS!!" yelling at the poor guy... :(

G1-P0-A1

Come to find out  that young mother that had a stroke, lost her baby over the weekend. She continued to have spotting throughout the night and eventually had a spontaneous abortion. Yesterday when i visited her she is still the same, clear in mind but unable to verbalize anything, still emotions labile. I saw her husband in the hallway lst night and briefly said hi and asked how everything is doing, he said she might be having another stroke coz of some functional decline and changes, she was on her way to MRI. Aww, I say a prayer for her.
 Our census is up to 33 , wow I havent seen that for a long time. I  am officially able to stay and get my hours again. I keep my fingers crossed, I have 3 d/c today. Finally published the mini book  Patient's Guide to our unit, helps me big time on multiple admissions. Time to revise my video orientation too.
Im working on staffings again for a late day next week, hoping to catch up with some procedures.

Opposites

Admitted a 34 y/o female with Dx of CVA. Aside for being a young CVA patient, what really makes this case sad is that she is 5 weeks pregnant. She and her husband had been trying for years to conceive to no avail. Just 5 days ago, they adopted a 6 year old boy, because they had given up hope of having their own child. 4 days ago she found out she is pregnant, the next day she had a massive stroke. It is a major stroke that left her right side of the body flaccid, she is aphasic and unable to take anything per mouth, thus the NGT. It is a very sad case, that kind that leaves an imprint in your heart and soul. all you can do is give them hope, draw inspiration by telling them our past success stories.
Incidentally, just 3 days ago we received a visit from one of our former patients. She is a very young mother of a 3 y/o very cute boy, I think she is 28 or 29 y/o. She also had a massive stroke. She had an undiagnosed hole in her heartwall that threw a clot, thus the stroke. She came up in our unit, with one side of the body totally flaccid and aphasic too. When she visited 3 days ago, she is walking onher own w/o any assistive device, and talking straight. Smiles and hugs were exchanged.
I hope this current patient will have a good recovery. As I was leaving for the night, she started having some spotting and moderate hematuria...she is only 5 weeks pregnant, her BP upon admission was high, 207/114mmhg. She received xray radiation bcoz her NGT had to be checked for placement, considering her current condition and their struggles to conceive, I dont know how I feel about her pregnancy. I have an ambivalent feelings about this.
Ironically, today I had another admission, young female, 26 y/o. Respiratory failure & GI bleed d/t possible OD. She had elective abortion 4 months ago...that really stopped me on my tracks and think about these 2 young females predicament...one who will do anything to get better because she is finally having her own baby, and one who chose to let go of the baby,, for whatever reason..

I reached for my desk calendar. March page was torn off. I was whining why would anyone tear the page when we're still in the middle of march. I was told the MD needed the calendar. I said "really he has to rip march page just so he can look at it? what's wrong with just looking at it ?" my colleague said, " no my dear he needed to look at April page so he ripped march page!!" really??

Last week he handed us an Rx pad with meds written on it, as it was given to the patient, she noticed at the lower left hand side, a "teeny tiny greenish mung bean sized B__ger!!! ewww!!! really? I dont know wether to flick it or what!!! pt needed the narcs so bad he didn't mind :) ewww!!!

Tragedy Strikes

Received a very sad news yesterday. A former colleague of mine and her family was in a fatal head-on-collision crash on their way back from spring break. Her husband and youngest son 10 y/o was killed on the spot and her and eldest son 12 y/o is in critical condition, with multiple severe internal injuries & 60% burn, both of the vehicles caught on fire right on collision. She is now at a hospital in New Mexico and her son is in Utah.
This tragedy made an impact on me and crushed my heart as I learned about this. Life is short, and we don't know when our time is up. It is very important to always make every second, every moment count, at work, at school, at home. Tell your love ones how much they mean to you and always do good in anything you do, when that time comes there will be no turning back.
When I heard about this I just want to hug my husband & kids tight and tell them how much I love them. I thank the Lord for each day that I wake up and see my family's face, sleeping quietly and safe, ... unharmed. Seeing tragedies like this opens up your eyes and heart to the many blessings, big and small, that otherwise we tend to overlook and ignore. I appreciate life more and the people around me, good or bad. I pray for my colleague and her son, for a speedy physical, mental & emotional recovery.