biopsy

this week we moved down to the medical floor. in general, the patients are sicker and they have more comorbidities. we all had a difficult time actually choosing patients on monday, because it seemed like all of the patients were going to go home. but I finally found two. the first lady came into the er a few days previously with what ended up being a uti, which turned into urosepsis. she also has a previous diagnosis of lymphoma, and has had chemotherapy and even a stem-cell transplant about seven years ago. the patient was also neutropenic, which I thought might be from her chemotherapy, but her last chemo treatment was back in november, so something else was probably going on. because she was neutropenic, I had to wear a mask everytime I went into her room. she had a really good day, in my opinion. in previous assessments it said that she was confused, but she never seemed that way to me. other then when she was sleeping she was alert and oriented, and just pleased as punch to have someone to talk to. she did have some trouble finding the right words sometimes, but I don't think that means that she was confused. maybe I'm wrong. one of the things that many patients with cancer have is called a mediport. perhaps because she came to the hospital through the er, they started an iv in her left ac, and didn't even touch the mediport. the nurse that I was working with noticed this, and decided that we would try to access it. we meaning me (with some help and guidance from her). it wasn't as hard as one might think it would be, but after had inserted the needle, and unsuccessfully tried to aspirate blood or flush saline. the nurse then tried, and just pushed the needle in a little bit further, and was able to get a blood return. we then hooked her iv up to the mediport, and dc'd her left ac iv. once when I was leaving her room, and after having asked if she needed something else, she stopped me to ask if I was going to work with cancer patients. I said that was what I wanted to do, and she said, "good. people with cancer need more good nurses like you." ahhh...how sweet. it made me feel good.

my other patient had been in the hospital since early february. she came in with intractable (meaning no treatment was helping) nausea and vomiting. she also had some other issues (hep c, type 1 diabetes, depression, alcohol use, seizures, and peptic ulcer disease). after a ct scan of her liver and finiding a mass, it was decided that she would have a liver biopsy to determine, probably, if the mass was cancerous or not. the problem was that all of the things that caused her blood to clot, were low. so it took her longer to clot then normal (measured by a pt/inr test). in an attempt to get her blood back to where it was supposed to be, she was given four units of ffp, and one unit of platelets quite a few times during her stay, but to no avail. flash forward to tuesday (which was yesterday, so it's not really a flash forward, but....). she recieved her ffp and platelets again early tuesday morning, and it lasted into the late morning. she then had her blood drawn to determine if her pt had gone down, and if she could get her biopsy. (I actually asked the patient while we were waiting for the results if she felt like she could clot better that day...it was funny...maybe you had to be there). a few hours, and a couple of calls to the doctor, and even doctor's visits later, it was determined that she would actually get her biopsy! they took her down to the cath lab to she the transjugular liver biopsy performed. yeah!

oh, and I found out that the neutropenic patient was getting a bone biopsy today to determine if she had cancer again. she was a little disappointed when she found out that I wasn't going to be at the hospital today. oh well....at least she liked having me around.

in other news, I bought a new bike on saturday. I was going to try to walk from my apartment to the school every day, but after just one day of trying, I decided that I needed another plan. (it's over three miles from apartment to school). so I bought a bike. my parents came down on saturday, and we all went shopping. it was kind of an impulse purchase, seeing as I did not try to look anywhere else, but I know it is something I will use, especially with the price of gas now. there is even a bike path along the river...so I will have a nice ride in the morning. I am going to go for a ride this afternoon, to see how far it is and how long it takes me. (while I didn't take this picture, this is my bike!!!! cute, huh?)