I can almost say I'm scared out of my mind

Whenever I get overwhelmed I get scared. First I pray to ask God for strength. Then I list everything that I need to get done and when. So now I've compiled a list of things I need to get done (and to also help people see what to expect when graduation is one week away):

Today
Order Phi Theta Kappa Honors stuff
Buy cap & gown
Fill out application for Georgia Board
Sign up for background check
Study

Friday
Final Exam
Have GA Application Notarized
Turn in GA Board Application

Ok, that helps put things in perspective. Not so bad I guess.

I went by a food bank today and they also hold a free clinic on Thursday evenings. The people that run that program weren't there but I was given a number to call tomorrow. I would LOVE to volunteer my services to this church. From what I understand they have a bunch of drs that volunteer their time and services. Also a bunch of people from this church. But what a great way to do something good, meet new people, and keep my skills strong? I don't think I'll start this Thursday night because I have finals the next morning, but I'd be excited as heck to volunteer from next week on! And it's only 1 block from my house! Oh wait. Next Thursday is Pinning. Ok, the week AFTER LOL

I also emailed the Red Cross about volunteering. Having O- blood I know how badly they need it. So I'm always giving blood when I can. But I'd love to be on the other side of the needle for once :-)

Until I start working somewhere I will love volunteering. I can't stand laying around the house. I love to keep busy. This will also teach the boys good things. They learn from what they see.

Ok, well I have to get working on my list. I know it's not everything that has to be done, but it's a start.

It's 2 am... 3 days before the final

I'm working so hard to keep motivated studying for this final exam on Friday. I did a great job reading the entire chapters on acid/base imbalances and shock. Then I got into watching Fringe (which was a very good episode BTW) & I can't seem to get back to it.

Of course, I feel very overwhelmed right now with everything I have to do and pay for. And money is so rare these days. With two growing boys in the house (13 & 4) food is rare too if it's not stocked on a daily (or hourly) basis! LOL

Marty is going to print up a 20 page study guide that I have and I'll use that to study with tomorrow. My main focus tomorrow will be meds and Neuro. Thursday I will finish with Endocrine, Multi-System, and whatever else I need to brush up on. I will go to bed around 9:00 hopefully so with last minute insomnia I will be asleep by midnight. Plus I'll head out to campus around 7:00 so I can sit and review my 20 page study guide one last time LOL

Yes, I actually have to sit down and plan these things out. Whether I follow it or not I still feel like I have a handle on a chaotic situation.

Without an exam review afterwards I won't know what my grade is until they post it online. So I will be an emotional wreck up until then. I have to score at least a 65% to pass Advanced Nursing. I KNOW I can do this, but I still get that little devil on my shoulder saying "But you might not!" ARGH! Think positively. God has brought you this far. BELIEVE!

I know I'm just tired right now and I need to go to sleep but I was hoping to see Marty when he gets home. I love laying on the couch next to him in the middle of the night watching what we recorded on Tivo that night. I've just got a headache. I need to rest up for another day of studying tomorrow.

So say I pass my final Friday, I have pinning practice next Wednesday, pinning Thursday night, and then graduation Friday morning. This is the end. I can't believe it. Sorta bummed in a way that this journey is about to come to an end and a new journey begins. But then again I'm happy :-)

Off to sleep I go...

Porkchop Recipes (Thanks Robin!)

A special thanks to Robin for these!!!! :-)

Pork Chop and Scalloped Potato Casserole
4 pork chops
1 large onion (sauteed in vegtable or olive oil)
1 cup milk
1 cup chicken broth (can be made from boullioun cube)
3 table butter
3 table flour
1 tea salt
1/4 tea pepper
4 medium potatoes pared and sliced thin
1 table fresh parsley (optional)

Brown chops on each side. Remove to plate. Sautee onios in same skillet. Move to side. Melt butter in medium size saucepan. Stir in flour, salt, & pepper until smooth. Slowly add milk and broth stirring constantly until sauce thickens and begins to bubble. Remove from heat.
Arrange potatoes in 11x7x2 dish. Top with onion rings then pour sauce over the top evenly. Place chops on the top of dish. Cover tightly with aluminum and bake at 350 for 1 hour. Uncover and bake 10 minutes loner or until chops or tender. Garnish with parsley


Jerk Chops (hot)

4 pork chops
1/2 onion pureed
1 plum pureed (optional)
2 teas dried thyme crumbled
2 teas sugar
2 teas salt
1 teas black pepper
1 teas cayenne
1 teas ground all spice
1/4 teas nutmeg
1/4 teas cinnamon

Puree onion and plum until they form a paste. Add all other ingredients and mix well. Dry chops and rub with the paste. Cook on grill until done.

Chops and Apples

4 pork chops (3/4 inch thick)
1 teas veggie oil
2 teas brown sugar
1/8 teas cinnamon
1/8 teas nutmeg
2 table butter
2 tart apples cored and sliced
3 table pecans (optional)

brush chops with oil and cook in skillet 5-6 min. Set aside. Combine all other ingredients in a baking dish and add chops. Cover and cook at 350 until apples are tender.

Gravy Baked Chops

4 pork chops (1 1/4 inch thick)
salt and pepper to taste
1 table butter
3/4 cup milk
1/4 cup of water
1 (10.75 oz) can cream of mushroom soup

Preheat oven to 350. Season chops with salt and pepper. Melt butter in skillet. Saute chops in butter for about 5 mins - less if chops are not as thick as recipe calls for. In bowl, combin milk, water, and soup. Place the chops in 9x13 dish and pour the soup mix over them. Cook for 45 mins at 350

Sunny's Creamy Chicken Pork Chops

1 teas olive oil
1 onion chopped
2 cloves garlic chopped
4 pork chops
1 (10.75) can cream of chicken soup
1/2 (14.5oz) can chicken broth
salt and pepper to taste

heat oil in skillet over medium heat. Add onions & garlic and sautee until translucent. Add pork and brown each side - stirring often to avoid burning onions & garlic. In bown mix soup and broth. Pour mix over chops in skillet stirring well to loosen onions and garlic and deglaze the skillet. Reduce heat and gently simmer for 10-15 mins, turning occassionally, until chops are done. Season with salt and pepper & serve


Teriyaki Pineapple Pork Chops

1/4 c firmly packed brown sugar
1/4 c soy sauce
1/4 tsp garlic powder
8 oz can pineapple slices in its own juice, reserve juice
4 center cut pork chops about an inch thick

In 12x8 glass baking dish, combine sugar, soy, garlic powder, and reserved pinapple juice. Place pork in marinade and coat all sides. Cover and refrigerate 6-8 hours turning pork once

Drain pork and reserve marinade. Place pork on grill and cook until done and brushing frequently with marinade. Place the pinapple on the grill during the last few minutes of grilling the pork chops - grill pinapple until heated though. Serve with pinapple slices on top of chops.

Chris and I did this. Once the pork chops marinated we cut if of the bone into long strips and put them on bamboo skewers. In addition we also bought some teriyaki barbacue sauce and glazed the meat while cooking. We served it with homemade fried rice.

Fried rice - I do mine on a pancake griddle and sometimes in a huge skillet. The griddle makes me feel like a Japaneese steak house. I do instant or regular rice. I make it in the morning and then refrigerate it until I am ready.I sautee a whole onion and put it aside. Place a huge slab of butter on the griddle, dump the rice on top and let it sit until the butter starts melting, then I mix it through the rice adding soy sauce too (add as much or little as your taste likes - just add it slowly until you think its good). Then, in the same small skillet I used for the onion I scramble an egg or two. I add the egg and onion to the rice and stir some more. Sometimes I add corn or peas to the rice from a small can. I used to do the egg on the skillet in the middle of the rice but I like to do it seperately cause I think it turns out better. We also sprinkle it with sesame. There isn't really a recipe cause all the ingredients are really to your taste.

Savory Beef Stew

Because I LOVE to cook and try new recipes I'm going to be posting a few. I hope some of you try it out and then tell me what you thought of it. Some of the recipes come by request. So it'll be easy to refer people to FB LOL

INGREDIENTS

* 3 pounds beef stew meat, cut into 1 inch cubes
* 1/3 cup Italian salad dressing
* 2 cups water
* 2 teaspoons beef bouillon granules (I HIGHLY recommend Superior Touch's "Better than Bouillon")
* 1 (14.5 ounce) can diced tomatoes, undrained
* 1 (10.5 ounce) can condensed beef broth, undiluted
* 1 (8 ounce) can tomato sauce
* 1 garlic clove, minced
* 1 bay leaf
* 1 teaspoon salt (I use more than this to taste)
* 1 teaspoon dried oregano
* 1/2 teaspoon pepper (I use more than this to taste)
* 6 small potatoes, quartered
* 6 medium carrots, cut into 1 inch pieces
* 1 medium green bell pepper, cut into 1/2 inch pieces
* 1 medium onion, chopped
* 3 tablespoons all-purpose flour
* 3 tablespoons cold water

DIRECTIONS

1. In a Dutch oven, brown meat in salad dressing over medium heat.
2. Add the next 10 ingredients; bring to a boil.
3. Reduce heat; cover and simmer for 1-1/2 hours or until meat is tender.
4. Add the potatoes, carrots, green pepper and onion.
5. Cover and simmer for 45 minutes or until vegetables are tender.
6. Combine flour and cold water until smooth; stir into stew.
7. Bring to a boil; cook and stir for 2 minutes or until thickened.
8. Discard bay leaf before serving.

Here's the website for Superior Touch's "Better than Bouillon" Beef Base
I buy it at Ingles and I'm sure it's most everywhere else in the "broth" aisle.
http://www.superiortouch.com/btb.htm

My First and Second Born

1. WAS YOUR PREGNANCY PLANNED?
#1 - Not really
#2 - Heck no. I was on the pill and taking it religiously!

2. WERE YOU MARRIED AT THE TIME?
#1 - No
#2 - Nope LOL

3. WHAT WERE YOUR REACTIONS?
#1 - "Uhhhhh... shit!"
#2 - "That's not freaken possible!" (In fact the dr had to do an extra ultrasound and show me the baby's heartbeat just so I'd believe it)

4. HOW OLD WERE YOU?
#1 - 17
#2 - 26

5. HOW DID YOU FIND OUT YOU WERE PREGNANT?
#1 - EPT
#2 - Blood test & Ultrasound

6. WHO DID YOU TELL FIRST?
#1 - My bf
#2 - My bf

7. DID YOU WANT TO FIND OUT THE SEX?
#1 - Oh heck yeah
#2 - Couldn't wait

8. DUE DATE?
#1 - It was changed from October 20th to November 18th
#2 - October 12th I think

9. DID YOU HAVE MORNING SICKNESS?
#1 - VERY BAD! I lost so much weight
#2 - YES! I was miserable for 8 months

10. Cravings?
#1 - Taco Bell, Apple Juice, and Pickles (& juice)
#2 - Milk

11. WHO/WHAT IRRITATED YOU THE MOST?
#1 - Hmm, I think I was pretty mellow during my pregnancy. I wasn't overly emotional. Oh wait. One day I was on the phone with my bf and my nosy aunt kept getting on one of the other lines (she was at our house doing laundry) and was running her mouth. I hung up with my bf, went out in the dining room where she had her back turned to me and I called her name. She turned around with a nasty attitude and said "WHHAAAT?" LMAO I punched her in the face. Left her with black eyes for a week (right Paula?) Wow, I couldn't believe I did that. My fam still wishes they could punch her in the face LMAO
#2 - My crazy ass boss, his wife, and the secretary.

12. WHAT WAS YOUR FIRST CHILD'S SEX?
#1 - FULLLLLLL boy
#2 - No doubt a boy

13. DID YOU WISH YOU HAD THE OPPOSITE SEX OF WHAT YOU WERE GETTING?
#1 - Yeah, I wanted a daughter because a few years earlier my daughter was stillborn at 6 months.
#2 - Yes, same reason as #1

14. HOW MANY POUNDS DID YOU GAIN THROUGHOUT THE PREGNANCY?
#1 - Maybe 15?
#2 - Until the last month only like 10 pounds.

15. DID YOU HAVE A BABY SHOWER?
#1 - HECK NO! I'm still pissed that my mom didn't throw me a baby shower. Damnit.
#2 - NOPE! Next time around I'm throwing my own damn baby shower LOL

16. WAS IT A SURPRISE OR DID YOU KNOW?
#1 - It was a surprise that my mom didn't want to throw me a shower.
#2 - Again, it was a surprise that I didn't have one LOL But then again, I didn't know many people in Georgia and I don't think the father's family traditionally throws one. I don't know.

17. DID YOU HAVE ANY COMPLICATIONS DURING YOUR PREGNANCY?
#1 - Actually it wasn't so bad. Just really painful. I have NO torso room for a baby. He was INSIDE my rib cage and the only way I could breathe was to arch my back. Of course, that killed my back.
#2 - Yeah I was text book "Pregnancy & Every Complication That Could Possibly Happen 2nd Edition". Sugar in my urine, ketones in my urine, protein in my urine, bladder infections, high blood pressure, pre-eclampsia, preexisting diabetes, gallbladder attacks, severe morning sickness that I had to be medicated for... and for some reason I'm willing to do it again against medical advise LOL

18. WHERE DID YOU GIVE BIRTH?
#1 - St Ritas Medical Center Lima, OH
#2 - Rockdale Medical Center Conyers, GA

19. HOW MANY HOURS WERE YOU IN LABOR?
#1 - I was sent to the hospital at 11:00 pm Sunday night and he was delivered at 6:00 am Tuesday. I still only made it to 5 cm with Pitocin and breaking my water LOL
#2 - I wasn't technically in labor. I was hospitalized with severe pre-eclampsia and had me on every freaking monitor in the world, which made me more miserable. One monitor kept saying I was having steady contractions so they gave me Terbutaline to stop the contractions (I was only 35 weeks along and had a cesarean before. They didn't want my uterus rupturing) Terbutaline is like HELL IN A SYRINGE!

20. WHO DROVE YOU TO THE HOSPITAL?
#1 - My mom
#2 - Marty

21. WHO WATCHED YOU GIVE BIRTH?
#1 - My bf was in the room
#2 - Marty

22. WAS IT NATURAL OR C-SECTION?
#1 - C-Section
#2 - C-Section

23. DID YOU TAKE MEDICINE TO EASE THE PAIN?
#1 - I asked for an epidural
#2 - I got a spinal I believe just before the cesarean.

24. HOW MUCH DID YOUR CHILD WEIGH?
#1 - 7lbs, 14 oz
#2 - 8lbs, 5 oz

25. WHEN WAS YOUR CHILD ACTUALLY BORN ?
#1 - November 14, 1995
#2 - September 5, 2004

26. WHAT DID YOU NAME HIM/HER?
#1 - Cody Allen Adkins
#2 - Colin Joseph Polak

27. HOW OLD IS YOUR FIRST BORN TODAY?
#1 - 13
#2 - 4

My big belly at 35 weeks before delivery. I had pre-eclampsia that turned real bad and they had to delivery Colin early.

Hyperthyroidism Study Guide

Here is my Hyperthyroidism study guide based on what Ms. Carson posted. I just added more details. If anyone finds something inaccurate, please let me know.

Hyperthyroidism

AKA Graves Disease and thyrotoxicosis
Increased production of T3 & T4
More common in women
Increased incidence with family hx

Possible Causes

• Autoantibodies


• Iodine Excess


• Stress


• Meds

Clinical Manifestations

• Restlessness/Anxiety/Psychosis - may be interfering with family, personal, and work relationships.


• Exopthalmos - bulging of the eyes ("startled look")


• Goiter - swelling of the anterior neck caused by low iodine, causing the thyroid gland to produce thyroglobulin (colloid) which accumulates in the thyroid follicles.


• Heat Intolerance/Sweating/Fever


• Tachycardia, increased cardiac output, Heart Failure


• Weight loss despite increase in appetite


• Prolinged menses


• Elderly - new onset atrial fib

Lab Values

• Low TSH - TSH is produced when thyroid hormones are low. Low TSH is present when hormones are high.


• High T3 & T4

Diagnostic Tests

• RAIU - radioactive iodine uptake test - elevated


• U/S - shows nodules

Collaborative Care

• Beta Blockers

Given to ease symptoms, esp restlessness, tachycardia, & increased bp

• Antithyroid Meds


• PTU: blocks the synthesis of T3 to T4

Safer in pregnancy

• Tapazole: Blocks syntesis of hormones

More toxic
**With ANTITHYROID MEDS watch for rash, N&V, agranulocytosis, Lupus
**Teach patient to watch for S/S of infection. MD may tell them to stop taking meds and to come in at once for blood work.
**Teach patient NOT TO USE DECONGESTANTS!

• Radioactive Iodine Therapy

Iodine taken up almost exclusively by the thyroid gland.
The radioactivity destroys thyroid cells
**WATCH FOR THYROID STORM!! (See Below)

• Subtotal Thyroidectomy

Attempts to get thyroid levels to normal first
5/6 of thyroid gland removed
Iodine prescribed beforehand to reduce blood loss
Monitor pt for S/S Iodine toxicity:
Swelling of buccal mucosa
Excessive salivation
Coryza
Skin Eruptions
Iodine Meds
No longer used as PRIMARY treatment
Decreases the release of thyroid hormones
Decreases the vascularity of thyroid (hense it's use prior to surgery)
Better given in milk or juice
GIVE MED THROUGH A STRAW! May stain teeth.

Nursing Care

• Teaching (see information given above)


• Activity Intolerance:

Group activities together
Schedule frequent rest periods.

• Anxiety:

Provide reassurance to pt and fam that mood issues are related to hyperthyroidism and should resolve once hormones are under control.
Provide treatments in a calm and unhurried approach.
Do not put patient in a room with ill or talkative patients.
Provide a calm and quiet environment.
Frequently reinforce treatment plan.

• Imbalanced Nutrition:

Well-balanced and frequent, small meals
Increase fluids to counter fluid loss from sweating and diarrhea
Avoid caffeine and alcohol.
Encourage high calorie and high protein foods.
Monitor I & O

Care of the patient after a thyroidectomy

• Risk involved


• Parathyroid Removal - Laryngeal nerve damage


• Thyroid storm


• Infection


• Hemorrhage


• Preop:


• Review hx


• Teach support of neck


• Preparing the room for postop:


• O2


• Suction


• Tracheostomy tray at bedside


• IV Calcium


• Post-Op


• Assess at least q 2 hrs for hemorrhage and breathing


• Semi-Fowlers position


• Assess for hypocalcemia


• Can pt speak?


• Home care:


• Decreased kcal


• Avoid goitrogens


• Excercise


• Monitor for hypothyroidism

Thyroid Storm
Almost always fatal if not treated

S/S:

• High fever (>101.3)


• Tachycardia (>130 bpm)


• Extreme GI Symptoms (ie diarrhea, weight loss, abd pain)


• Altered Mental Status

Management:

• Lower Core Temp (Tylenol, cooling blankets, DO NOT GIVE ASA!)


• Humidified O2 (Also monitor O2 with ABGs and Pulse Ox)


• IV Dextrose (replenishes depleted glycogen stores in the liver)


• PTU given to prevent more production of T3 & T4


• Hydrocortisone (treats shock and adrenal insufficiency)


• Iodine (decreases output of T4)


• Beta Blockers + digitalis (reduces serious cardiac symptoms

Senior Practicum coming to a close :-(

Ok so working back to back hard 12's is kinda hard on the feet but I love what I'm doing. I started out in NICU, went to L&D, and now I'm catching babies right after they're born and taking care of them in the first few minutes of their life. So far (knock on wood) all of the babies are getting really decent APGARS and I only had to give one baby oxygen. Just a blow by to help him out. But I LOVE it!!!! I think I'm going to add NICU to my list of nursing jobs I want to apply for.

I felt so good at the end of my second 12 hour in a row the other day when my faculty liason came by. I was walking down the hallway when I heard her ask the nurses at the nurses station how I was doing. They all said I was doing really good and one lady even thought I was unit ready! Awww that made me feel good. I'm supposed to shadow my preceptor but even that isn't enough sometimes. I butterfly to all of the nurses! I attend all of the deliveries and help out with the laboring mother and then switch over to the baby in the warmer getting APGAR scores and all that. The doctors and midwives have even been real supportive of me! One of the midwives I know really well on a personal level and I ran into her last week. I hadn't seen her in AGES!
I think this hospital has a hiring freeze going on, but I would love to work in this particular department. I hear it's real rough working there on other units because they don't have techs. Just RNs. (Don't they know how invaluable techs are to an RN?!)

But I did great on my evaluation. Better than I thought I would have! There haven't been any issues so far but you know there's always something. Nope, not this time! At least not according to my preceptor. I thanked one of the nurses the other day for allowing me to help her out and told her she was a great teacher. I learned so much from her. But she turned it around on me and said that I seek out the knowledge and I want to learn. I go way above and beyond what they would ever expect out of me. Holy heck working at this place makes me feel so much better about myself and my skills (as I'm learning them).

Being the ultra-sensitive type I know I will get teary eyed walking out my last day (Monday). I will never forget what I learned here. I've had great clinical experiences before, but never as great as this one. The whole staff has been wonderful and we've all gotten along great. I need to find something for them this weekend. I know how they love sugary stuff so I might just load them up with chocolates. Maybe something else that I can think of. Too bad I can't afford to get them a foot massage gift certificate at one of my fave spas here in town. If I win the lottery I will! LOL

Anyways, I know that was pure rambling and I don't mean to "toot my own horn" but for once I really feel good about myself as being a nurse. One thing I really lack is self-confidence. It's funny, if someone talks bad about me it really doesn't bother me. But I will tear myself down on things. Hmmm, shouldn't it be the other way around? HAHA! But nursing has given me some incredible self-confidence.

Like I always say: "I'm loving it!"