This week I've been doing nursing care for an elderly Russian man who speaks very limited English and had come into the ED after having increasing headaches over the last 12 months, and then had some kind of seizure while driving. The did a CT Brain scan and found something looking like this:
Then they did a craniotomy to take a biopsy and it turned out to be Gliobastoma Multiforme, one of the worst kind of brain tumors which has a very grim prognosis - 6 months to a year. After the surgery. A few days after the surgery he went into a coma for about 24 hours. As part of the neurological observations we had to do sternal rubs and press hard on the nail beds to inflict pain (to assess whether the brain is responding to painful stimulus). It leaves a pretty nasty bruise when it is done over and over.
I accompanied him to get an EEG done which measures the electrical activity of the brain. His brain function was normal and they did some other test where they lift up an arm and it flops back down to the bed quickly when let go. However when the arm was lifted and let go close to the face, the arm stopped falling a couple of centimetres from the face, which showed that there was some kind of consciousness there because otherwise they would have hit themselves in the face. The findings were consistent with a psychogenic pseudo coma which is a state mimicking acute unconsciousness with intact self-awareness, due to severe depression, inability to cope, near death experience and a number of other factors. They become 'locked-in' to this state.
As soon as the patient's family left, I decided to check on him and he started waking up! Since then he has been awake and fully conscious and has also said he can remember everything his family were saying to him while he "was asleep" and complained that people kept "pinching and punching" him. So bizaare.
Another patient I had this week had epididmo-orchitis which is inflammation of the testicles, causes by trauma or STD infection. He said he was hit in the balls by a soccer ball. It make the testicle that is inflamed change shape and become really large so they are in a lot of pain and have difficulty walking. He was given IV antibiotics and pain relief.
If you want to see what it actually looks like you can do a google image search. Decided not to put a picture of someone's inflammed testicles on my blog, lol.
Yesterday two males in their 20s were admitted after a single vehicle car crash. Lots of lacerations to the face and body from smashing the windscreen, but no seat belt bruises on either of them. They both said the other one had been driving and they both had illicit drugs in their system. They had neck braces on and were supposed to be lying straight and avoid moving their spine until it could be confirmed that they didn't have any spinal fractures, but they were both completely non compliant and insisted on getting out of bed and taking their neck brace off because it's too tight. Idiots!
Had my first formal feedback from my clinical educator and she thinks I'm doing really well. She said my strengths are: performing nursing care in accordance with recognised standards of practice, seeking additional knowledge when presented with unfamiliar situations, demonstrating increased responsibility and accountability, approaching patient assessments in and organised and structured way, and ensuring my nursing practice is sensitive and supportive to cultural, social and psychological issues. The things I need to develop are my drug knowledge and interpreting supplementary data such as blood test results to help me plan care and interventions for my patients.
Last night I slept for 12 hours to catch up on sleep debt. Today I'm working on an assignment that's worth 40% and due Monday.
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