Critical Care Book - Theresa Brown

What did Theresa Brown do before nursing?

-She was a professor and was teaching writing at tufts university for nursing

-Ph.D. in English

Why did Theresa switch to nursing?

she wanted to find meaningful/fulfilling work

Chap 1 - Why the professor became a nurse

-11yr old leukemia patient named Sean & his father

--> Sean suddenly began to not feel well (chest hurting) & upon walking said he couldn't see.

--> his BP was 70/30 (very low)

--> he gets sent to the PICU after Sean asks Theresa some tough questions

-It was her own sons 11th birthday

-She says having kids changed her life

Chap 2 - Getting My Feet Wet Pt 1

pt 1

-She needed to move her patient, Jim, from his bed to a chair with help of her preceptor (Penny)

--> big guy, 70s, on oxygen, not really oriented

-Upon sitting him in the chair, she heard a loud ripping noise

--> the once clean sheet had a pale brown substance on it

--> his back had split open

--> they decided to call a code

-He had a seroma (fluid-filled sac from his previous surgery where he had a mass removed)

--> his respiratory status had also worsened

-The Unit director said "just slap on a 4x4"

Chap 2 - Getting My Feet Wet Pt 2

pt 2

-She receives a patient, Mildred, who was newly diagnosed with Leukemia and is accompanied by her husband, Charles.

--> Charles asks her "What do they say about the kind of cancer she has?"

--> Theresa is unsure how to answer, but Charles clarifies and says they are afraid she knows something bad and just doesn't want to tell them

--> She tells them that she really doesn't know any more about her cancer than they do, and that she isn't withholding any information (which seemed to relieve them)

-Mildred asks what her treatment will demand from her, to which Theresa answers she is in for a rough ride

-Mildred never ended up "clearing" from her cancer

-Theresa mentions Florence Nightingale and how she called nursing "one of the fine arts"

--> ease given to a suffering human heart

Chap 3 - First Death

-Healthcare field considers it's first death a "rite of passage"

-Theresa's first death occurred during her orientation at her job

-The patient who died, Mary, had disease-ridden lungs and no more treatment options left

-->Mary had a DNR/DNI, which is why she wasn't in the ICU

--> Mary was also on a PCA (pump that gives a continuous dose of morphine)

-When Mary first came in, her condition was labeled as "trouble breathing", though it was much more serious than that

--> they needed to switch her over to their oxygen

--> Her preceptor, Emily, gave her adenosine to regulate her cardiac rhythm, which was very painful for Mary

--> Al, Mary's husband, sat in the corner of the room silently the whole time

-Theresa saw her weeks later, but she looked much worse this time

-->her oxygen mask nearly covered her whole face, and she was experiencing "air hunger"

-Theresa tried to find a priest for the family, as Mary's death was imminent

--> the priest performed her last rites

-They needed to wait for the family to come to them to remove her breathing mask

--> eventually they did, so Theresa was instructed to give a bolus dose of morphine and remove the mask

-Meanwhile, a patient named Sal was waiting to be discharged amongst all of this

-Mary did eventually pass

-Theresa went for a walk on a rainy sunday night two days later with her dog, and fell pretty hard. She couldn't stand.

Chap 4 - Benched

-Theresa's role changed from nurse to patient after her fall

-She called her friend Judith, who she told to just take her home and not to the ED (she thought it wasn't as bad as it was)

-Once her husband came home, she got into the van with his help and they went to the ED

-Her X-Ray didn't show anything broken, and she would need a MRI (which the doctor said would be near impossible on a Sunday night)

-HR tried to fire her after a month , but the unit director saved her job

-MRI revealed that she had subluxated her patella

--> she had a huge bone bruise

-She would need about two months to heal, and with the proper diagnosis and treatment she was well on her way

Chap 5 - A Day on the Floor

-Every day on the floor is different

-Theresa prefers face-to-face report (seeing gestures, a grimace, it tells more of a story)

Chap 6 - Condition A

FIRST CONDITION A

-"A" stands for arrest, cardiac arrest

-Patient's who seem to be doing well then die suddenly are considered Condition A's

-After finishing her orientation, after her knee injury, she had her first Condition A

-->middle aged woman with lung cancer (considered "stable" or "fine")

-->Theresa was called to her room 30 min after leaving her care to a nursing assistant

-->the woman was spitting up blood (blood was uncontrollably spilling out of her mouth and nose

--> they had to call a code, her heart kept stopping and CPR as well as suctioning blood and putting in a trach wasn't helping

--> the patient had died so suddenly, which they assumed was due to a portion of her tumor breaking off

SECOND CONDITION A

-Theresa wasn't there for this one

-Her patient, Robert, died in the hallway after a radiation treatment

-His wife happened to not be with him, though she usually was

-Theresa had to tell her that her husband experienced cardiac arrest

-At the end Theresa says, "What can one do? Go home, love your children, try not to bicker, eat well, walk in the rain, feel the sun on your face, and laugh loud and often"

-"The antidote to death is life"

Chap 7 - Openings

-Theresa has a young patient, Abraham, who had a small abdominal tumor he had been trying to cure with prayer

--> the tumor grew so large, he had to go to the ER, where they removed the tumor and part of his bowels (colostomy was needed after)

-Abraham was very particular with everything (IV lines arranged, pills given in a certain order)

-She had a poor view of surgeons, which was exasperated by Dr.Anderson being delayed when he said he would be on time

-She gave Abraham a small look into her own life, which she had always been told not to do

-She says she will protect her children from the horrors she experiences at her job, though the truth will find them eventually

Chap 8 - Doctors Don't Do Poop

-Theresa explains that one day she cared for a patient that was incontinent of stool, his stool was liquid and mucusy

-->patient was Mr.Barton, older man diagnosed with leukemia, body wracked by chemo

--> he had VRE (hospital acquired infection)

--> cleaning him was a two person job

--> they had to put a diaper on him to take him to CT

--> she realized he felt infantilized

-Mr.Barton's son, Josh, told Theresa his father wanted a bible after essentially being told he was going to die no matter what

-"nurses have to get to the heart of the matter, whatever that may be"

Chap 9 - Switch

-Theresa felt her floor was more of a prison and not a home, so she wanted to change floors

-One situation after a long shift showed how urgent this switch was needed

--> Her patient, Irene, found out that her lung cancer was in its final stages (it was shocking bc everyone thought she was doing well by how she looked)

-She wanted to leave for the night, but the nurse who was taking her place was usually late & she didn't want to leave Irene without a nurse

-Irene started to have trouble breathing around 7:40pm (10 min after her shift had technically ended)

-Crystal, another nurse who Theresa describes as a roving bad mood, has questions for her

-->This was Theresa's first taste at real bullying in nursing

-She ended up switching to their sister unit, which she describes as being totally different

-"Nurses eat their young"

-"Loyalty Schmoyalty"

Chap 10 - Access

-Nurses need things to do their jobs (phones, papers, and alcohol wipes)

-Theresa has a patient, David, who had relapsed and the doctors wanted to give him more chemo

--> he needed a "line"

-David was considered a difficult patient

--> he swore at staff, aggressively refused care

--> he had notoriety, which wasn't a good thing in a hospital

-"No surgery, no line, no chemo"

-OR came to take David to his surgery, and Theresa told him when he came back he could eat

--> but, 4 hours later OR called and said David had not been operated on

-lots of loop holes but he eventually gets his hickman, happy story, yay

Chap 11 - Poision

-Chemo is poision

-Theresa's patient, Bill, had leukemia and was symptomatic

-She gives her first chemo a while back to a different patient

-Chemotherapy is a deal with the devil