Monday, October 22, 2007

Natural mood enhancement

NewFNP did not go to nursing school to have days like this. There are some days when one just wants to be a researcher. Or a bank teller. Today was one such day.

For starters, how do all of the depressed patients know to come on the same day? When they go to the ED for headache and back pain, does the attending tell them to head to newFNP's clinic at 8:30 on a frigging Monday morning? If depression is contagious, that may explain why newFNP was in a pissy mood after her first three patients. It wasn't just newFNP who got bum-rushed with neurovegetative complaints today. Nope, two of us had multiple patients in need of what newFNP charts as 'supportive encouragement' with a side order of SSRI.

Then, one of newFNP's few patients who are circling the drain came in after having been discharged from the hospital yet again. In health age, this gent is at least three times his chronological age, putting him at about 163 health-years-old. The most fucked up things is, despite test after test and hospitalization and after hospitalization, newFNP isn't entirely certain why. This is partly because he is so unaware of what his doctors and nurses in the hospital are doing and is, thus, unable to share any info with newFNP. It is, however, in large part due to the fact that newFNP has never received any documentation regarding his inpatient care.

What newFNP knew today was that his BP was a troublesome 56/36. That is on the low side for him, but - astoundingly - is not out of his range of normal. The highest newFNP has even seen him is around 80/50. He's got a touch of the old renal failure and truly variable glucose. Addison's? Perhaps, but newFNP has never been able to get an ACTH on him, nor has she been able to get his hospital records.

Now, newFNP has sent him to the ED once to rule out Addisonian crisis and a second time when he was hypotensive and having syncopal episodes at the vital signs station. Today, he was rather perky aside from complaints of dizziness. NewFNP had him drink about 32 ounces of water in 30 minutes and then rechecked his BP. It was 70/50. He felt better. NewFNP's big treatment for this guy today was none other than water.

Take that, big pharm! Water saved the day.

NewFNP left work today feeling as though she had really helped no one. It was a horrible feeling. Thankfully, newFNP's city is enjoying unseasonably warm weather - the kind of weather that makes an evening walk while listening to one's iPod cure a rotten day in the clinic, proving newFNP's rule that a little physical activity really improves one's mood.

Let's hope this weather holds on a bit longer.

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