Category Archives: Pathophysiology

Cancer is the Worst.

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We recently studied over cancer in Pathophysiology. Reading the content really made me think about possibly working in oncology as a nurse practitioner. I’ve started looking at possible preceptors in the area that could give me some exposure, as well as potential employers. MD Anderson is in Houston… that would be AMAZING, only I’d have to live in the one Texas city I despise most. Traffic, pollution, crime… not that appealing. But to work at one of the most innovative, ground breaking facilities in the world? Dream. In fact, they’re internationally known for cancer treatment of Leukemia, which I just did a concept map on and found really interesting. I love analyzing lab values and understanding just what happens to instigate cancer.

But it’s the saddest job I’ll ever have! I’m not one of those nurses who can help diagnose something like Cancer, and then walk away the same person. I think that’s why I’d love it.

At one point, I had the meanest, most obnoxious patient I’ve ever loved. There was a lot of push and pull: hiding his medications from me, arguing with me about taking his medications, calling me on my personal phone asking to run errands (how he got it, I don’t know), dealing with destructive family members, and then… calling the last ambulance for him that ultimately led to hospice. I was so taken by this man!  He hollered at the unit nurses until I reasoned with him to stay by offering to buy him whatever meal he wanted when he got home. So he went home, and died hours before I came with dinner. Dagger. To. The. Heart. I’ve never cried so much! Before he died, I picked up his medications once with his direct instructions to “ask the pharmacist to go on a date with me!” Usually, we don’t pick up the prescriptions, but family issues left him with no one to do it for him. I met the pharmacist, told her what he said, and we had a great laugh and swapped stories! When he died, calling her was the hardest phone call I’ve ever had to make. I still think about him.

I think of the man who’s neck pain turned to thyroid cancer. The young man who just got his life together when his extremity numbness turned to brain metastases. The elderly woman who had gone a year knowing she had undiagnosed breast cancer, never sought treatment, or told her family because she didn’t want to hurt them. I think of the man who showed me a picture of him jumping out of a coffin, laughing because that’s how he wanted his family to remember him: not scared of death. And I remember my very first death as a nurse’s aid, when I gave a patient a diet coke and she laughed and said “honey, I’ve got cancer– think I could get the real thing?” and she passed peacefully before I came back, sneaking her a real coke. But, I think of all the lives we saved. I think of all the lives we didn’t save– I know that I gave the best care to them that I could, but I still carry them around with me. I mean, I really do. And it hurts.

So, why would I think to choose a career that is emotional sabotage? For the same reason it hurts: I carry those people with me. This consideration just came to me this week and I’m becoming more passionate about it every day.

In other news, I’m going to Maine in July for my physical exam course!! I’ll also be doing a skills workshop with suturing, I&D, EKG & X-ray interpretation, etc. I’m so excited! Housing includes lobster bakes, welcome parties, and weekend trips to certain areas of Maine. Here’s a picture of the campus, it’s beautiful!! They say the best day to buy plane tickets is on a Tuesday, so we shall see tomorrow!

As a reminder, these stories might be made up, they might be real. I might have added or subtracted facts. They might be stories from coworkers, or fake stories from coworkers. If you feel that these stories are about you or someone you know, this assumption is seriously mistaken. Cancer is the second most common cause of death in the United States and affects millions, so stories like these are unfortunately all too common and may resemble your experiences or someone that you know. I take confidentiality very seriously! Please see disclaimer.

Stress Less

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Just as I was starting to feel the weight of the world on my shoulders (patho will do that to you), I read my chapter on stress and disease. It reminded me of a course I took during my BSN on holistic health. I would encourage all of you to do a quick survey of yourselves here: http://www.stresstips.com/lifeevents.htm During my BSN course, I made a promise to myself to eat better, sleep more, and stress less. Ha. If you should take the above survey, you’ll see the profound effects on stress on your body’s immunity. Greater than 300 points, you’re at an 80% high probability of incurring a stress-related illness, 150-299- you’re at 50%, less than 150 and you have a 30% probability. The survey is not partial to eustress or negative stress. If you just got married, you’re only 3 points less than the person experiencing a physical injury. When I was in my BSN, I had a score of 350 (profound injury, move, change in sleep/eating habits, etc). Guess what happened? I had bouts of palpitations, bronchitis, and it took hours to calm my body down enough to go to sleep. I responded to that by doing more homework until my eyes couldn’t stay open… then I slept a few hours and went to work. It’s amazing that I didn’t have an MI at the age of 22.

Here’s a little snippet from my notes (for the sake of blogging, I decided to keep it short).

As it relates to pathophysiology, stress causes numerous alterations in cellular processes. The adrenal glands produce excess epinephrine and norepinephrine, increasing heart rate and blood pressure. The hypothalamus may alter sleeping and eating habits. The autonomic nervous system may cause muscle tension and shunt blood from periphery functions, diverting it to essential organs. CRF stimulates the pituitary gland to secrete vasopressin, increasing blood pressure. Glucocorticoids raise blood glucose levels to provide energy in response to the stress. Thyroxine increases energy consumption by cells and increases protein manufacturing. Aldosterone may increase, resulting in electrolyte imbalances. Increased production of fatty acids may increase triglyceride storage in the liver. The increased cortisol levels promote nonspecific immunity responses and increase presence of free radicals.

In other news, my car was wrecked by some lady doing an illegal, unprotected left turn in front of me. I thought it was going to be totaled, but it’s going to be salvageable! I worked a lot of extra hours to pay that thing off so I wouldn’t have that bill during my MSN! As a nurse and advocate for safety, I’m going to take this to the city. There have been NUMEROUS accidents, yet the city has still refused to put up a protected green arrow. This intersection is one block away from one of the ERs I work in.

I’m 300 pages into pathophysiology! I can do this! If I can ever finish this first unit, I can do anything. The next chapters are neuro, psych, cardiology, etc. I’m so excited to leave cellular biology in the dust. Imagine reading 300 pages and each paragraph has about 15 new concepts in it.

For those of you that are in pathophysiology, I have a few highly recommended resources:

Rapid Review of Pathology

Merck Manual

These little guys condense the information down to outlines and bulleted points. You won’t get all of your information this way, but it’s very helpful. I got to the point where I read so much, that I woke up the next morning and felt like I lost it all. These help me keep myself in check. The rapid review has online questions when you purchase the book. I have an iPad so I put both of these on there (the rapid review is available on nook, so you need to get the nook app for your iPad).

Have a wonderful week!

Cartoon from http://scrubsmag.com/nurse-cartoons-stress-tests/