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coronavirus

A neverending nightmare

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Shania Lynn The Cure For The Common Read Photo

Tonight was one of the worst nights I have had taking care of Covid patients. Nearly our entire 52 bed unit is covid and majority of them are either on high flow oxygen or optiflow. Patients are now put on a list to transfer off the unit as step down and CCU beds become available.

One of the patients I was caring for, was maxed out on optiflow plus a nonrebreather and interchanging those with a CPAP. This is all while she is at rest. We finally got a step down bed for her and was in transport to her new room when her oxygen dropped to the 40s (a normal being 90-100%, her baseline in the 80s). RT put her on a nonrebreather for transport but it was not enough to sustain her for the short transfer downstairs. We called a code and she was quickly placed on a CPAP continuously and her sats gradually improved.

The CCU charge nurse informed me that there are currently 5 patients among their many covid who will most likely not survive… including a patient in their 30s. All the charge nurses now must keep each other informed of our most critical patients to plan for transfers.

Some patients look terribly sick and others look fine but their lungs are just not exchanging the nutrients needed to sustain their blood saturations. Lungs are often clear with their sats in the 80s or lower. O2 can change from 2L- 15L and higher in the matter of one hour.

I know we are gripe, complain, and beg for people to stay healthy etc., but it truly is a terrible never ending nightmare

Until next shift,

Shania

The rise of Delta: not the airlines.

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Due to a high number of unvaccinated individuals and anti maskers, hospitals are now hit with a second covid-19 surge. I, as well as many other nurses, have experienced the nightmares of covid returning as beds are full, patients are sick, and staffing is strained.

The Delta variant is now the major strain in the US. It is about 2x more contagious and transmissible than the original covid-19, meaning that one infected person can infect upwards to 5 other people. Those who are unvaccinated including children are most at risk for infection and hospitalization.

Loss of taste and smell are less common with this variant and typical signs are symptoms resemble that of the flu including headache, sore throat, runny nose, and congestion.

Even with the variant, vaccination prevents 88% of people from having symptoms and 96% of people from ending up in the hospital.

Take home points:

Get vaccinated!

Wear a mask in public places.

Prevent the spread and help the strain on the hospital system.

Until next shift,

Shania

I got the COVID-19…

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Speak out on behalf of the voiceless and for the rights of all who are vulnerable. -Proverbs 31:8

After working five 12-hr shifts this week, I was one of the fortunate people to receive the Pfizer COVID-19 vaccine. I choose to receive this vaccine for the return of social gatherings, hugs, concerts, game days, to protect those who are immunocompromised, and to relieve the strain on the healthcare system.

Any new medication or vaccine does have some risks and concerns. After speaking with multiple hospitalists and doing my own research, I am hopeful for better days to come.

What is special about an mRNA vaccine?

  • mRNA vaccines create the same protein (spike protein) that is on the SARS-CoV-2 in our bodies so that we can produce antibodies that will fight an infection if we are infected.
  • This differs from the flu vaccine which is an inactivated form of the virus. This is not the case with the COVID vaccine- you cannot get COVID by simply taking the vaccine.

How is this safe when developed so quickly?

  • Many people, including myself, have been hesitant to accept a vaccine that has been developed so quickly. However, I have learned that scientists have been familiar with  mRNA vaccines for years. Once COVID hit, these scientists were able to identify the spike protein on the actual virus and create that same protein into a vaccine for our protection.

How is it administered?

  • The vaccine is an intramuscular injection like the flu vaccine and is administered in 2 doses either 21 days apart (Pfizer) or 28 days apart (Moderna).

Considerations/Unknowns

  • It is unknown how long natural immunity will last for someone who has already had the COVID-19.
  • mild s/e include pain at the injection site, muscle aches, fatigue, h/a, chills, joint pain, and fever. These were more common with the second dose than the first.

What is vaccine efficacy?

  • A vaccine is shown to be effective if it reduces the chance of becoming seriously ill.
  • Pfizer has shown 95% effectiveness, meaning that 95% of people will not become seriously ill if infected with the virus. This is actually wonderful, considering the flu vaccine is at most around 50% effective.
  • it is unknown whether the vaccine reduces transmissibility- continue to wear masks!

I hope this relieves some concerns about the vaccine. I believe in the science and pray for a happier and healthier 2021.

Until next shift,

Shania

Sources:

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/faq.html

https://www.mayoclinic.org/coronavirus-covid-19

Mayo Clinic answers questions about COVID-19 vaccine

Clots, Codes, and COVID

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A 50 y/o COVID positive male is admitted to the med-Surg floor on 4L BNC. Shortly after arriving, the patient turned blue and became hypoxic. The rapid response team was called and the patient was immediately taken to get a CT scan with PE protocol to assess for a clot in the lung. The patient had to be placed on a bipap for transfer to radiology. This involved a respiratory therapist, ICU nurse, charge nurse, and a primary RN. I was instructed to carry 2 extra oxygen tanks as the patient was depleting the existing tanks rather quickly. As we arrive at radiology, the current 2 tanks are emptied, and I had to run to another department to grab additional back ups.

Once the CT was completed, we moved straight to the cardiac cath lab. There, they told the patient that it was necessary to perform a rapid sequence intubation and subsequent transfer to the ICU after all imaging was done. The pt became tearful and stated he could not breathe throughout the full 2 hour code.

Covid has been such a strange virus and we continue to learn more at each patient encounter. Prior to this admission, the patient was healthy with minimal preexisting conditions. The last night shift I worked, I happened to walk into his room to fix a beeping IV and was so excited to see this man awake, alert, and talking to me.

He told me that he had several clots throughout his entire body.. his heart, lungs, and his legs. He stated that he had coded twice in the ICU. He was covered in bruises and complaining of severe generalized pain. He was placed on a heparin drip to prevent any further clotting. I was so excited to see how “good” he looked and he was so grateful to be alive.

Covid is no joke and can change a life in seconds. This man may still be on oxygen, be quarantined in the hospital through Christmas, be covered in bruises, and suffering from generalized pain; however, he is alive. This is another humbling reminder to always count my blessings.

Until next shift,

Shania

The Corona Pool

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As cases continue to rise in the hospital, fatigue continues to settle into the organization. We have filled the ICU, expanded the ICU, and currently have nearly two full COVID floors apart from critical care.

There have been an increase in patients and a decrease in nursing staff due to also succumbing to the illness. In order to combat the increase in patient census, incentives have been put in place to encourage nurses to work overtime. Even with several nurses working five 12 hour shifts (the corona pool), we often still do not have enough staff to cater to our patients.

Caring exclusively for covid patients has brought many challenges, insights, and humbling to my practice. Patients are forced to be isolated in their dark hospital rooms for days. Staff is instructed to only go into the room when necessary, so we call them to see if they need anything. They are served meals on paper trays. They are forced to keep their doors closed. They are often transferred to a different room in the middle of the night to allow grouping of all covid cases. They are allowed absolutely no visitors, even at the end of life. One minute they can be communicating effectively on room air to the next minute on optiflow and unable to walk to the bathroom.. oxygen levels can change drastically. A multitude of patients have stated they want to die and give up fighting, then they do die. Patients have screamed and cried for nursing to help them as they are scared and can’t catch their breath even on the highest of oxygen settings, fearing an impending intubation.

Your nursing “heroes” are still here and very tired. Our own bodies are fatigued and overworked. I love my job, but never would I imagine to be in the horrific situation we are in currently. Never knowing what the next day will bring is scary. Fearing a continual expansion of critical care, caring for higher acuity patients, and watching management being forced into bedside nursing roles is scary.

But it’s all political, right?

Until next shift,

Shania

COVID Update: Are we really heroes?

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Over the past couple of months, the world was forced to adapt to a new normal. Businesses were shut down, jobs were lost, jobs were deemed essential or nonessential, healthcare workers became heroes, and people appreciated the importance of science. There are two extremes: those who believe the coronavirus is a government-created fake to steal our rights, and those who remain isolated in his or her home. People either wear masks or continue to hang out in public crowds. Hospitals are either overwhelmed and under-resourced, or nearing shut down as revenue has dropped so drastically.

I have been affected by the latter. The rural organization that I am apart of recently furloughed and laid off several hundred workers due to a continued low census/revenue. We have tested several hundred individuals with a majority of them either negative, or positive with mild symptoms and instructed to remain isolated at home. I have yet to have any known exposure, nor have I cared for a true COVID-19 patient. I consider myself very fortunate and lucky. We have at most one positive COVID patient in the hospital per week. Census remains to be so low that many nurses are put on stand-by or cost-containment at least once per week. The so-called heroes are unable to work or make money. Many essential workers are given hazard pay, however at an organization where the usual salaries are difficult to come by, we are eliminating positions and praying that we continue to have a job as a new week begins.

So, am I really a hero? The Oxford dictionary defines a hero as someone who is idolized, shows courage, and noble qualities. By this definition, nurses and other healthcare personnel can be considered heroes. However, I do not search to go into harm’s way. I wear my cloth mask, adhere to crisis guidelines, educate the public (who many do not listen), and #stayathome despite the world starting to reopen. I go to work every shift with the mission to practice compassionate, evidence-based care while providing for the specific needs of each patient and family. And my reward? The personal satisfaction of helping others and the risk of getting called off on the next shift.

I absolutely love my profession, my hospital, my coworkers, and my patients, however I do not consider myself to be a hero. My mission is to educate, treat, and inspire people to do good and to remain healthy. My wish is that this pandemic has encouraged others to never take life for granted. I hope that the day we…

  • Hug our friends/family
  • Visit our grandparents
  • Be a support in the hospital
  • Go to a restaurant
  • Return to the theater
  • Shake someone’s hand
  • Go shopping
  • Fly on an airplane
  • Talk to our spouse and children…

Remember the year that these things were not safe and appreciate every moment.

Closing thoughts: This pandemic will not end until there is a miracle drug or vaccine. Even with the city opening up, please continue to social distance, maintain respiratory etiquette, wash your hands, wear a face mask, and be sensitive to others’ emotions.

Until next shift,

Shania

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615-856-8181
shania@shanialynnvo.com