Caring for the ill at home

With COVID19 all over the place, and communities trying to protect themselves with quarantines, what do you do if you’re the caretaker for a loved one who is ill right now? Maybe it’s a mild case of COVID19, or just a bad cold.  Here are some basics, from your friendly, neighborhood nurse.

  • Stay hydrated. Push fluids. Water, electrolyte drinks, broth, juice, or whatever they’ll drink. But keep the fluids coming all day long.  Try to limit things with lots of added sugar like colas and some coffee drinks – the sugar feeds bacteria and viruses. But if ginger ale is all your loved one will drink, let them drink it.
  • Protect the lungs. In hospitals we use incentive spirometers.  At home we can use pinwheels, blowing bubbles, or blowing out candles (real or fake). The key is, we want the person with illness to be filling up their lungs and blowing out several times an hour while awake.  Use commercial breaks, or turn it into a game during press conferences – whenever someone says “Chinese virus,” you blow imaginary spit-balls at him!
  • Get moving. Being mobile is key to maintaining health. Get out of bed. Walk around. Sit in the living room and watch TV. But don’t spend the whole day in bed. Get outside when you can, even if just for a few minutes.
  • Manage symptoms. Have a fever? Take some acetaminophen. NyQuil, Theraflu, or your favorite cold remedy is just fine. Hot tea with honey, throat lozenges, a well-maintained (cleaned) humidifier are all good ideas.
  • Stay home. Unless you’re headed out to see the doctor because you already called and they told you to come in, anything else can be done from home.  Need something from the store? Send a neighbor, friend, or family member. Feeling bored? Stream some movies or TV shows. Need your favorite dish from the Italian place down the street? Find someone to deliver it. Stay home when sick to keep from spreading contagions around the community.
  • Rest. Yes, you’re right, we did say to get moving a few bullet points ago. But all things in moderation, right? Don’t overdo it.  Just because you can do the entire Mt. Everest-sized pile of laundry in one day doesn’t mean you need to.  Pace yourself, rest, and allow your body time to heal.
  • Avoid the things that your immune system doesn’t like. Your immune system doesn’t like sugar. Alcohol is a sugar. Your immune system doesn’t like alcohol. Avoid sugar and alcohol.  On the other hand, make sure you’re eating protein, vitamin C, and getting some vitamin D through dietary or supplemental sources.

Those are the big things, friends. Take care of yourself, take care of each other. If someone in the house is sick (or is healthy, but immunocompromised), wipe down high-touch surfaces frequently. And maintain social distancing. It really does help. We’ll get through this.

When to call the doc

Our primary care physicians, and nurse practitioners, and physician assistants, are being inundated with calls about sniffles, being in the same grocery store with someone who was coughing, along with all the other typical calls they get on a day to day basis.  So, if you or a loved one is feeling out of sorts, is it time to call the doctor?

Let’s talk a minute about the actual symptoms for COVID19. Fever, cough, shortness of breath – those are the big ones that everyone agrees on.  Note that sniffles, sneezing, headache, tummy ache, and fear of running out of toilet paper do not make the list.

If you have a loved one, specifically someone elderly or immunocompromised, who is not feeling like themselves today, how do you know when is the right time to call to doctor? Let’s look at a few signs to really look out for:

  • Fever – a fever is a temp of 101.5ºF or higher.  This is certainly a reason to call a doctor, especially if the temp doesn’t go down with a fever-reducing medication.  But’s let’s not totally depend on this one.  The elderly tend to have a normal temperature that is below our ‘accepted’ norm of 98.6ºF, and they don’t spike fevers the way younger folk do. So a lack of fever doesn’t mean we’re in the clear.
  • Too tired to stay hydrated.  If you’re trying to get Pop-pop to take a few sips of broth and he won’t do that, it’s time to call a doctor.  If you or your loved one isn’t taking in at least 24 oz of fluid in a day, call for medical advice. Dehydration is a serious problem as we fight infection, and even more so when we’re fighting a lung infection.  When we’re not hydrated, those lung secretions get thick and sticky, making them harder to cough up. If you can’t keep your loved one hydrated, he or she may need to be in the hospital, at least long enough for IV fluids.
  • Too tired to move around. If you or your loved one is getting out of bed less than every few hours during the day, it’s time to think about calling a doctor. Lying in bed all day isn’t good for our lungs – it allows secretions to consolidate and fester, and that’s no good.
  • Shortness of breath – we hear about it on the news, but how many of us know what it looks like? If Gramma has to stop mid-sentence to catch her breath, or pause between words to breathe – even when she’s sitting down – it’s time to call the doctor.

These are the big reasons I’d call a doctor for a loved one.  But the bigger picture is, when in doubt, go ahead and call.  That’s what your family doctor would want.  As for 9-1-1 – save it for true emergencies, and when we’re talking about medical emergencies, that would be if you can’t wake Gramma up, Pop-pop has chest pain, you see signs of a stroke (facial droop on one side, speech or vision changes, single sided weakness), etc.

6 steps to prevent coronavirus – from a nurse

The news outlets are sensationalizing, and the politicians are downplaying the coronavirus, so where can people go to get practical tips to keep themselves and their families safe? Ask a nurse.

Here are 6 simple things you can do to make sure you and your family stay safe.

  1. Know what disinfectants to use at home. Guess what – even though Coronavirus can arguably live on hard surfaces for up to 9 days, it’s actually quite easy to kill. It’s an ‘enveloped’ virus, which means that the same products used to disinfect from the common cold or the flu should also be effective against coronavirus.  Pick your favorite household disinfectant, and here’s the key – read the label to see how long the surface needs to stay wet to truly disinfect. It could be as brief as 30 seconds, or as long as several minutes. But follow the label, and clean high-touch surfaces frequently. Door knobs, light switches, your steering wheel, cell phone, faucet handles…
  2. Wash hands properly, and teach your family to do the same. Here’s a nurse’s guide to handwashing:
    • Wet your hands
    • Add soap, and lather all hand surfaces for 20 seconds – don’t forget your knuckles, between fingers, under the nails, and up to the wrists
    • Rinse the soap off under running water
    • Use a paper towel to dry hands
    • Use a paper towel to turn off the sink
  3. Keep your hands away from your face – that means no nail biting, eye rubbing, resting your chin on your hand, etc.
  4. If you’ve been around someone sick, visited someone in the hospital, been to the doctor’s office, or you’ve been in a crowded area: take off your clothes when you get home, wash hands, then put on clean clothes.  Viral particles can live in your clothes, so take them off instead of spreading germs around your home.
    • As a caveat to this one, try to stay away from places sick people congregate. Need stitches? Try urgent care instead of the Emergency Room. Have a friend in the hospital? Send a card or gift basket instead of visiting.
  5. Stay home if you’re sick. Keep your kids home if they’re sick. There are delivery options for groceries and meals. You have neighbors and friends who can leave groceries on your front porch. Keep your germs to yourself, whether it’s coronavirus, the flu, or the common cold.
  6. Cough into your elbow. Sneeze into a tissue. Then throw it away and wash hands. In healthcare we call it “respiratory hygiene,” and it helps to prevent the spread of contagions.

Summer reading: 5 perfect books for nurses

Looking for a great book to take to the beach? Maybe just something to read while you sit on the front porch sipping your sweet tea? (Sorry – Georgia, here.  We sit on the porch with iced tea.) I’ve read a handful of books over recent years that spoke specifically to the nurse in me, and I’m always looking for things similar to them.  Here’s my list.

1. Cutting for Stone

Oh my gosh, y’all.  The story centers around a nun, who happens to be the surgeon’s nurse (hello, OR nurses?) at a mission in Addis Ababa.  It’s written by a physician who obviously respects the nurses he’s worked with.  Imagine, a story that sweeps across Ethiopia, with a forbidden but necessary love story, and all centered around the operating room.  It made me want to be an OR nurse.  It’s written in a way that I just couldn’t put down, and I’m eagerly awaiting every book Verghese writes now – he just has a way with words.

2. The Winter Soldier

Honestly, I didn’t have high hopes with this one, but it certainly delivered.  I’m a fan of historical fiction, and this is one of those rare, really good novels set around World War I in Eastern Europe.  Add to that, it’s about a medical student commissioned out of necessity as a doctor, who arrives at a field hospital and is trained in medicine by a skilled nurse, and you’ve got a winning combination.  Of course, there’s a love story to keep the pages turning – what summer reading wouldn’t? And as any novel with doctors and nurses that I would recommend, the nurses are used to their full capacity and given the respect they deserve.  This one checked off so many of my boxes – historical fiction with impeccable attention to setting, dramatic love story, and a nurse heroine with enough medical details to be plausible.

3. In Falling Snow: A Novel

This is another historical fiction tale, set in World War I, but this time it’s at a convent turned hospital in France.  You’ll fall in love with the nuns, the doctors, the nurses, and the gentlemen who stay nearby.  The brothers, the suitors, the patients.  If you thought your patient assignment was tough, take a look at how these nurses make it through the shift, in the midst of bombings and all the trappings of war.  You’ll be witness to nursing coming of age and learning to cope not just with their professional struggles, but with the struggles of serving during war.  Come alongside them as they fall in love, lose those they love, and grow personally and professionally.

4. Magic Hour: A Novel

Any psych nurses out there? Sadly, this story is not about nurses, but it’s one we can surely relate to and get emotionally invested in! In this tale, a child psychiatrist’s career has been derailed by a patient tragedy.  Then she’s given the opportunity restore her career and her confidence by responding to a high-profile case involving a child in trauma.  Come alongside her as she restores her professional reputation and possibly learns to love all at the same time.

5. Midwives (Oprah’s Book Club)

Any OB nurses out there? In this story, a birth goes wrong – as any midwife or OB nurse has seen it go wrong.  A legal struggle ensues, pulling the midwife and her family into an unwanted spotlight.  But are there ulterior motives? Were the midwife’s actions really part of the cause of tragedy? This will keep you turning pages late at night.

This is why

There are days that are absolutely awful in the NICU.  Heart-wrenching days that make you want to crawl in a hole. But we celebrate the little moments, and that’s what redeems it all. Yesterday was one of those days.

I worked with Baby G. for two days in a row, parents were there all day loving on him. Continue reading

Overreact much?

Cute little patient in the NICU. Mom’s basically your typical first-time mom, wide-eyed, scared, excited all at once.  Dad is an MD who works in the hospital. In this hospital.  He knows what can go wrong. And therefore he tries to will all the bad away.  Day 6 in the NICU he asks for a mask because he has a tickle in his throat – doesn’t want to spread germs to his newborn.  We provide one, and remind him Continue reading

How is he?

screen-shot-2017-01-05-at-1-50-42-pmI never realized how subjective that question really is. Recently I took care of a sweet boy with trisomy 13.  Mom called again and again, looking for updates that would give her some indication of what she can hope for.  He’s already made it past a month of life, defying the very few odds available as guidance.  Continue reading

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