Ask a nurse anything.

HI ATS, I am a critical care RN with some other letters behind my name that I won't get into, but anyway. I searched, and was surprised that I didn't find another post similar to this. So... here goes. Ask away.

I recently read an article where a bunch of nurses fielded questions, and gave a lot of "inside" info to how things really are in the medical profession. It was quite popular, and the nurses were very candid as I will be. If there are any other medical professionals on ATS that want to chime in please feel free.

I do not intend to diagnose, or offer modes of treatment for any particular problem. You should go see your doctor for that, it is their job. I will offer my opinion, but it is just that my opinion based on personal experience.

What I would rather focus on is a medium of communication to help people get the best care they can if, and when they get sick. We are on your side always, even when it doesn't seem that way. For example: A nurse will never tell you that your doctor is a moron. We will however tell you that you can always get a second opinion. I can also explain why we can't, or don't always tell you everything you want to know about everything going on. Or why visiting hours are strictly enforced sometimes, and not at others etc... I'll let you in on a lot of the "code" words we use to do our best to advocate for YOU our patient, but not lose our jobs.

A nurse walks a tight rope of legal, and ethical constraints that most people simply cannot fathom. Some jobs are physically difficult, some jobs are mentally difficult, some jobs are emotionally difficult. Nursing is all of the above. I absolutely love what I do, or I wouldn't do it. Believe me I do not get paid enough to do what I have to do sometimes, but I really can't imagine having near the satisfaction from doing anything else. I am often asked. especially as a male nurse, why I didn't become a doctor. Simple, I didn't want to. I am who I want to be, and have no regrets. So ask away ATS I look forward to your questions.

reply to post by Binder


My question: How well do you get along with medical maintenance personnel?

My sister is a nurse, and I KNOW nurses are the heart and soul of our medical system, so THANK YOU!

My issue:
I have been having panic and anxiety for years, coupled with distressing GI problems and debilitating depression. Everyone in my family has an auto-immune disease. It runs like wildfire through the generations: Hashimoto's, Type 1 Diabetes, Crohn's, Collitis, Coeliac.

I have had limited health insurance (unlike other family members), and every time I coax a doctor to consider the possibility that I, too, have an autoimmune disease, they tell me, "its in your mind. its the anxiety. its the depression."

Once I get health insurance again, hopefully soon, should I simply give up on telling doctors that I am anxious and depressed, and just focus on the other symptoms?

I want to tell them what I am enduring, but am afraid of the stigma. Once the word "anxiety" and "depression" crosses my lips, it seems they tune out and write me off as a mental case.

I really need help...I suspect a gut inflammation like Crohns. What I have confirmed is severe vitamin deficiency (D, E, B12, B6) and fatty liver (ultra sound) with URQ pain after eating and swelling in, ahem, sensitive places. Along with the usual fatigue and aches and pains, I am really at my wits end.

Thanks for reading

reply to post by Kovenov


I hate to admit this, but sometimes I like our cleaning crew better than a lot of the nurses. Those guys work hard for their money, and get even less appreciation than nurses for it. The maintenance crews are really unsung heroes.

reply to post by Binder

I do not intend to diagnose, or offer modes of treatment for any particular problem. You should go see your doctor for that, it is their job. I will offer my opinion, but it is just that my opinion based on personal experience.

Then why does your title say 'Ask Anything'?

I think broke my clavicle when I was born because I've had a lump on my left clavicle for as long as I can remember. I've gotten kind of fat recently, and during this time, I noticed that it disappeared. I don't know if the rest of my clavicle moved up from the weight gain, or it somehow fixed itself. When I lose the weight I'm thinking that it will reappear. Any clue?

reply to post by JanJamboree


Your situation is not that uncommon. In fact I have a very good friend who is also a nurse in a very similar situation. I would have my cortisol level checked. Now, if that comes back high which I suspect it will. You have a conundrum here. #1: stress is a killer. You are kind of in a "Which came first, the chicken, or the egg?" scenario. Did stress(emotional, physical etc...) cause the problems, or are the problems causing the stress? The answer is probably a little of both. I would do everything in my power to fix what I could, and then find a doctor willing to listen, and work with you on the rest. Yes I know it will be a challenge to find a doc like that, but they are out there. I would educate myself on nutrition, and find out if any of my problems were triggered by foods like glutens.

Even if you can't get a medical facility to help you. Help yourself. Eat well, excersize, and don't spend emotional energy on things you cannot change right now. Stress causes CRAZY autoimmune responses, especially in a chronic situation. I am NOT saying it is all in your head, but after suffering for so long, it has undeniably gotten into your head at least to an extent. Health is holistic, envolving the whole body including the mind.

Attack this from both sides. Don't rule anything out. If it is all in your mind, find help to fix it. If it is mostly a physical problem then having a centered, and strengthened mind will help you on your course to find the solution. In my experience it is usually a bit of both, and it really doesn't matter which came first. Endeavor to fix both, a healthy body is ruled by a healthy mind, but it is challenging to maintain a healthy mind in a sick body.

So I would recommend a balanced, gluten free diet, excersize as much as you can tolerate even if you don't feel like it, and socialize with others. This will help with the inflamatory response, immune system, and depression. That may help you weed out what the source of some things are, and make a possible medical diagnosis easier. find a doctor willing to work with you and recommend more specific things, and give you access to resources because you can't do it alone, and you shouldn't have to.

reply to post by BrokenCircles


Remember that "legal, and ethical" tight rope I mentioned. I am not a doctor, and therefore cannot diagnose or treat any condition. You may ask me anything, and I will tell you my opinion, but I am not telling you that X, Y, or Z is what you have, or should do. That is your doctors job.

reply to post by satron


Your theory sounds as plausible as any. A broken bone often forms a calcification(lump) when it heals, and is actually stronger than the surrounding bone. Broken clavicles do happen during birth. If that is what happened then yes, when you lose the excess adipose(fat) in the area then you will be able to feel the lump again. Since it has always been there, and doesn't move that sounds pretty reasonable.

reply to post by JanJamboree


After re-reading your post, and doing some more thinking about your question about telling doctors about your anxiety, and depression. The direct answer is yes, and no, I know unnerving, but bear with me. You need to find a GP(General Practitioner) that will listen to you, let you vent, and be your guide through this process. He or she should be empathetic, a good listener, and show genuine interest in your well being. This is more important than how smart, or how well recommended they are. Some times newer doctors are better for this reason. So if you are going to see your GP who you trust implicitly, then yes, tell them everything going on so they have a complete picture of your heallth, both physically, and mentally at the time. This will give them information to make decisions as to who to send you to for more specific, and focused care.

Now, let's say Dr. Caresalot sends you to the toe specialist. Don't go on, and on, and on about your mood swings, and depression at the toe specialist. Talk about your toes, get the toes fixed, and then let Dr. Caresalot move on to the next problem. When you see a specialist focus on the problem they are there to solve. Yes, a lot of things are interrelated, but try not to go on, and on about everything. Doctors are human too, and make assumptions, and get bored at long irrelevant stories. However, it is Dr. Caresalot's job to listen to the long irrelevant stories, and gleen information to point them in the right direction. So when you are with your primary doctor who coordinates the big picture of your care plan be honest, and give them everything, but when you are seeing a specialist for a specific problem, keep it focused

For the past month I have, on my doctor's orders, been receiving weekly B-12 injections for the last 4 weeks.
My doctor says I need to now continue to receive a monthly injection for the next 6 months.

I have asked why these injections are necessary, but have only been told that my B-12 level was very low (apparantly learned as a result of teh regular blood tests I have due to Type 2 diabetes).

I have been told that I should notice an increase in energy as a result of these injections, but, to be honest I haven't felt any change in my energy levels, nor any other physical effect; aside from a sore arm after the injection.

I have not been charged for any of these injections; not even my normal co-payment.

The injections have been given by a physician's assistant, not my doctor herself (I'm a male if that matters).

So there does not seem to be a definite financial benefit involved.

And, to date, I haven't been able to get a solid medical justification out of my doctor, or her PA, for these shots.


Any ideas? Thanks


Considering that this is ATS, my Tinfoil Hat is starting to weigh a bit heavy on my head!

I have a question for you.

I have a lot of trouble with my knees. They hurt terribly, they ache, give out, click when I walk etc... but what I really would like to know is something else. Below both knees, on each shin I have a hard boney bump. It feels like bone. When I kneel down, it feels like I'm kneeling on marbles. One bump is close to marble size and the other is a bit smaller. If I'm kneeling a lot, they both get red and enlarged, and hurt like hell.

My Dr. ordered x-rays for the actual knee pain and said they came back with no osteoporosis in my knees, but either didn't tell me what the bumps were, or I've forgotten. I did do some web searching and my bumps look like Osgood Schlatters photos, ( and I'd have remembered that if my Dr. told me that) but I've only had these for a year or so and I'm in my 40's. Could they just be bone spurs? Or any other suggestions that I could look at or suggest to my Dr?

If you don't want to make suggestions, I understand. My Dr. did write me a script for a rheumatologist, but I haven't had
a chance to see one yet. I can ask when I see one though.

reply to post by Bhadhidar


My first thought is to ask if you have been tested for pernicious anemia. B12 can only be metabolised in the presence of intrinsic factor in the gut. A lack of intrinsic factor can be caused by a genetic deficiency in the bodies ability to make it, or alcohol abuse. If you are diabetic also please don't let the latter be the case, also a lack of food containing B12 can cause a deficiency. Are you vegan? If so, rethink your position, or be prepared for injections the rest of your life.

As far as the 6 months of injections. the doctor is saving your life. B12 is stored in the liver. If you have no stores in the liver for whatever reason, in about 3 months without B12 you are dead. B12 is crucial in the proper functioning of your nervous system. The reason for injections is that it bypasses the gut, and puts the cyanocobalamin(B12) directly into circulation where it can replenish your liver stores. You may not be feeling the "bump" from the B12 because your body might be packing it all away in its rainy day fund to keep you alive if you were that short on it.

99% of diabetes care is self care. Eat right, check your sugars, and excersize. A blood sugar over 150 mg/dl is killing glomeruli in the kidneys, keep it under that. Dialysis is a real bummer. If you do not have pernicious anemia, and are not over consuming alcohol then eating B12 rich foods should make things right as rain. B12 rich foods are organ meats(especially liver, I know, YUCK!) beef, high fat fish, eggs, and hard cheese.

There is no conspiracy, a B12 deficiency is nothing to mess around with. I just feel as though your doctors have not educated you very well on why this treatment plan is so important. It has to do with more than making you feel you have more energy. It sounds like they are trying to replenish those deficient liver stores. Help them out by eating some B12 rich foods, and limiting alcohol, and make sure they have ruled out pernicious anemia.

reply to post by Binder


Hi and thank you for your kind offer and service.

Perhaps you might like to elaborate on why visiting hours are enforced stictly sometimes and not others?

Could you please elaborate on code words nurses use to hint to patients and fmaily that they need to look deeper into answers or issues, or that they should find another doctor or hospital etc.

What signs should we as patients and visitors should be on the lookout for that things are not as they should be for us a pateints and familly.

Are there any key questions I should ask as a patient and a visitor.

What sort of anwers that we are given that should be a red flag for us a patients and visitors.

whats a good way for us as patients or visitors to let a nurse know that we would like to talk to them privately about care issues.

is it true that hospitals now have to counsel terminally ill patients on a end of life plan?

In your expereince and those of peers that you trust, is there substance in some, any of the hospital and or medical conspiracies.

thank you

reply to post by virraszto


This is why I love lots of questions. It makes me dig way back into the books, and research, and refresh the old rusty halls of what I learned umpteen million years ago.

I think whether what you have would be "officially" diagnosed as Osgood-Schlatter's or not the treamtment regime would still apply. "RICE" rest, ice, compression, elevation. Osgood-Schlatter as I am sure you researched is caused by irritation of the patellar tendon where it derives from the tibial tuberosity. That's just a fancy way of saying the tendon is all pissed off where it connects to the bone. A calcification forms as the body's response to protect the insertion site of the tendon. Even though this is most common in very active adolescents, and young adults it doesn't mean it can't happen to us older folk. I don't know your detailed history, like what you do for a living, or how active you are, family history etc, etc... So other than seeing an orthopod which it sounds like you already have, rest it, ice it when swollen, elevate it, use a brace or immobilizer to take some stress off, and use NSAIDS for pain, and inflammation. Also if kneeling causes more irritation, STOP KNEELING! If you have to kneel a lot, get some really good knee pads. Bottom line: You gotta stop pissing off that patellar tendon, and let it heal.

Very good questions, and I quoted them so I can categorically answer.


"Hi and thank you for your kind offer and service."

You are very welcome, and I enjoy teaching, and sharing knowledge.



"Perhaps you might like to elaborate on why visiting hours are enforced stictly sometimes and not others?"

I was so hoping someone would breach this subject. The reason is two fold. I am going to be blunt here, and I hope everyone takes it the right way. It is good to discuss this here, and not on a unit where it usually happens. OK... a hospital is full of sick people right? Obviously your loved one is not the only sick person there. Yes they are important to you, and so they should be. But...you must realise a nurse can have anywhere from 2 or 3, in an ICU setting, to 10 or 12 in a regular floor setting of these precious sick people for whom they must care. Bottom line: It isn't all about you. Deal with it. It may be that we are protecting the dignity, and privacy of another patient, or their family, or that your loved one has asked that we limit visitors because you are bugging the crap out of them while they are weak, and sick, but they love you too much to say it to you. So, we play the bad guy on their behalf. Believe me it happens A LOT. Don't bother asking aunt suzy if she has ever done this because she will, and should deny it. Don't become a nurse if you want to always win popularity contests. We play bad guy a lot to protect the comfort, and dignity, and privacy of our patients. When it is your turn we will do the same for you.

I will share a very straight forward instance. I once had an incontinent patient. He was not very old, and had a wife, and children. He had a large accident(I.E. he crapped all over himself, the floor, and half of the medical equipment in the room), and did not want the humiliation of his wife, and children seeing him in that situation. Of course I got a huge lecture by the wife about how insensitive I was to not let her have immediate, and continual access to her ailing husband. However, his needs, and dignity overrode her need to be in his business, and I would do it again. I am here for you first, not to try to humor your extended family. There is a saying amongst critical care nurses, "I am here to save your ass, not kiss it." However there is no excuse for needless rudeness, or insensitivity, which can happen as nurses are only human too.




"Could you please elaborate on code words nurses use to hint to patients and family that they need to look deeper into answers or issues, or that they should find another doctor or hospital etc."

It depends alot on the situation. "You could get a second opinion" is a big one. Another would be "Have you heard of Dr. Smith?" A lot of times it is a leading question, in fact that is probably the #1 thing nurses use to slip you the 411 under the table. For instance, instead of asking an open ended question like "how do you feel?" We might say "Isn't it time for some more medicationx?" If it is something you must ask for, for us to "officially" be able to give it, but we feel you need it, and we cannot come right out, and say "You should ask for this." Basically just pay attention, listen, and trust your nurse. It isn't very "hidden." Like "Aren't you feeling a bit short of breath right now?" Ahem... Ahem... COUGH, COUGH!!!!! (nudge, nudge, this is where you get a clue) Don't assume your nurse is nuts. They are probably trying to help you without involving a bunch of 1st year residents that might kill you at 3am out of shear curiosity about what that might look like.




"What signs should we as patients and visitors should be on the lookout for that things are not as they should be for us a patients and familly."

Ambiguity, passing the buck, etc... If the nurse or the other staff really does not want to discuss anything preliminary with you, and insists on you speaking with the doctor only it is probably really bad news, and really should only come from the doctor. In most facilities the nurse would get in BIG, BIG trouble for discussing something like that with you before the doctor did. We will slip you good news, but bad news always comes from the big guy.


Continued...

"Are there any key questions I should ask as a patient and a visitor."

As a patient, ask anything. We want you involved in your own care. Ask about meds being given, ask about your plan of care, ask about lab results, ask if everyone is washing their hands between patient contacts. As a visitor a lot of these same questions also apply especially if your loved one is less able to communicate, or advocate for themselves. I know you are in Australia, but I think most standards of care are fairly universal. In America we have HIPAA laws which prohibit us from discussing a lot of specific information. If you are the patient we can tell you, and you can tell your loved ones, but we cannot tell your loved ones. So if you called, and asked me "What is my mom's blood pressure right now." I legally cannot answer that question, or I would lose my job, and go to jail. Please don't put your nurse in that position. We will piss you off to no end before we will let our kids starve to satify a curious george.



"What sort of anwers that we are given that should be a red flag for us a patients and visitors."


The two that come to mind immediately would be #1 If you are not next of kin, and call to check on a loved one, and the nurse says "I would come visit him." You better get your backside up there. or #2 "Dr. Smith will be here at 9am you should discuss this with him." again bad news comes from the big guys.




"what's a good way for us as patients or visitors to let a nurse know that we would like to talk to them privately about care issues."

In my experience, and what I would preffer? Be direct, just say "Can I speak with you privately for a moment?" Most nurses will find a space, and time to discuss sensitive issues with you. We do that a lot, it is a big part of the territory.



"Is it true that hospitals now have to counsel terminally ill patients on a end of life plan?"

In America yes. In Australia I am not sure, but I would imagine yes. As I said before standards of care are fairly universal. This is a very important improvement, and a big ethical consideration. Everyone deserves comfort, and dignity in their final days.




"In your expereince and those of peers that you trust, is there substance in some, any of the hospital and or medical conspiracies."

Oh heavens no! Can I interest you in some swamp land in Florida? As with anything else of course there are conspiracies. some with a lot of merit, and others not so much, but we could fill a whole other thread with that.


THANK YOU!!!!

You've answered a lot of questions and may be tired; so, I'll ask mine and it's okay if I wait. I'll check back tomorrow. I actually have oodles of questions but will start with these which are the most troublesome. It's about ethics.

1. Are they still allowing deformed babies die of starvation and telling the Mother that the baby was born dead? I know for a fact that that was common protocol at one time. Reasoning was the hospital is not required to FEED a patient.

I even saw that happen to full grown adults. Death by starvation. They (RNs) tossed the plate of food on a tray on the patient's bed and left, knowing full well she was unable to move or feed herself. Later, they'd take away the tray. I spent my own time feeding her and turning the book pages for her. A young woman in her 30's with MS.

So, is it true they are not required to feed patients?

2. Most lesser educated patient's families don't know the difference between brain damaged and brain dead. I saw a doctor advise a family that their son may be brain damaged. They immediately said to pull the plug and signed donor papers. The doctor did not question their decision, nor advise them of the difference. Did the doctor, hospital of family get PAID for this organ donation?

3. I've seen poor people and uninsured get non-treatment as opposed to patients with insurance getting the proper treatment. I'll skip a very long and detailed story here. These same poor people die and miraculously end up being organ donors or such. Again, it seems somebody makes the decision who will live and who will die based on income or insurance - and - somehow the poor people end up donating organs. Who's getting paid to do this? Why don't they follow the so-called ethic guidelines they post? The double-standard is obvious to me; but, not to the patient's poorly educated family.

What other un-ethical things go on? Why?

Awesome questions guys!!!

I'm really enjoying this thread, but it is after 4am here!!!! I just realised it, and the wife is giving me the "Go to bed" gesture. Keep em' coming, and keep me on my toes. I'll be back after some shut eye.

reply to post by Trexter Ziam


Trexter, excellent, excellent material to discuss, and I will formulate a much better reply after some sleep, and thought. This is the beginning of some excellent ethics debate. I look forward to discussing this in detail.