I poke you with big needle.

I am so bored. I have to sit around for hours waiting for freaking class to start. So, I'll just tell you about my day.

I got to go to 2West again today. I put in 4 IVs. 2 went in perfectly, and the other two I got in with good blood return, but when I tried to advance the catheter, I hit a valve and blew the whole vein. It's okay, though, because it happens a lot, not something you can really avoid unless you can see the valve, and the nurse did the same thing twice after me, lol. Putting in IVs is addictive. :)
OH RUSSELL. lol

I would have went home a long time ago if I didn't need the points from class.

I got an A in medsurg clinicals. Yay. Now to move on to pediatrics.

We tried to order my new hot pink computer the other day, but now all of the sudden, shipping is no longer free, and we would have to pay an extra $65 for ground, so we're going to wait and see if we can get free shipping again. I hope they do it soon.

I can't wait fro spring. Russell and I are going to start walking together when it gets nice outside. We'll probably ride bikes, too. Andrea needs to hurry up and get her butt moved into the trailer because we're going to have tons of fun. She's going to bring up her bike to ride with us, too. Oh, and I'm going to have to set a time for spring cleaning. It needs it bad even though we just moved in April. Trailers get dirty easy. I'll probably try to do some over spring break. We'll probably go in to Braxton for some of it, too. We both actually are supposed to get off work. Yay!

Headlines: Chunky girl bites patient's finger to get to sandwich.

It's funny how I can get called chunky and fat 8 times and get kissed on the cheek twice BY THE SAME PATIENT all in one work day. I probably shouldn't let myself feel so bad since the same old man said to me "I love looking into your BLUE eyes". What's even nicer is the fact that after I put his glasses on him he says "I can see now. You look even fatter." This is also the same man that when I bathed him and asked him if he could wash his own privates or did he need me to, he said "I'm not shy. You can grab right on to that thing and get 'er done!" He was a big pervert and hit on everyone that walked into the room....in front of his wife. I think I even remember him telling me that if he had a sandwich in his hand then I would probably bite his finger off...

I may be chunky, but that doesn't mean that I want someone to tell me that repeatedly to my face. Russell said "what's that guys problem?" and I said, "I guess he's just being honest." He wasn't too happy about my answer.

Gee, I'm really looking forward to going back to work tomorrow.

I guess it's time to go eat dinner now like the fat girl I am.

Nothing's going to change destiny.

Not even my raspberry smirnoff is helping right now. I'm just so damn frustrated. Work is really pissing me off. The job is not bad...it's the coworkers. I am so tired of people acting so vicious. They're trully assholes. I'm not saying everyone is, but there are a good bit there that I could have burned at the stake.

School sucks for the most part. I did really enjoy the lecture today in pathophysiology. We talked about the cardivascular system with the patho part and patient care included. It was 3 hours long, and I actually listened the whole time. It was very interesting. Did you know that the reason why men have a better survival rate than women when it comes to heart attacks is because their heart produces extra "channels" to reroute blood flow if there is damage to a particular part. Women do not normally get these until after menopause because of the production of estrogen and birth control pills (which gives you more estrogen - mine even has extra estrogen in it *cries*). This seems very interesting to me.

Another reason why I am so frustrated is because I DON'T KNOW WHAT I WANT TO DO! I think I do and either something stands in my way, or I learn more about it and it no longer appeals as much. Wound care nursing sounds great, and I loooove gross stuff like that (stop making those faces), BUT I would have to pay for out of school classes and take a $400 certification exam every 5 years to make not much more than a regular RN. Yes, I am also in it for the money. I guess my plan is still to get my masters....we'll see if I can find something. It's enough to make you want to rip your hair out.

OH, and any bastard in this world would be damn lucky to have Ms. Andrea Ware! Any who think differently are just duckheads.

Maggot therapy

Lately I've been thinking a lot about specializing in wound care nursing. I have to do a presentation about something of my choosing for my clinicals, so I chose maggot debridement therapy. I'm going to paste my handout for your knowledge and enjoyment.

Maggot Debridement Therapy (MDT)

MDT is the medical use of live, sterile maggots for cleaning non-healing wounds. The use of maggots for this purpose has been noted for centuries even as far back as the Renaissance. Many military physicians used maggots during warfare. They found that soldiers who had their wounds colonized with maggots had a lower mortality rate than those who did not.

Medicinal maggots are approved by the Food and Drug Administration (FDA). They are considered the only living organism allowed for production and marketing. The FDA say they are to be used only "for debriding non-healing necrotic skin and soft tissue wounds, including pressure ulcers, venous stasis ulcers, neuropathic foot ulcers and non-healing traumatic or post surgical wounds.”

Medicinal maggots have three mechanisms of action: debride wounds by dissolving only necrotic, infected tissue; disinfect the wound by killing bacteria; stimulate wound healing. This leads to reduced wound odor, earlier healing, and less pain.

Debriding is a difficult task for physicians because they are not very precise in removing only the necrotic tissue and not healthy tissue. This can create a larger wound, more bleeding than is necessary, and the infection can spread leading to sepsis or amputation of the limb. Using a physician or other means of debriding the tissue creates a longer healing time, and it can be very expensive.

Maggots digest nutrients through extracorporeal digestion where they secrete a broad spectrum of proteolytic enzymes that liquefy necrotic tissue. The maggots then absorb the dead tissue. They start at a size of 1-2mm, and they normally grow to about 8-10mm during the digesting process.

Maggots also disinfect wounds through their antimicrobial secretions. These secretions include allantoin (found in many shaving gels that have a soothing effect on the skin.), urea (used for protein metabolism), phenylacetic acid (used in the production of Penicillin), phenylacetaldehyde(used in perfumes), calcium carbonate (used in teeth cleaning products), and proteolytic enzymes (break down protein into simpler compounds). The bacteria that are not killed by these secretions are ingested and lysed within the maggots. This includes antibiotic resistant forms of bacteria such as Methicillin-resistant Staphylococcus aureus (MRSA).

Maggots promote wound healing in a few different ways. The most obvious is micromassage of the wound by the maggots. This stimulates growth of granulation tissue. The maggot secretions appear to amplify growth healing of epidermal growth factor which is a polypeptide hormone that stimulates cell proliferation especially of epithelial cells by binding to receptor proteins on the cell surface. In addition, they stimulate growth of fibroblasts (gives rise to connective tissue), slow-growing chondrocytes (mature cartilage cells), and cartilage-specific type II collagen (strong, insoluble fibers serving as connective tissue between cells).

Preparation of Maggots

Putrid meat is hung outdoors to attract the wild flies. After eggs are laid in the meat, the meat is transferred to ventilated glass jars until they hatch (8-24 hours). The larvae are fed brewer’s yeast and ground meat for seven days after which they are placed in a jar with clean, warm sand to pupate. The correct species are sorted from the adults.

The flies are placed in a cage with honey, yeast, and water. Temperatures stay in the human comfort range. Gravid female flies begin laying eggs on cubes of meat about a week later. Seven hours afterward, the eggs are washed off the meat into containers. The eggs are disinfected with 10% bleach, and then they are transferred to sterile cultures with a medium of agar, dry meat, and dry yeast. This culture is placed in an incubator at 27 degrees Celsius for 24 hours. Representative maggots from each dish are tested for aerobic and anaerobic microbes. The sterile maggots are shipped in bottles packed in ice.

Application of Wound Dressings

The wound is irrigated with sterile saline, and then a dressing is placed on the border of the wound to protect the skin from the maggots’ enzymes. The maggots are placed on the wound and held in place with nylon mesh. The area is lightly covered in gauze padding and bandaged.

The dressing should be changed daily to check the maggots and the wound. The maggots, however, should be removed every 2-3 days with new maggots being placed depending on the state of the wound (all necrotic tissue should be removed). The maggots need oxygen to survive, so the dressing cannot be anaerobic.

Pictures of maggot therapy!

Warning: these pictures are not for people who are grossed out easily.