From a grammar perspective, fall is a noun, adjective, and verb and has many meanings. A few from Merriam-Webster Online (2010) include the following:
"to descend freely by the force of gravity"
"to leave an erect position suddenly and involuntarily"
"the distance which something falls"
"the season when leaves fall from trees"
"of, relating to, or suitable for autumn."
The two themes that these definitions cover serve as the inspiration for this article.
Falls are a very common accident. While not every fall results in injury, many times it causes fractures and soft-tissue damage. Recently, this became a personal challenge for me. Many of my experiences were similar to those encountered by plastic and reconstructive surgery patients. I thought I would share some of my stories highlighting some things nurses may not have thought about.
That was not the first time when I had left the erect position unexpectedly, but it was my first fracture. After a weekend of being in bed with intestinal cramping and a long day at work, I was really tired. While getting off a shuttle bus at the railway station, I missed a step and fell onto the concrete sidewalk. As I was unable to put weight on my left leg and had very blurred vision for several minutes, EMS (Emergency Medical Services) was called. The fire department staff was outstanding. They transported me to the emergency department. After x-rays, it was determined that I had a tibia plateau and fibula fracture. At this point, I learned that this type of fracture is not considered an emergency. Getting up my stairs to go to bed was a big challenge as was getting down them the next day to go to the orthopedic surgeon's office. Surgery was scheduled for 3 days later.
This was just enough time to get really freaked out about who would do my anesthesia and be the circulating and scrub nurses. I was so concerned about all the things that could go wrong that I forgot to tell the surgeon that I had an allergy to nickel until right before surgery. This almost caused the surgery to be cancelled until titanium implants could be found. The stainless steel implants have 5% nickel. Because I had tolerated stainless steel earrings and watch backs, the risk was determined to be minimal and surgery went forward. When obtaining the history of allergies, nurses should think outside the drug and food allergy box to include things that might have a bearing on implanted materials.
With a history of allergy to many different antibiotics, I was justifiably concerned about what antibiotic would be administered. Unfortunately, it was not possible to get the previous medical records from my surgery at a hospital in the same system. I was given Ancef (cefazolin sodium), which I appeared to tolerate during and immediately after surgery. However, shortly before I was discharged the next day, my face became very red. By the time I got home, my face and throat were red and swollen. Benadryl (diphenhydramine) for a few days relieved the symptoms, but this could have been much more serious. With a patient with so many allergies to medications that were previously tolerated, being alert to changes in appearance can help prevent undesirable outcomes.
Knowing all the bad things that can happen from having surgery was a bit overwhelming in spite of the fact that many surgical experiences result in the expected outcomes without complications. While this might be attributed to working in the field, patients are becoming more educated also. Perioperative care providers may be faced with an increasing number of patients apprehensive about surgery.
Before surgery, I had determined how much sick and PTO (paid time off) I had available and talked with the company that helps administrate when you have to take leave. My mind was at ease about being able to take the time off necessary without going broke. Unfortunately, the relationship with this company and my employer was very new, and wrong information was relayed. The lesson learned here was talk to the employer's benefits coordinator first.
Turning attention to the season, fall brings many gifts. It is always so special that first day one walks outside and smells fall in the air. It is a distinctive smell and is probably different depending on where one lives. It may be the wood smoke from the fireplaces and wood burning stoves, leaves changing, fall flowers, and/or pumpkins. Inside it may be the smell of the heater coming on for the first time in months, hot chocolate, cinnamon, baked goods, and/or warm blankets and sweaters. Fall brings Halloween and Thanksgiving, a time to have fun with family and friends. For Plastic Surgical Nursing, this time of year brings the focus issue. This year's theme was to be international aesthetics. However, world events brought a different opportunity. Bringing Comfort to Haiti is a collection of moving experiences and The Ethical Dilemmas of Aesthetic Medicine: What Every Provider Should Consider addresses some important issues.
Once inspired by the articles in this issue, consider sharing your observations and expertise with your colleagues by writing an article for Plastic Surgical Nursing. Submissions are conveniently accepted online at http://www.editorialmanager.com/psn, and I am very happy to mentor authors.
Please feel free to forward your comments to me and the editorial board by writing us at Plastic Surgical Nursing, American Society of Plastic Surgical Nurses, 7794 Grow Drive, Pensacola, FL 32514, or send an e-mail to Candise Flippin at [email protected].
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