Saturday, March 12, 2005

A Day to Myself

It is so nice to have a day to myself. I have absolutely nothing planned, nowhere to go & no one to refreshing. I have spent my morning putting my nclex books for sale on Ebay. I don't need them anymore! Woo hooooooo! May as well make some money, right?

I was so busy at work on Thursday night. I think it's because I told my preceptor "I'll take 3 patients from now on." What a difference it is from 2 patients...especially when one was a total care patient. I couldn't help but feel bad for him. He was a 72 yr old gentleman that is in end-stage renal failure & his AV shunt was clotted & infected. He came into the hospital a few weeks ago & has declined since then. It's sad to see that happen. In his room was his walker from home. After seeing him laying in bed, very confused & lethargic, it was hard to believe that he walked himself into the hospital just weeks ago. I don't believe he has been out of the bed since he arrived because his health deteriorated so much. He had an NG tube for feedings and because he was confused, we had to restrain his hands so he wouldn't pull the NG tube out. I don't like restraining people, even when it is in their best interest. It just seems so...I don't know the right words...I just don't like seeing them restrained to a bed against their will. The nurse I got report from was just awful. It made me question if he had even spent anytime reading the chart or even in the patient's room. He told me that the gentleman came in because of an infected shunt in his RIGHT arm, so they put a new one in his LEFT arm. That wasn't true, the infected shunt was in his LEFT arm & they put a new one in his LEFT arm because his right arm was ecchymotic & weeping a yellowish type fluid - I'm not sure what was going on with that. As we read through the doctors orders, we saw an order from TWO days ago to d/c his central line (because it was clotting) & put in a peripheral line. Where in the world did this doctor think we could put in a peripheral line? Definitely not in his left arm with the new shunt there & the right arm was totally off-limits with all that yellow fluid weeping out. Did the doctor even observe this patient??? Doesn't seem like it. Anyways, the real concern was why was this order not addressed on the day the order came in? We asked the day nurse & his reply "I never saw the order." What? Do you not read the chart? So what does my preceptor tell me - call the doctor & tell him it can't be done. Ummm....I'm supposed to just outright tell the doctor that? Is he going to be ok with that? It just sounded like I was setting myself up to be yelled at or at the very least, thoroughly questioned about a patient that I had just received a poor report from the day nurse. We paged the doctor, but (thankfully) he never called back. We did attempt to put an IV in, but it just wasn't happening. Looking back now, I should have documented all of that, but it slipped my mind totally. Now I know better. Charting is my weakness right now....when it comes time to chart, suddenly I can't think of the words to say & I'm usually good at putting my thoughts into writing. I'm working on it. Something else I forgot to chart on was respiratory. This poor man was practically drowning in his own fluids...he couldn't cough it up. We suctioned him, but couldn't get it all out. So I called the doctor at five am to tell him I needed an order for respiratory to suction & provide respiratory treatments. I'll talk about the dr's call a little later, but I did get the order. Respiratory came up, did what they could, but the man still had a terrible unproductive cough. I don't think I could ever be a respiratory therapist - it looks like torture when they do suctioning, not to mention the lovely looking fluids they pull out of people's throats...ugh. On top of all that, the day nurse tells me in report....look, his potassium level is 3.3 & that was at 5 am that morning. Why in the world did he not contact the doctor during the day?? The gentleman was on the potassium protocol, but that is only good for people with kidneys that function properly. So I had to contact a different doctor to get an order to help raise his potassium level. It amazes me that the day nurse had no clue what a low potassium level can do to a person - it can kill them! It was definitely an eye opener seeing that there are some nurses out there that just don't have a clue. They probably mean well, but that isn't going to make a person's health improve. This gentleman's temp had been as high as 104 during the day. There is a doctor's order that read "If temp is >101, get a blood culture & contact me for Ancef orders." We show it to the day nurse & his reply "I didn't see that order." I wanted to ask "Are you blind??" Since the patient's temp was down to 99 when I got report, we didn't contact the doctor. I definitely passed that important message to the nurse that took over after my shift in case his temperature did rise. It was 100.4 when I left. Did the day nurse not realize that a temp of 104 is not a good thing? I swear, he was the worst that I have encountered so far.

Well, next to the doctor phone calls. I don't know what it is, but it seems like 90% of the doctors on staff are from another country...which is fine, but I can't understand anything they say - especially over the phone. They talk so fast & with their foreign accents, I can only interpret like every 3rd word out of their mouth. When a doctor gives an order, we're supposed to write it down & repeat it back to him. That sounds nice in theory, but the doctor's usually don't want to take the time to have us read it back which I don't understand because it's in their best interest that the order is correct. This is what I hear "tkadjfaoireakfsaopokra, ok?" Huh??? Maybe it's cause I'm new, but I can't imagine ever being able to understand what these doctors are saying without the need to say "Can you repeat that?" Not to mention sometimes it's the middle of the night when I call & they are half asleep & mumbling their words. Hopefully in time I won't mind calling the doctor, but right now it's not on my favorites list.

My other patients were pretty easy to care for. One lady was in for chest pains R/O MI. She didn't have a MI, her labs were normal. I don't even see why she was still there after 3 days. She was asymptomatic, labs were normal & nothing was ordered for the following day. I had a new admit around 9 pm. He had been to his doctor that day & his pulse was 35. So his doctor sent him over for a direct admit. By the time he got to my floor, his pulse was 60 & he was asymptomatic. So he was pretty much an easy 23-hour observation. He was a very nice gentleman. I like doing admits...I like asking them 1,000 questions (on the admit form) & getting to know who they are & trying to make them feel comfortable with their hospital stay. I guess it's the customer service side of me from jobs in the past. He was in the same room as a long-time friend of my family. I don't think I told that story earlier...

I was at work a week earlier & the nurse's call bell rang. I looked at the screen & immediately recognized the name. He is a gentleman that was a really good friend of my dad's in the past growing up. He's known me since I was born! So I pick up the phone to see what he needed & he went on & on about something he bought in Chicago. That is not the norm...usually people call to say they have to go to the bathroom or need pain meds, etc. So I go into his room to see if he recognized me as I probably haven't seen him in about 10 years. He didn't recognize me, he was confused & just kept going on about this story from Chicago. That was so weird to see - someone I had known for a long time to be so disoriented. Anyways, when I came into work on Thursday, he was so much more with it & he immediately knew who I was. It was nice to see that he wasn't confused although at one time during the night he had gotten up & I thought he was trying to climb into bed with my patient! That wouldn't be the first time a patient has done that...that is one reason I don't like the semi-private rooms. You never know who your roommate is or what condition they may have. At my old hospital, every single room was a private room so I got used to it. Never had to worry about someone invading someone else's space. Most hospitals are not like that though, so I will get used to the semi-private rooms.

Anyways, the night flew by. I don't know how I'm going to be able to care for 5 patients. So much paperwork!!!! I guess it takes time to learn how to be organized. Tuesday is my last day of class...yay! Freedom at last! Now it's just work, work, work & I'm looking forward to it! I have a light week next week...I work on Sunday & Saturday, have class on Tuesday & many days off inbetween. I'm looking forward to have a few days off in a row.

Suddenly I am craving a peanut butter cookie - a nice, warm cookie. Hmmm...where can I get one of those? I'm really trying to eat better because I got on the scale earlier in the week & did not like what it said. So I've been eating pretty well since Wednesday & managed to lose the extra pounds I had gained this month. Now I just need to continue eating well & add in exercise so I can get rid of the rest that I need to get rid of. Easier said than done, right?


sekirley said...

Ahh ranal patients.  My favorite.  Today I had a renal patient with AMS.  Last dialysis about 5 days ago.  EKG showinf classic peak T waves and tather wide QRS's.  Pretty textbook HyperK huh, among other things.


stefaniwantsabmw said...

Thanks for sharing!  I am also going to school to be a RN although I have long way to go...It is nice to hear what to expect...