Tuesday, March 22, 2005

What a night, what a night

My night started out well - I had the same patients from the night before, so taking report was very quick & easy.  I am not one to sit around & gab about my life like a lot of the other nurses - I like to get my assessments done quickly & my meds pulled before it gets crowded around the Pyxis.  So by about 7:50, my assessments are done & I'm just waiting until 8:00 to pass meds to my patients.  My charge nurse said "There is a patient in the ICU that is getting ready to be intubated & may code - do you want to go down there?"  I said sure - because the more you observe, the more you learn & get used to how a code situation goes.  So we arrive there & the doctor is just getting ready to intubate.  Our top surgeon was there also & he was putting in a central line because this guy had a bad IV site & they had to get some meds into him.  He didn't actually code to the point of needing CPR, but they did have him on a ventilator & called in the heart cath team.  I would have loved to observe the heart cath, but since this guy was in such grave condition, the doctor wasn't allowing it...grrr.  So back to my floor I go.  Later we got a call saying the patient had a triple ventricular aneurysm = death is imminent, there isn't anything they could really do for him to repair it.  :(  I don't like hearing stuff like that.

Around midnight I went in to give one of my patients her meds.  I was only in there a couple of minutes when she started having an asthma attack - I didn't know what to do.  My usual "try to take a few deep breaths" wasn't going to help her because it was impossible for her to take deep breaths.  My preceptor was off the floor on a break - so I approach the first nurse I see - a much, much older nurse.  I thought surely she must have experience with situations like this.  I say "My patient can't breathe, I don't know what to do."  This older nurse slowly says "Maybe you should call respiratory."  So I reply "How exactly do I do that?  I've never had to call them before."  She slowlyyyyyy looks around & says "Oh, there's the number."  I'm like panicked now because this older nurse seems so unconcerned that my patient is not breathing well.  Luckily another nursewas overhearing it & went immediately to the patient's room & confirmed that she was having an asthma attack & we needed respiratory "STAT."  So she calls them - which let me fill you in on our respiratory department = they hate when nurses call them.  I have never seen people so resistant to wanting to do their job.  It's not like we were asking for a miracle, we needed a breathing treatment & they are the ones who have the medicine to do breathing treatments.  So anyways, this nurse calls respiratory & is getting an attitude from them saying "We were just there a few hours ago & she was fine."  Hellooooooo....that was a few hours ago, she is not fine now.  I'm in with the patient while all this is taking place & I am feeling so unhelpful because there is nothing I can do to make it easier for her to breathe.  She already had 2L of 02 on, she was already sitting up on the edge of the bed leaning on her bedside tray - I could see the panicked look in her eyes & there was nothing "I" could do to help.  The respiratory therapist finally shows up, gives her a breathing treatment & within 2 minutes - she is back to breathing normal.  Thank god!  Meanwhile, the nurse that was helping me says "We need to call the doctor, there is nothing ordered for her & she needs some orders."  So she pages the doctor & then writes out what I should say to the doctor & what orders to ask for.  Did I mention that I don't like calling doctors?  So I was a little nervous about the upcoming phone call, but grateful that she wrote out what I should say so that I don't look like a total idiot when he does call.  I went back in to check on my patient & she is joking & laughing - totally back to the way she was before the asthma attack.  She was thanking me for being there for her & getting her help - I don't think she was even aware of how scared I was.  While I was in with her, the doctor called & the other nurse handled the call.  She said afterwards that it's a good thing she did because the doctor was being a complete a**hole on the phone for waking him up.  Ughhhhhh....they annoy me.  They get all the glory, but if only people knew how annoyed these doctors get when nurses advocate for the patients & call the doctors to get what the patient needs - and they give us such an attitude.  If only the patients could see how their doctor acts, they would definitely lose respect for them. 

Anyways, as I was looking at the med sheet, I see that she has respiratory treatments ordered for every 4 hours.  Turns out our lovely respiratory therapist "forgot" to come give it to her around 11 pm.  I pointed it out & he says "I was on my way to give her one."  Uh huh, sure buddy.  I tell him to please not be late the next time she needs one since it is so obvious that she definitely needs these treatments.  Sure enough, he showed up "early" for her next treatment - glad to see he paid attention.  Ok, back to the other nurse being on the phone with the rude doctor - she gets the necessary orders that we needed, doctor is not happy that we are telling him what we need.  They seem to be such control freaks.  As this is all going on, my preceptor makes it back from her break & says to me "Did something happen while I was gone?"  Ummm, yes, my patient nearly stopped breathing.  She says to me "Why didn't you page me?"  How????  No one has ever shown me how to page anyone in the hospital & not that it would have mattered, she was on a smoke break & was outside anyways.  Then she says to me "I wouldn't have handled it this way.  There was no reason for the doctor to be called."  Huh??  I was very grateful that I had an experienced nurse there that took control & helped me out.  The doctor had ordered 1 mg of Bumex (diuretic) & my preceptor was saying she didn't think the patient needed it, but since the dr. ordered it, go ahead & give it.  We put a foley in & sure enough....within 6 hours, she had a urine output of 1250 ml - that was a lot of fluid she was retaining. Later my preceptor said to me "You did the right thing, you needed help & you brought someone with experience in to help you. You made the right call." 

It was scary & I did feel helpless, but the outcome was good.  I probably overreacted, but I don't like seeing my patients in distress.  I still can't get over how slow that other nurse was..."Well, maybe you should call respiratory."  Maybe???  Ya think???  Lol..live & learn.  I definitely won't go to her next time there is a crisis. 

My second patient was pretty quiet the entire night - he just rested in bed.  My third patient has me convinced she's a hypochondriac.  She was complaining about her roommate coughing all the time & now she has pneumonia.  Well, the roommate has COPD & therefore has a chronic non-contagious cough.  My patient was constantly calling me into the room saying now she has a sore throat & she has chest pain from coughing so much & she's worried she's going to break a rib from coughing.  I talked to my charge nurse & we offered her a move to a different room.  Her reply "I already caught whatever this other woman has, why spread it to someone else?"  So I offer her some hot tea & she refuses it saying "What good will that do, I'm already sick."  Ok, I listen to her lungs.....all lobes were clear.  She's sitting there sucking away on cough drops convinced she has the flu or pneumonia.  Needless to say, I'm glad I was off tonight.

Although we had the championship game at volleyball & lost.  Oh well, we lost to a good team, so I'm not feeling bad about it.  We win most of the championships so I guess we can let another team win now & then.  

I'm working Wednesday night & Thursday night, then I'll be off for almost a week.  Time to get this house straightened up a little.  And also spend a little time with my niece & nephew - I haven't seen them since the beginning of the month.  I need to decide if I want to take them to Sea World or not...hmmm.  I guess I'll see what the weather forecast is next week & make a decision.   

1 comment:

alleypdorris said...

Hi, My name is Alice and I am a nursing student in Mississippi.  I stumbled on your journal and the first few entries really hit home.  

I will graduate in May and take NCLEX, god willing, lol, in June.  It was just refreshing to hear that there is someone else that shares some of my frustrations.  I mean I am in a classroom everyday with people that share the same feelings but at least you have some new insight.  

Thanks so much, again.