First week...complete...almost.

My first week on my own without a preceptor went well.  There is one thing I really like about being a nurse & there is one thing I really don't like about being a nurse....funny how they are one & the same = never knowing what type of patients you are going to have or how your night is going to go. 

I don't know why some people call nurses control freaks - because we have absolutely no control over how the night will play out.  There always seems to be little things that happen through the night...problems.  Most of the time there are quick solutions...medications, repositioning, some type of intervention to alleviate the problems.  Tuesday night I had one patient complaining of pain in her abdomen & heart burn, another patient who seemed A&Ox3, but yet would not call for assistance when she felt the need to get out of bed (a possible TIA pt), my third patient was a man who was very upset that he wasn't able to get discharged because his PT/INR was way too high and my fourth patient who was sooooo fixated on moving his bowels. 

I focus on my first patient because pain is not something to overlook.  Her daughter was at bedside & I noticed that the patient acted much different (more needy) when her daughter was around as opposed to when she wasn't.  It's also interesting to see how as people age, the roles get reversed.  This was a daughter caring for her mother so very much like a mother would care for her own child.  Anyways, I  give her some tylenol & later morphine to take care of the pain & allow her to sleep. 

My second pt - I kept reorienting her & having her do return demonstration on how to contact the nurses station should she feel the need to get out of bed.  I really did not want to have to restrain her, but I also didn't want her falling & breaking her hip either.  My third patient...his early morning PT/INR came back at something like 95.5/8.58 - soooooo very much outside of normal limits.  I call the doctor at 5:30 am & it sounds as though he is whispering his orders.  I ask if I can call him back from a different phone as the one I'm on...you can't control the volume.  He wouldn't allow it...he kept repeating his order.  I made him say it 3 times before I repeated it back to him...Vitamin K 2 mg IV x 1.  I run to the ER to get the medication.  Vitamin K doesn't sound like it could be all that dangerous, does it?  HA!!!!!!  (Nursing students, listen up - it will be a test question...lol).  It is the antidote for Coumadin - helps with the clotting factor.  It normally isn't pushed IV, it's usually a SQ or PO med.  The nurse in the ER questions the dose...saying 2 mg doesn't sound like much.  I run it by my clinical leader who is also an ICU nurse, she says it is the proper dose given the route.  I try to look it up online before pushing it & am unable to find anywhere on medline that shows it being an IV med.  I use my common sense & push it slowly after flushing his IV with 5 cc's of saline & following it with another 5 cc's of saline.  I find I have a few extra minutes so I google Vitamin K IV & find that it is indeed a very dangerous medication.  In fact, it says only cardiac nurses may push the drug, otherwise a physician has to administer it.  Then I remember...I am a cardiac nurse...lol.  The article goes on to say that some patients can go into shock immediately after administration which surprises me because 2 mg appears to be a very small dose in a syringe (0.2 ml).  Luckily my patient tolerated it just fine.  I am curious to see how his PT/INR was after that, but I won't find out until Saturday night. 

My last patient was a new admit around 2 am.  He was on a clear liquid diet & he was wanting prune juice.  He went on to say that he drinks 5 glasses of prune juice at night and another 8 glasses in the morning with breakfast (ick).  He was so fixated on moving his bowels...unlike anything I've ever seen before.  Since he couldn't have prune juice because of his diet orders, he seemed to think that drinking warm water would stimulate his bowels <sigh>.  Why do older people get so fixated on their bowel movements???

Needless to say, I was glad when my shift was over.  I was tired, needed sleep.  No more than 60 minutes after getting home, the hospital was calling & asking if I wanted to work a 4th shift Wednesday night.  No thanks!  They called again today asking if I would work Saturday night.  After adding up what I would make for one extra night of work, I found it hard to resist...nearly $500.  So I am most definitely doing overtime! 

There is a job fair next week - time to see what else is offered in the real world.  Stay tuned!!!  :)

 

Bet you're wondering!

Hi to all those that take the time to read my journal - keep posting & writing to me.  I really enjoy it.  And I'm sure you're all just going crazy with the suspense of wondering how my first night without a preceptor went for me, aren't you?? 

Well, worry no more - it went great!  Probably because I only had 3 patients.  :)  I must say, at the beginning of the shift, I was a little anxious because my first patient's heart rate was between 160 & 170.  Wayyy too high for my liking.  The day nurse had called the cardiologist & he ordered Lopressor PO...ugh!  So she gave the dose at change of shift & I had to wait about 45 to 60 minutes before it had any real effect.  Eventually it was between 80 & 105, but anytime he moved it would shoot right back up to the 150's.  Grrr!  He had a heart cath done on Monday which was negative.  So who knows what is going on with him.  My second patient was an older woman who had been admitted a month ago.  She went into cardiac arrest at home, the paramedics revived her, she coded again in the ambulance on the way to the hospital so the paramedics revived her again.  She was admitted to ICU where she had yet another cardiac arrest - they saved her.  Eventually she was moved to PCU (my unit), she went into cardiac arrest again!  Revived & back to ICU...cardiac arrest once more, revived yet again.  This all happened in about a 1 to 2 week span.  By April 9th, she became a DNR & wouldn't you know it - she hasn't gone into cardiac arrest since then!  She slept pretty much the entire night & was discharged before I got to work yesterday. 

My third patient is an older woman also who came in with a UTI, sepsis, aspiration pneumonia & altered mental status.  She was perfectly alert & oriented both nights.  Had to crush her meds & feed them to her with pudding.  Not much to really say about her. 

So my first night on my own, I had 3 patients - everything went pretty smooth.  Last night (my second night) I had 4 patients.  The same two above minus the one discharged yesterday.  My two other patients were a gentleman that was admitted with chest pain R/O MI.  He was on a zillion meds, but no complaints of pain or discomfort.  And my second patient was a new admit - an 81 yr old woman admitted with a possible TIA.  She had been in the ER since 9:30 am & didn't get to my floor until about 10 pm!  I would go crazy sitting in the ER for that long.  She was perfectly fine with me....no signs of neuro deficits & her labs were great. 

I did have a funny episode my first night.  I had received a wet read of an ultrasound that showed one of my patients had DVT's bilaterally in both lower extremities.  So I call the Dr. - it was about 10:30 pm when I called for the first time.  I got no call back.  So I wait 20-25 minutes & call again.  No response.  I wait another 20 minutes & call again.  This time the answering service puts my call right through to the Dr.  So I say "Hello Dr., so & so's ultrasound reading came back & this is what it says...".  He then proceeds to ask me if she's on any aspirin.  I reply "yes she is."  He asks if she's on any Lovenox.  I reply "yes she is, but it was held today because her hemoglobin was too low."  Then I hear silence.  I'm waiting & waiting for a response figuring that he must be thinking what to do next.  Nope, he fell asleep on the phone!  I say "Hello, are you still there?"  He wakes up & has me reread everything we just talked about.  Silence again - not a peep out of him, not even a snore.  I say "Hello????"  He wakes up & we repeat the conversation yet again (beginning to feel like I'm in my very own version of the movie Groundhog Day...lol).  So we repeat the conversation & his reply now is "What would you like to do?"  Huh????  What would I like to do for a patient that has blood clots in her lower extremities?  I didn't know I had the authority!  As much as I wanted to say "I would like to go home", I explained to him that the reason I was calling him was to find out what to do for this patient considering the results.  He gave me an order of Lovenox twice a day instead of once a day & said he'd follow-up in the morning.  Awww, those poor tired doctors!  <g>  Needless to say, it was later discovered that she already had a Greenfield filter put in a couple of months ago & thus the doctor discontinued the Lovenox & isn't worried about the clots. 

So that was my past 2 days in a nutshell.  I am pretty tired & heading to bed......sweet dreams!

I am a nurse.

My last night with a preceptor went well.  I pretty much handled everything on my own, but I think I'll always have a few questions to ask here & there.  It was my first night having 5 patients.  They were all ladies - very nice ladies.  My first one was in with an allergic reaction.  She's 49 yrs old, was in a motorcycle accident last year that pretty much destroyed her left foot.  She was on antibiotics to control the infection & even though she had been taking the antibiotics for over 6 months, she somehow developed an allergic reaction to one of them.  The thing is - they don't know which antibiotic is causing the reaction.  So they have taken her off all antibiotics for a few days & will restart her on them one at a time to try to figure out what is causing the reaction.  She has to have antibiotics in order to fight off the infection, so they need to figure out what will work for her.  I felt bad for her, she was itching all the time.  She had a red rash all over as well as a prickly type rash where you could see the red raised bumps.  She did a show & tell with the x-rays of her left ankle & leg.  It's unfortunate, she'll probably never be able to bear any weight on that leg because it was so mangled in the motorcyle accident. 

My next patient was a new admit, an older woman (in her late 80's) that came in with difficulty breathing.  She was exhausted from being in the emergency room for so long, she just wanted something to eat & to get to bed.  She had a really bad cough, one of those where you cough so much it actually hurts your body.  I showed her how to use a pillow to splint while coughing.  She said it helped a little. 

My third patient was another older woman.  At the moment I can't even remember why she was there.  Aacckk, I'm losing my short-term memory!  Oh wait, she came in because of syncope (dizziness).  She has muscle spasms that travel from one leg, then across her back & down the other leg & she loses her ability to stand.  Her & my first patient were fixated on having a bowel movement - funny how people in the hospital are so focused on that.  Gave her a little prune juice & she slept pretty quietly through the night.

My fourth patient came in with a nosebleed that would not stop along with pneumonia & a COPD exacerbation.  The bleeding had finally stopped the day before, but now instead of coming out her nose, it was going into her intestinal track & she had a consult with the GI doctor today.  She kept asking me for a back massage - as if I was a massage therapist.  Needless to say, that didn't happen.  I didn't have the time to devote to giving massages.

My fifth & final patient was a woman on reverse isolation.  Her WBC count was 0.5 - that is very, very low.  She also was very pruritic (medical term for itchy...lol).  They didn't know what was causing her to be having that reaction, but luckily the medication we switched her to finally kicked in after a couple of hours (Atarax).  After being in her room & my first patient's room - I was suddenly starting to feel itchy after watching them scratching all over - weird how that happens, isn't it?  Although I think my itchiness is from changing both my laundry detergent & fabric softener.  Thing is, I'm not sure which is causing the reaction.  I guess I'll throw them both out & just go back to my usual. 

Anyways, another uneventful night.  Uneventful - I like that word.  It sounds so meaningful & descriptive, doesn't it?  Basically it means the night went well & there were no crazy episodes that had me running around not sure of what I was doing.  My preceptor filled out my final evaluation form & my check-off skills pages (so to speak).  And that is it.  The past 10-12 weeks have flown by.  Amazing how much I've learned & how much confidence has been built up.  I'm no longer a student nurse, no longer a grad nurse, no longer an orientee.  I am finally on my own.  I am a nurse. 

This is it!

Tonight will be my last night with a preceptor!   We had a department meeting last night.  Afterwards one of the clinical leaders asked me if I thought I was ready to be on my own.  I do feel ready, for the most part anyways.  I know I'll encounter situations in the future that I haven't dealt with yet & that makes me a little nervous, however, the only way to deal with it is to experience it first hand, right? 

One nice thing about this hospital, we get to set our own schedules.  So I'll be working Sun, Mon & Tues for the next 2 months.  I like it because I still have my weekends free for the most part.  Gina pretty much has the same schedule.  I wonder if they'll split us up (our dept is on 2 floors).  I hope not, it would be nice to help each other out if we need help. 

Work went well over the weekend - pretty much uneventful with my patients.  When I arrived at work Sunday night, there were 2 patients on the floor that needed to have a thorocentesis.  I observed the first one & then assisted in the second one.  It was interesting.  The doctor was polite, welcomed me to the hospital & explained what he was doing step-by-step.  My patients on Monday were pretty easy to care for.  I had one that was confused & had to have wrist restraints on so she wouldn't pull out her IV or try to get out of bed.  She even tried to bite me!  It was like dealing with a toddler.  So strange how some people do revert back to being a child as they age.  One of my other patients asked why I was checking on her so often.  I said I just wanted to make sure she was ok (I had the time to check on them).  She replied "The other nurses I've had hardly ever came into the room."  How sad!  I felt like a mama bear checking on her cubs...lol. 

My friend Julie's grandmother passed away yesterday morning.  I'll always remember her saying to me years ago "Who are you keeping company with?"  My thoughts & prayers are with you Julie!!!

Ok, time for me to get some sun.  It's another beautiful day here in Florida & I've already slept for nearly 10 hours - so I'll probably be up the rest of the day & rely on some caffeine to keep me up through the night.  Gina's working tonight also, so I'll have someone to chat with.  See ya!

Beautiful Day

I'm just getting ready to head to work in about 10 minutes.  It is a beautiful day here in Florida - sunny, breezy, cool - just beautiful.  I hope it's like this during the week so I can get some sun & maybe even a little yardwork done. 

I worked last night - it wasn't bad.  Only one episode of chest pain (not mine) that lasted approx 5 min.  Her cardiac enzymes (2 sets) were both negative, so I don't believe it was heart related.  I had another gentleman that came in because his left hand had been numb & he was having a hard time moving his fingers.  While filling out the admitting assessment form, there is a question regarding "drug use" - as if anyone is actually going to tell me they do pot, cocaine, heroin, etc.  They all say "No, never" or "many many years ago."  I got the same response from this gentleman, but people - anytime you come in with stroke like symptoms, they are going to do a drug screen on you.  I won't say what his results were, but he was lying to me <sigh>.  By morning, he was able to move his hand/fingers & was feeling better.  We'll see how he's doing when I return tonight.  My other two patients were pretty manageable - another lady admitted with chest pain & a gentleman with a pneumothorax.  Both rested quite well through the night.  I'm hoping for another good night tonight. 

On a good note, Dale Jr. finally placed in the top 10 in today's race in Texas.  Go Dale, go Dale - win it next time!  #8

Peace, y'all!

 

Amusing, yet true

A Graduate Nurse throws up when the patient does.
An experienced nurse calls housekeeping when a patient throws up.  (I run in the opposite direction).

A Graduate Nurse wears so many pins on their name badge you can't read it.
An experienced nurse doesn't wear a name badge for liability reasons.  (I don't even have my last name on my badge, much less any pins!) 

A Graduate Nurse charts too much.
An experienced nurse doesn't chart enough. (I feel like I don't chart enough, but I probably chart too much.)

A Graduate Nurse loves to run to codes.
An experienced nurse makes graduate nurses run to codes. (Yep, I love running to codes, haven't participated in any yet...but I am a voyeur in these situations.)

A Graduate Nurse wants everyone to know they are a nurse.
An experienced nurse doesn't want anyone to know they are a nurse. (Yep, still proud to say "I'm a nurse.")

A Graduate Nurse keeps detailed notes on a pad.
An experienced nurse writes on the back of their hand, paper scraps, napkins, etc. (Napkins come in handy!)

A Graduate Nurse will spend all day trying to reorient a patient.
An experienced nurse will chart the patient is disoriented and restrain them. (Hmm, suppose I should reorient my patients, but I don't restrain them, well at least not too often.)

A Graduate Nurse can hear a beeping I-med at 50 yards.
An experienced nurse can't hear any alarms at any distance. (This is one of my pet peeves, I cannot stand to hear an IV pump beeping continuously.  It seems to be true though, the experienced nurses are unable to hear the annoying sound, but I can detect it even if the room is on the other side of the hall at the opposite end.)

A Graduate Nurse loves to hear abnormal heart and breath sounds.
An experienced nurse doesn't want to know about them unless the patient is symptomatic. (I don't like hearing themcause it usually means I need to do something about it!)

A Graduate Nurse spends 2 hours giving a patient a bath.
An experienced nurse lets the CNA give the patient a bath. (I've done my share of baths as a patient care tech, time to let the CNA's have their turn.)

A Graduate Nurse thinks people respect Nurses.
An experienced nurse knows everybody blames everything on the nurse. (I'm starting to see that the nurse does get blamed for everything, but I think we're still respected...at least I hope we are.)

A Graduate Nurse looks for blood on a bandage hoping they will get to change it.
An experienced nurse knows a little blood never hurt anybody. (Not me, I don't want to see any blood anywhere - cause once again, it usually means I need to do something about it.)

A Graduate Nurse looks for a chance "to work with the family."
An experienced nurse avoids the family.  (I'm not crazy about patient's families.  I understand their need to be involved, but they do create extra work/stress to the situation usually.  But I do understand, if my family member were in the hospital - I'd be one of those annoying family members wanting to know all the information possible.)

A Graduate Nurse expects meds and supplies to be delivered on time.
An experienced nurse expects them to never be delivered at all. (Yeah, I'm still a believer that meds should be delivered on time.  I try my best to accomodate.)

A Graduate Nurse will spend days bladder training an incontinent patient.
An experienced nurse will insert a Foley catheter. (The foley sounds much better to me!!!!!)

A Graduate Nurse always answers their phone.
An experienced nurse checks their caller ID before answering the phone.  (I only answer if I absolutely positively have to!)

A Graduate Nurse thinks psych patients are interesting.
An experienced nurse thinks psych patients are crazy. (I don't even want to think back to psych clinicals, but it's true - even if you aren't a psych nurse, you will be dealing with psych patients in the hospital.)

A Graduate Nurse carries reference books in their bag.
An experienced nurse carries magazines, lunch, and some "cough syrup" in their bag. (No reference books here.....magazines most definitely!)

A Graduate Nurse doesn't find this funny.
An experienced nurse does.  (I think it's very cute!)

Inspiration

I came across this & I find it inspirational...

There have been situations in your life that you thought you would never get through. And yet, you did.

There have been challenges you faced that you thought you would never overcome. And yet, you did.

There have been losses you've suffered that you thought you would never be able to get beyond. And yet, you did.

For you are here today, stronger, wiser, more experienced and more knowledgeable as a result of it all. Though the road has had its rough spots, you've successfully made your way along it.

There will certainly be more rough spots ahead, and there may even be some particularly difficult ones right now. So it pays, every now and then, to look back and remember that even though you thought you wouldn't get through, you did.

And perhaps, if you think about it, you'll see that there's really never any reason to doubt yourself. For when life challenged you to make your way through, you did.

And now, even more importantly, you will.

-- Ralph Marston

Overwhelmed yet energized

Warning - this is going to be a long entry.  

I worked Sunday night - it was a challenging night.  I walked in to do an assessment on my first patient only to find the infection control doctor walking out & saying "The patient is unable to move anything on his left side, is this a new development?"  Ummm.....let me check, nothing was mentioned in report.  Do my research, it is a new development.  Called the admitting doctor, received some orders, one of which was to call for a neuro consult. The neuro doctor came in right away & saw the same stuff we were seeing....no movement on the left side.  The patient was responsive, A&O to his name & location, answered most questions appropriately.  Neuro doctor wants a CT scan of the brain.  We get that done & find that it is negative.  Hmmm...seems very strange that the patient is unable to move the left side of his body, but the neuro doc says all we can do right now is continue to monitor.  My other patients that night were for the most part stable.  I did receive a new admit with chest pain, but they gave her some nitro & lopressor in the ER & by the time she got to me, she was stable & ready to go to bed.   

Fastforward to tonight...my night was the most overwhelming I have experienced so far as a nurse...at least as far as patient conditions go.  Yet here I am nearly 12 hours later & feeling ok...not even one bit frustrated...probably still in shock...lol. 

I had 4 patients.  Two were stable...yay.  Two were not...boo.  My patient that was unable to move the left side of his body was now nearly unresponsive.....wouldn't say a word, just staring off into space.  The night before when I had him, he could answer questions & would speak a little.  Last night...nothing.  It was downright eery!  The  ex-wife was there as well as his daughter...which just made things more difficult.  I came into the room at change of shift & met the ex-wife, she was at his bedside holding his hand.  So I inform her the doctor ordered another CT scan of the brain (again) & the transporter was there to take him.  She starts crying....hysterically crying.  We tell her everything is fine, his vital signs are stable, the doctor just wants this procedure done to find out what is going on with him.  She calms down, we get him on the stretcher & the transporter tells her she can go with if she wants - bad idea - but she goes with.  While they are gone, the daughter comes walking towards the room...sees that his bed is empty & assumes he died & that we've already gotten rid of his body in the 20 minutes that she was gone (???).  So she comes running in, starts hysterically laughing mixed with a little bit of crying - it was the most bizarre thing I've ever seen.  She falls to the floor!  We get her to sit in a chair & relax, your dad is ok...just went for a procedure, they will be back soon, your mom went with him.  She sits in the chair, trying to breathe & finally relaxing & then goes for a walk.  Next thing I know, she is running down the hall towards me, yelling my name saying "Jenniferrrrrrrr, my mom just called & says they are taking my father to the OR for emergency surgery!!!!!!!!"  Huh??????  I said no, that can't be right, they would notify us if this were happening.  She's ready to freak out again & keeps repeating "Emergency surgery!!!"  Then her mom calls & says "no, it was a patient mix-up."  The (grrr) people down in x-ray mixed up their patients & were trying to take mine to surgery - just what the family members needed to see or hear.  An incident report was written up on that.

So we get him back to the room & he continues to be unresponsive.  Next thing I know, the ex-wife is hyperventilating & then drops to her knees & starts throwing up in the trash can.  Ugh!!!!!!  The daughter starts in with her hysterical laughing/crying episodes.  My preceptor comes in & we start assessing the patient together while other nurses & techs are helping the family members.  At the same time, my patient in the other bed is asking if he can have a cup of ice...as if nothing is going on around him...lol <sigh>.  My preceptor tells me I need to call the doctor, that this patient is getting worse.  So I call the neurologist - no call back.  Call him again - no call back.  Call his admitting doctor -he gives me a few orders & when I ask about possibly transferring him to ICU, he says no, they can't do anything more for him than you can on your floor.  Uhh...hello......I have 5 patients, in the ICU, they only have 1 or 2 patients to a nurse - he can be closely monitored there.  So he says to wait & see what the neurologist says.  Ok, fine. 

In the midst of this happening, my other unstable patient is complaining of chest pain radiating down her left arm.  So I go check on her......I know it's something serious.  My preceptor is gone somewhere, so I ask another nurse for help.  She gladly helps - I have to say, my co-workers are helpful when you ask for help.  So she is helping me with this patient, the charge nurse also starts helping.  My preceptor comes back & takes over that patient & tells me to focus on my unresponsive guy.  Ok, good...cause I really can't do 2 things at once with different patients.  The neurologist calls back, my call gets intercepted by another nurse who is asking him something non-important - he yells at her cause he thinks she's the one that called him "stat" over something non-important.  He hangs up on her. 

Great.......so I have to call his answering service again & now I'm worried he's in a bad mood & will yell at me too.  He calls right back, I talk to him about my unresponsive guy & this is the first time where I feel like I'm having an actual conversation with a doctor & not simply taking orders.  I feel like I just might finally know something...lol.  He's as wonderful as can be, not only gives me some medical orders - but explains why he's ordering it & he says the patient needs to go to ICU.  Ok, great!  That's what I was thinking too.  Told him "thank you very much" & he was just as nice back to me.  :)  I'm getting so much better at these doctor calls, aren't I?   

Now I need the patient's chart.  It's NOWHERE to be found.  We search everywhere.  My preceptor calls down to radiology where he had his CT scan done.  They basically tell her they don't know where it is & it's not their problem, then they hang up on her!!!!!!  The nursing supervisor was present when this happened (yay!) & she went down there to find it & to also write-up whoever it was that hung up on my preceptor.  They did have the chart down there.  I write up my orders, finish up my nursing notes, call report to the ICU nurse & take my patient over there along with the hysterical family members - who have calmed down a little because my preceptor sat down & talked to them - thank god I had her there to help.  We get my patient to ICU....he actually speaks a couple of words while there (figures!!!!!!).  I was saying to him "Can you hear me???"  He mumbled "Yep."  I said "Say something!"  He said "Something."  Lol....but that was it, non-responsive after that.  We thought for sure he was having a stroke - but the CT scan was negative...so who knows what is wrong with him.  I go over the orders with the ICU nurse who is not happy at all.....the orders weren't 100% correct, she knows I'm an orientee but wasn't giving me any breaks.  I wasn't the one that put the orders in, other nurses did & then handed it off to me to get to ICU right away....but since it is my patient, I was responsible for them.  I do understand that & in the future I am sure I will learn how to do things perfectly, but for now, I'm learning.  Some of these nurses act like they've never been the new nurse on the block. 

Soooooo....I get back to my floor & I'm not there 60 seconds when the charge nurse says "Jennifer, ER is on the phone to call report for your new patient."  What?????  It's now about 11 pm.....I have not sat down since taking report from the day nurse at 7 pm!!!  My other patients still need their evening medications.  I quickly administer those & I take report from the ER & my preceptor tells me she has handled everything with my other patient that was having chest pain...whew.  My new patient is also being admitted with chest pain.  We get her to her room around 11:30, do my physical assessment, get her paperwork in order, she's complaining of chest pain, rates it at a "6 or 7"...feels "heavy, aching."  Get her some sublingual nitro tablets...give a total of 3, 5 min apart, no change in her pain level - only now I've added to it because it is burning under her tongue because of the nitro.  Labs are drawn (cardiac enzymes to rule out a heart attack - these are her second set - first set CKMB was slightly elevated, troponin was 0.10 which is within normal limits).  I'm constantly checking the computer for results...keeps saying "pending."  My preceptor gets back from her break, calls the lab to ask where the results are (it's over an hour now, so much for "stat" labs) & they read them off to her over the phone & will put them in the computer shortly.  Her cardiac enzymes were sky high - the highest I have ever seen!!!!!  The lab person who received those results should have been on the phone to us immediately. I don't remember exactly what her CK was or the mass, but Troponin was now 4.06 or something like that.  Normal level is 0.0 to 0.49.  Needless to say, she's having an acute MI (heart attack) right now!!!!!!   

So another call is made to a doctor...a cardiologist this time - a doctor who has never even seen this patient.  He was to have a consult with her today.  Anyways, I read the lab results to him & even he is like "Wow."  He gives me some orders, among them......transfer pt to ICU.  So we go through the whole routine again.  This time it went a little smoother, but still......time consuming.  At the same time, the other ICU nurse that took my first patient is wanting to talk to my preceptor to complain about the orders or something.  We take the second patient to ICU, then I go back to my floor, my preceptor goes to calm down the ICU nurse who has no compassion for me being a new nurse. 

I'm not back on the floor more than 5 min when the charge nurse is once again......assigning me another new admit.  Ughhhhhhhhhhh!!!!!!!  It's now 3:30 am, I have had no breaks, have not really even sat down much or even done any charting.  Luckily my preceptor took the new admit so I could get caught up.  All the charge nurse cares about is filling up the beds because it makes her looks more efficient.....she doesn't care that I am over my head in paperwork, have barely had any time other than to quickly check on my remaining patients & all that stuff. 

The next admit is a patient complaining of chest pain & has a blood pressure of something like 86 over 48--------so unstable!  Thank god my preceptor took her.  I did manage to catch up with the paperwork & left on time.  My preceptor was saying she has never had a night like this one & that they happen so very rarely.  Figures it happened to me. I'm proud of myself though, I kept calm & cool.  There were a couple of moments where I just wanted to cry.....not because I was emotional, but just stressed & needed a release.  Other times I felt like screaming....lol.  I'm feeling good right now....tired, but good.   I am off until Saturday night....time to rest & recover. 

Only 4 days left with my preceptor (I think).  After last night, it's scary to think about being totally on my own, but it's also comforting to know that others will jump in & help when needed.  Although I know in the future my preceptor won't be so readily available if she has 5 of her own patients to care for.  Oh well, I guess this is how you learn the ropes, by getting hands on experience.  I'm not complaining one bit though!  :)

Update

It worked out - I have a new tenant!  He's a carpenter/contractor & is coming over tomorrow to measure for new carpeting & tile.  The deal in exchange for all the work he's going to put into it is 2 months rent free.  It would have cost a lot more than that for me to fix it up myself & I wouldn't even know where to begin.  He is hoping to have the carpet in & the walls painted so he can move him & his family in by the end of the week.  I still am in shock that this is working out as well as it is.  What a nice ending to a miserable early morning!  One less thing I have to take care of <whew>!

Ugh

It was just one of those nights: never-ending yet time was flying by.  I got to work & found out I would be with a different preceptor & on a different floor - a floor that I'm not crazy about mostly because there is no room to do any charting & people are always talking - it's so distracting.  Plus on this floor, rarely do they have a tech & we also didn't have a unit secretary.  Which is fine if you have patients that are self-care & no new admissions.  Unfortunately, my 3 patients were total care & I got a new admission around 4 am.  I'm not going to go into details, because I'm tired & want to forget the night.  I'm frustrated because I felt like I could never catch up.  As soon as I got one thing done, 10 more things suddenly had to be done...it was never-ending. 

On a good note, I came home this morning & about an hour later there was a knock on my door.  It was the same guy that was knocking on my door last week.  Turns out he wants to rent my home invaded rental house.  :)  Can it get any easier than that?  He knows my ex-tenant, knows about the home invasion & shooting and is still willing to move in & pay what the rent was with my ex-tenant.  I have to do a background check & get some references from the guy - hopefully he'll be decent & will save me from having to fix up the house & search for a new renter.  He's willing to take it "as is" & will fix it up himself.  Please, please let this work out!

Nap time for me - have a great weekend everyone!

Time to catch up

I put in a 60 hrs in less than a week!  Wed, Thurs, Sat, Sun & Monday night.  I think I'm finally caught up on my sleep - got 8 hours yesterday during the day & slept another 4 last night.  I have today off, then back to work tomorrow night.  I feel like all I do is work & sleep.  Oh well, at least I don't have to study anymore & the money is good.

Wednesday night was my rough night.  I had 3 patients.  One admitted with a TIA that was to be discharged the next day.  He was stable, no complaints.  Another was admitted for chest pain, but turns out he had a twisted bowel.  He was stable, c/o abdominal pain but didn't want anything for it.  He said it happens every time he eats & it would go away on its own.  My third patient was discharged that evening & I got a new admit.  A "regular" at our hospital.  He had end-stage renal disease, was on dialysis - when he has it done, he c/o of shortness of breath, so the dialysis nurse sends him to the hospital, he's admitted for a few days, then goes home & the same scenario is played out the following week.  He was confused & disoriented when he got to the floor, but seemed content to sleep.  Around 2 am, my patient with abdominal pain - his telemetry strips were reading frequent PVC's.....go in to assess him, he continues to deny any chest pain.  The PVC's are getting more & more frequent, take a look at his K+ level & it's 3.3 and was never addressed by the doctor <sigh>.  Go in to reassess him, now he's vomiting & c/o chest pain.  Put out a call to the doctor.......no call back.  While this is going on, my other patient - with end stage renal disease wakes up & claims "I am having the worst chest pain I have ever had in my life."  Uh oh...don't like hearing those words.  I place a call out to his doctor.  He calls back, says to give him 2 mg morphine & he'll check on him in the morning.  Um, ok.  Back to my first patient with chest pain.....place another call to the doctor.  No call back.  It's almost 3 am now.  Wait 15 min, call again......he finally calls back.  I tell him the patient's status, he orders K+, prevacid, nitro & an EKG.  I hang up the phone & my charge nurse says that's not good enough - it isn't treating his current problem of PVC's & did I mention he had been sustaining a heart rate of 160's to 180's for the past hour?  She puts a call out to the patient's pulmonologist.  He calls back, they hand the phone to me (you know how much I love talking to doctors in the middle of the night, especially with someone in extreme condition).  I tell him what's going on & his reply "Why are you calling me?"  I can't exactly tell him the charge nurse made the call nor can I say we didn't like the orders that the admitting doctor gave.  So I skip over that & simply say "We need some orders to treat his current condition."  So the pulmonologist starts rambling off different medications & when my charge nurse saw me writing "Cardizem bolus, then titrate to heart rate of 120", she is calling ICU & telling them to get a bed ready.  She as well as another nurse or two jumped in to help...get another IV site started as well as packing him up in order to get him to the ICU a.s.a.p.  I'm writing the doctor's orders as well as writing my nurses notes & charting everything possible before turning the chart over to the ICU nurse.  We get the patient to the ICU & he is now having runs of V-tach.  Not a good thing.  I went back to my floor around 5:30, praying that he's going to be ok.  Luckily my other 2 patients were stable.  The other one with the chest pain responded fine to the morphine & had no further c/o pain.  I went home that morning mentally exhausted & worried about my patient in the ICU (as well as trying to figure out what was going on with my house that had the home invasion/shooting).  I had a feeling since the beginning of that shift that he was the type of person that didn't want to bother anyone.  I must have asked him at least 10 times if his abdominal pain was getting any worse or if he had any chest pain & he kept denying it.  Perhaps he was in denial & just hoped the pain would go away or perhaps he just didn't want to bother us - but I wish he would have said something sooner.  He was apologizing to us while we were getting him ready to go to ICU...apologizing for bothering us & thanking us for taking care of him.  He was apologizing to his roommate for keeping him awake all night.  Poor guy!  More worried about others than himself.

I returned to work that evening & worked with a different preceptor.  I was praying for a better night & I received it.  I had 3 patients.....all self-care & all who had no complaints the entire night.  They either rested in bed or slept my entire shift.  I looked up my ICU patient in the computer to make sure he was still alive.  He was!  I checked out his cardiac enzymes & they were negative......I was amazed considering all that his heart was dealing with early that morning.  I was relieved to have a quiet night.

I came home Friday morning, went over to my rental house to see what kind of condition it was in, then came back home & wasn't really tired.  I got maybe 45 min of sleep that day.  That evening I met some friends at the mall to watch Julie's 5-yr old daughter, Morgan, in some type of model fashion show.  She did great - she's adorable!  Then I went to have a couple of drinks with Kelly & we saw the movie "The Upstage of Anger."  I was trying my hardest not to fall asleep during the movie.  I was exhausted! 

I returned back to work Saturday night - I hate the first night back to work because you have all new patients & getting report from the day nurse is so time consuming.  Although with this group of patients I got, the day nurse really didn't tell me much at all - I had to search through the charts to get the info I needed <sigh>.  I decided that was the night to move up to 4 patients on my own.  That was time consuming as well as it being daylight savings time & I was losing an hour.  My first pt had necrosis on his right foot.  He was a really friendly patient, got to talk to him for a little while about different things.  He had a few complaints about pain, which I gave him Lortab...other than that, didn't hear much from him through the night.  My second patient - who happened to be the most stable - ended up being the most bizarre.  He was in for a possible TIA - the doctors weren't really sure what was going on with him.  He was alert & oriented, lovesssssss to talk & talk & talk.  Very easy to care for, no complaints through the night.  My third patient was this very obese woman who had come in on March 17 to have bowel surgery & a colostomy.  She was in the ICU for a couple of weeks, then downgraded to my floor.  Being that she was obese, she could barely move.  She was confused most of the time - seems she thought she was shopping in K-mart, kept asking me how much everything in the room costs.  She was on TPN before being transferred to my floor, switched to a pureed diet - which she was refusing to eat.  So their was a consult with the GI doctor to put in a PEG (feeding) tube.  The GI dr. called me & told me to call the family & find out their wishes.  I called her Power of Attorney/family member & he said she didn't want a feeding tube & he wanted to follow her wishes.  My fourth patient was a transfer from med-surg who was allergic to practically every antibiotic, so they were starting her on this new one & she had to be monitored closely for any reaction.  Luckily she had no reaction to the antibiotic.  My night was pretty good...just busy trying to keep up with all their medications & charting.

I went in on Sunday night - I had my same group of patients.  Report was quick & easy.  My only problem patient was the one with the antibiotic allergies.  There was an order for her to wear an sequential (anti-embolic) compression device (SCD's) - basically these things that you put on a person's legs that gives them a massage every few minutes while they are resting in bed - it keeps the blood flowing, decreases possibility of blood clots.  She hated wearing it & would complain every chance she got.  She would keep calling me back to the room & ask if she could have them off.  I tried educating her on the importance of wearing them & she continued to complain non-stop.  I think it was more of a control issue - she didn't like having to do something she didn't want to do.  I told her she was welcome to discuss it with her doctor in the morning.  The night wasn't bad. 

My final night of the 60 hr week....same patients, easy report.  My first patient with the right foot necrosis was scheduled to have his leg amputated below the knee.  He was so quiet & withdrawn.  I felt for him - wished I could say something to make him feel better, but I also knew that he needed to come to terms with it on his own.  He slept part of the night, was nauseous the rest of the night.  I attributed it to nervousness about the upcoming surgery, but gave him some Reglan to help decrease the nausea.  My second patient - the one that likes to talk - went into his room & he had it set up like it was his office.  Had his laptop, some folders, a lot of business cards.  Asked him what he does for a living..."I'm unemployed."  You would have thought he was running a business in his hospital room.  He was bizarre.  My third patient...she was ready to be discharged to a skilled nursing facility/nursing home except when they found out she was eating & didn't have a feeding tube, they wouldn't accept her.  So the dr. called the family, told them to come pick her up & all of a sudden.......their wishes changed.  "Put in the feeding tube."  They didn't want to have to take care of her at home.  I can't say I blame them....she was very large & difficult to manuever.  I'm not sure they would have been able to take care of her at home.  So the GI consult is back on for a feeding tube.  And my fourth patient - said she spoke to her Dr. & he said she didn't have to wear the leg compression device....wasn't true, but I can't force her to do something against her will, so I simply charted everything she said regarding that situation.  The night was good, but I can't believe how much paperwork there is.  I probably spend too much time documenting everything that happens, because when I look at the other nurse's notes, they chart one time - like 3 sentences & that's it.  I guess I'm just used to what they required us to do in school - document anything that is out of the norm. 

Only about 2 more weeks of being with a preceptor!  Well, I guess they evaluate me at that time to see if I'm ready to be on my own.  I'm ready!  I like my preceptor, but I want to be free.  We have a good staff in which you can pretty much ask anyone for any help or advice - so I am not worried about that.  I need to go fill out my paperwork for benefits.  I can't believe it's been 3 months already!!  Where does the time go?

 

Home Invasion??? Shooting???

Drama, drama, drama...how I cannot stand drama!!!!!!

I'll try to make a long story short...I had to work on Wednesday evening.  About 10 minutes before I was to leave my house to go to work, some guy was knocking on my door.  I looked out my window (where he couldn't see me) & I didn't recognize him.  I live in a somewhat rural wooded area - there was no reason anyone I don't know should even be knocking on my door.  Needless to say, I didn't answer. After he gave up & left, I opened my door to see if maybe he had left me a note or something.  Nothing!  I decided to look under my doormat because I own a different house (that I rent out)& thought maybe the rent check would be there. 

Instead of a check, there is a note with a house key.  The note reads "Due to the recent home invasion & shooting of my son, he no longer will be renting your home."  Huh???  Home invasion???  Shooting???  In my house???  What?????????????????????????????????

I didn't have any time to find out much in details because I had to get to work.  It was going through my mind though - like was this some random home invasion/shooting or did he know who shot him?  Why would someone break into a home & shoot someone (especially my renter???).  Throughout the night I was able to piece together the story.  First my renter tried to say he was walking his dog down the street & it was a drive-by shooting.  I knew that couldn't be possible because stuff like that doesn't happen in this town & plus I would think I'd hear about it.  Anyways.....the real story as it stands is...

TWO MEN  ARRESTED IN SHOOTING 

Two men trying to collect a debt at gunpoint went further than they apparently intended when one man, while trying to pistol-whip a victim, accidentally fired his gun. The stray bullet struck another victim, scaring the defendants ? out of the home Saturday afternoon. The shooting victim?s injuries were not life threatening and he was taken to the hospital by a friend. Investigators had no problem finding one of the gunmen, though, since he left his name and number where they could easily find it.

Sheriff?s deputies were called to Florida Hospital at approximately 1:18 p.m. to see a patient there, Kelly, who said two men had stormed into his house and shot him. While piecing together the facts of the incident, investigators found out that the victim who had been pistol-whipped on the head, Jesse, was actually the men?s primary target. Jesse told investigators that the confrontation between him and the defendants started about six months ago when he had first owed money to some associates of the defendants. On Wednesday, the gunmen, confronted Adkins at a gas station about the money still owed, Jesse said, and they had a brief physical fight.  

The gunmen then went to the victim?s home Saturday to collect the debt. They got into the house through an open front door and forced Kelly into Jesse's bedroom. That?s when one of the gunmen hit Jesse on the head, which caused the gun to go off, shooting Kelly.  Both defendants then fled. 

Investigators easily tracked down one of the gunmen. Following the fight Wednesday at the gas station, he had discovered that his wallet was missing so he went back to find it. It wasn?t there so he left his name and phone number with the store?s clerk. Once deputies found him, he admitted to the accidental shooting. Further investigation then led to the arrest of the other gunmen. 

The deputies? work was not done yet, though, as it was discovered that Jesse had an open warrant. He was arrested, charged with obtaining property with aworthless check. The gunmen were both charged with armed burglary and aggravated battery. All three men were booked into the County Jail in Daytona Beach. 

So that is the story.  Luckily, Kelly was not injured badly.  In fact, I don't think you can get any less injured if you were shot at close range in the chest with a gun.  The bullet went right through the center of his chest - it did not damage any blood vessels, internal organs or his lungs.  Just a clean shot that went in & right back out & into the wall at my house.  <sigh>  He wasn't even kept overnight at the hospital!

 APRIL FOOL'S!!!!

  Nah, I'm kidding.......it definitely is a true story. Seriously.......it really did happen!!!!  I wouldn't lie to you.  :)

I went & checked out the house today...I was rather surprised that it was as clean as it was.  I didn't expect a single guy to do a good job at moving out.  It will need some repairs, like new flooring & some paint...but it's in pretty good shape.  Now the wonderful task of finding new renters...lucky me!

  Anyways, I have been up now since 2 pm on Thursday...time for me to get in a nap before going out to have some fun tonight.  I worked both Wednesday night & Thursday night...plenty of details to come as I have been on what feels like a rollercoaster ride between work & this recent turn of events.  Ciao for now!!!