Tuesday, April 26, 2005

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!


luvspspnkids said...

Thats a wild night or two! What was causing the repeated heart attacks with that elderly lady? WOW! I am glad you did so well though!


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sekirley said...

Sounds like a pretty good first day!!!!!