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!!! :)