Tuesday, April 12, 2005

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!  :)


threedays3028 said...

Crazy day! Sounds like my days! Just a word-just because we have 1 or 2 patients in the ICU doesnt mean we are on easy street. Quite the contrary-we do hourly vitals, blood sugars, procedures galore, etc! Because a lot of my patients are traumas they may require q 5 minute vitals until they are stable.ICU patients can be scary patients because they are so unstable and they require a lot of work. It sounds like you did a great job. Pat yourself on the back!
Dont worry about the nurses who give you a hard time-they are just trying to dump their crap on you-I just avoid those nurses and doctors for that matter. I always go by the philosophy that the ones who are the most insecure about their practice and skill are the ones that will be the hardest on you. It's hard, but just ignore them-no ego-just move forward and let them make themselves look like the jerk.
Good job again-

jennerizer said...

I'm sorry if I made it seems as though I thought ICU nurses had it easier.  Not at all....I admire what y'all do over there in ICU!!!  I just meant that with this unstable of a patient, he needed closer observation than what we would be able to provide in PCU with 4 other patients to care for.  He ended up spending 6 days in ICU until his family had decided to make him a DNR & he's being moved to med-surg.  Turns out he did have a stroke as well as having a couple of different viruses & his carotid arteries are 90% blocked - doesn't look good.