Wednesday, April 6, 2005

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 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 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?


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