Wednesday, June 29, 2005

It sure would be nice...

I'm not even sure how to begin this journal today.  I worked Sunday & Monday night - called in sick for Tuesday night.  Gina & I were both on the 2nd floor both nights - which is nice.  They should have "team nursing" cause we work really well together - especially when we have no patient care tech to help us out.  Which by the way - I'm getting tired of not having the support of additional help.  I'm getting frustrated with administration - it's not that we have a lack of patient care techs, for some reason - they send them home.  That's the main reason I called in sick on Tuesday - I was so sore & achy from having to do nearly all primary care nursing.  It wears on you - I don't care what kind of shoes you are wearing, having to be on your feet for 12 hours, bending over, pulling patients up in bed, helping them to the bathroom, helping them to the chair, etc & having to complete all the required paperwork - it wears you down both mentally & physically. It sure would be nice to have the supportive staff that we need, but I don't see things changing - yet another reason to leave this hospital.

Anyways - my patients were sweet little angels Sunday night.  They were all (for the most part) able to do things for themselves.  I had one that needed assistance to the bathroom.  This was the same one that I had felt bad for because he had an echocardiogram done that showed a 10-15% ejection fraction.  Normal is anywhere between 60-75%.  The ejection fraction is how much blood your heart is able to pump out - there is always a reserve of blood left in the heart to keep it lubricated, but the majority of blood should be pumped out to circulate around the body.  His was 10% meaning his heart was pretty much shot & even with medications, it wasn't going to help much.  My clinical leader told me that at the hospital she used to work at, they would simply send people home to die with ejection fractions as low as his.  He was definitely not a candidate for a heart transplant as he was 67 years old and a heavy drinker/smoker.  Still though, I felt bad for him.  I wondered if he was even aware of his condition, did he realize the implications?  He was on my mind the entire night & the next day.  Not to mention he had a 30-beat run of V-tach that night.  But he was asymptomatic, didn't even notice a thing, called the doctor & told to just continue to monitor.  Ok, I can do that.

My second patient was an ICU transfer.  She was a little itty bitty thing...50 years old, weighs 63 lbs.  Came in with respiratory distress, has severe scoliosis - so severe that she has to sleep sitting straight up.  The neat thing about her...she always had a smile on her face.  She was so pleasant & sweet.  I wish all of my patients were like her.  Needless to say, she was doing very well & ended up being discharged on Tuesday. 

My third patient was a retired OB nurse.  I was told in report that she has some psych conditions, that she's depressed, has a flat affect, etc.  Her admitting diagnosis was renal insufficiency.  After assessing her, I did notice that she was pretty quiet.  I encouraged her to talk, asked about the book she was reading - not getting a whole lot out of her.  She had q12h H&H's ordered.  She had received blood during the day, but by the next morning her H&H were low again.  So they called in the GI doctor to see if she was bleeding internally somewhere.  The nice thing about her, the second night I had her - I managed to get her to talk & smile.  I would like to think it's because I'm so sweet & wonderful, but who knows. :)

My fourth patient was a new admit that showed up about 1:30 am, diagnosed with syncope.  She was brushing her teeth that night & passed out.  She was tired & just wanted to sleep.  Who am I to stop her?

So my night went well...or "uneventful" as one would describe it.  Meanwhile Gina had 4 total cares & she was whining about it to me every chance she got (right, Gina?).  She ended up jinxing my patients because Monday night was not as wonderful as Sunday night had been. 

The guy that I had been thinking about & feeling bad about his ejection fraction - well my attitude changed pretty quickly.  I'm not sure if it was because when I came in I saw that he was eating food from Long John Silvers (so much for the 2 gm Na diet restrictions) or if it was because this man somehow "accidentally" (and I use that term loosely) pulled out THREE iv's.  He had a dopamine/dobutamine drip running into one.  I had checked earlier in the night & saw that it had good blood return - things were great - until about a 1/2 hour later.  He calls me & says "I forgot I had an IV & when I got up from my chair, I pulled it out."  Ok, accidents happen - no big deal.  Clean up the blood, cover the site, get him back into bed & bring in an ICU nurse to get a couple new IV's in him.  He was a tough stick - that's why we resorted to the experts = ICU nurses.  Two new IV's, dopamine/dobutamine drip going again, pt is comfortable in bed...things are good.  Sweet dreams & good night.  Nope, about an hour later I hear a loud noise come from his room - not a good noise.  I walk in & he's on the floor, a distance from his bed.  I say "What are you doing?"  He replies "I was using the urinal at the side of my bed & lost my balance & fell."  Needless to say - IV #2 is ripped out & he's bleeding all over the floor.  Luckily he wasn't injured - landed on his butt, didn't his his head or any other body parts on anything.  Stop the bleeding, back into bed, start the dopamine drip into the spare IV site - put on the bed alarm so that this doesn't happen again.  About a half hour later, the bed alarm sounds.  I go in, patient is sitting on the side of his bed using his urinal.  I turn off the bed alarm & I hear him ask "What is that?"  I explain the bed alarm & he says "no, that!"  And he points at his pillow - there is blood all over it where his arm had been.  I thought maybe the last IV he pulled out was still bleeding - but nope, he pulled out IV #3.  I was getting frustrated, he was aggravated - as if it was my fault this was happening.  My clinical leader took over, gave him a bath, got him back in bed, brought in the ICU nurse again.  The ICU nurse says to me "Did the dopamine infiltrate?"  Ummm, I don't think so.  He told me it looked as though the skin was irritated & red & it might be from the dopamine.  His advice "You probably want to get some regitine just to be safe."  Regitine!  We heard all about that in school & all about that in nursing orientation.  I was kind of excited to see how this stuff worked.  I told my clinical leader about it, she called the nursing supervisor to bring us some regitine.  I'm thinking this is really important & time is of the essence.  Nope, I sat & waited for this medication to arrive.  Finally I gave up waiting & Gina & I went to do vitals on our patients. 

I had to do orthostatic blood pressures on my syncope woman.  Well, her blood pressure was up around 200 to 222 over 76.  Not good.  Which is my priority...high BP or dopamine infiltration?  My clinical leader did not seem alarmed by either, but then again, it doesn't seem like much alarms her  Looking back, I think my priority should have been the high BP.  Instead we focused on getting the regitine administered & then I put in a call to the cardiologist for my high BP patient.  When he finally called back (45 min later), he orders (or at least what I heard) was Quanidine.  I look it up to make sure & it says it's used for heart arrythmias & malaria (what a combination).  I figure's for her heart.  I fax over the order to pharmacy & they called to question it saying he probably said Clonidine - which they were right. But why do they make drugs that sound so similar (Quanidine/Clonidine...don't they sound alike?) - especially when someone with an accent is saying it & is not happy that I am bothering him so early in the morning?  Oh well, we got her the right med - glad pharmacy caught it. 

That was my Monday night.  My feet were so sore - I need to find a massage therapist or at the very least get a pedicure.  Poor Gina though - I called in Tuesday & they never bothered to get a replacement nurse.  So Gina & one other nurse were left with 10 patients & no tech.  Ridiculous!!!!!  And she had her first death occur.  I haven't had to deal with that yet.  She was telling the doctor what happened & she started crying & he was trying to comfort her...awww.  As much as I would have wanted to help her out, I'm glad I was home sleeping. 

Now I'm off until next Tuesday night...sweeeeet!  My non-paying renters moved out...yay!  But the house is a mess...ugh.  Oh well, I'll look at the bright side - they left without causing a scene.  I can't believe it's nearly the 4th of July.  Where is the time going???  Happy 4th of July everyone!

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