Wednesday, August 31, 2005

So devastating

I don't even have the words to describe what has happened the last few days as a result of Hurricane Katrina.  I never imagined that tropical storm I had been joking about a week ago would have developed into being one of the worst natural disasters to have ever hit the United States & that New Orleans would be  destroyed.

I'm sure by now anyone reading this entry has seen the images on tv & are also in shock like I am.  I really don't even know what to I won't say much at all this evening.  Tonight I'd just like to encourage everyone to say a prayer for those suffering directly from the destruction & a prayer for those that will be helping to get this country back to normal - if there even is a normal anymore.

Friday, August 26, 2005

Uneventful shift

The hurricane party is cancelled - because the hurricane has already come & gone through the night Thursday night. It ended up making a quick turn & hit the very south end of Florida. I'm hearing 4 people died & 5 are missing - how terrible. Just goes to show that even though it's only a category 1, it's still deadly. My part of Florida didn't really get much of anything - a little bit of rain - nothing like they had been predicting. It's beautiful & sunny today but way too hot for me. I can't wait until the cool weather gets here, who knows when that will be though.

Last night was pretty much what I wanted - uneventful. I had 4 patients - 4 very wonderful patients. All of them were pleasant & friendly & just a pleasure to work with. It is a rare night when you get all wonderful patients.

My first one was in with a-fib. When I went into this patient's room, you would have thought he was on vacation in paradise. He had a smile on his face, the sun was setting in the background, he was joking around, said he loved our hospital. We were waiting for the cardiologist to show up to possibly discharge him. Time went by, no cardiologist. So I put a call out to the doctor - very pleasant doctor & he called back saying "I thought that patient already went home." Ummm, nope, he's still here. "Well then, send him home." As much as I didn't want to give up my happy patient, I gave him the news & he was dressed & ready to go in 15 minutes.

My second patient came into the ER complaining of chest pain - come to find out he had a collapsed lung for the last 3 days & didn't even know it. He thought it was just the Florida heat that was wearing him out. So he had a chest tube to heal his pneumothorax. He was sharing a room with the patient I described above & he was a lot like that other patient - very happy to be there, loved the hospital, says everyone is friendly, they all explain what is going on, even the doctor putting in the chest tube was explaining exactly what he was doing - sweet. All I really needed to do for this patient was give him his meds & he went to sleep for the night. Didn't hear a peep out of him until morning when he requested giving himself a bed bath at 5 am. I love these self-sufficient patients!

My third patient was this elderly woman...all 86 pounds of her. Just a sweet little woman that didn't want to bother me for anything. When I went to assess her, I pulled up a chair & chatted with her first. I wanted her to feel comfortable & to feel like more than just a patient that we assess & leave. I think that's one of my strengths - comforting the patient & making them feel like more than just a patient in a hospital bed - if that makes sense. We chatted for a little while & I got her some hot chocolate - she was thrilled. She came in with a hemoglobin of something like 6.2. She received blood, of course, which raised up her H&H, but then it would start to decline again. All GI tests were negative, no blood in her stool, they didn't know how or why she was losing blood. Today she has a bone marrow biopsy scheduled. Hopefully they'll be able to figure out what is going on. She had no PM meds, so once I got her covered up with plenty of blankets, she also went to sleep for the night. Sometimes I feel like a babysitter. :)

My fourth patient was a new admit that the day nurse for some reason didn't assess. He's a new nurse, so I cut him some slack, but he did have this patient for well over an hour & didn't do a physical assessment nor a admission assessment - not good, especially with a patient in for chest pain. He hadn't even read over her orders. I guess he just wanted to get out of there. Luckily, I wasn't busy so I was able to get it all done pretty quickly. She came in with chest pain rule out MI (heart attack). Her cardiac enzymes were negative & she has a stress test scheduled today. After talking to her, it seems that she has a lot of anxiety but can't figure out why. She was thinking maybe it was connected to menopause - I don't really know cause I don't know a whole lot about the signs/symptoms of menopause - other than hot flashes & mood swings. All she really needed from me last night was Percocet & Phenergan. She also went to sleep around 10 & I didn't hear anything out of her through the night. No further complaints of headaches or nausea - gotta love that.

So I went most of the night with just 3 patients - which was nice, but the time dragged. I volunteered to help the other nurses with some of their patients, but even with that the night seemed never-ending. I'm not complaining though...with as tired as I was, I am glad I had an uneventful shift.

Around 5 am I got report on an ICU transfer. This patient came in the day before with abdominal pain & no appetite. Some tests had been run & it looks like he has liver cancer. He has no idea yet. For me those are very tough situations - the patient not yet knowing his poor diagnosis. They still had to run a couple more tests to confirm their suspicions, but it is definitely looking like liver cancer. :( He got to my floor around 5:45 am & just wanted to go back to sleep. Easy enough...sweet dreams.

That was my night pretty much. Time to go jump in the shower & wake up so I can get ready to go out tonight. I have no idea what we're doing now that the hurricane is already gone. Kinda hard to have a hurricane party when there is no hurricane. :) It's Aaron's birthday so we'll have a birthday party instead. Have a good weekend everyone!

Thursday, August 25, 2005

Yep, it's a hurricane!

What a strange weather day it's been so far.  It goes back & forth from being beautiful & sunny to being overcast & pouring rain......then back to being sunny & beautiful.  I like the rain though - not looking foward to driving in it though.  I hear they just upgraded the tropical storm to a hurricane - lots & lots of rain coming Florida's way. 

I had computer class training this morning.  It's nice to finally be working in the 21st century where they have computer charting rather than redundant handwritten paperwork.  Class was from 8 am to 1 pm.  I tried to get some sleep this afternoon, but it didn't go as planned.  I need to get ready for work shortly...7 pm to 7 am...ughhhh.  Hopefully it will be an uneventful night!

Wednesday, August 24, 2005

Hurricane Katrina??

We've got a possible hurricane on the way & I am hoping I don't get stuck at work.  Right now it's a tropical storm, but expected to be upgraded to a hurricane before it gets to Florida.  It's not due to hit until Friday AM sometime.  I'm hoping after 8 am because I work Thursday night/Friday morning & then I am off until Sunday night.  I don't want to spend my weekend at the hospital.  Aaron & I are planning to have a little hurricane party.  :)

Gina & I have been in orientation all week at the new hospital.  Why is orientation always so boring?  The neat thing about this time around...we know a lot of what they are talking about - so I guess we have learned something.  Woo hoo!  Tomorrow is the last day - it's computer training.  We use the same computer system at the other hospital, so it should be a piece of cake.  Our first actual night on the floor isn't until next Friday night.  We each have a preceptor, but our manager is already telling us to let him know when we're ready to be on our own.  Kinda scary that he has that much confidence in us to be on our own considering he really doesn't know much about us, but who knows...maybe he sees something in us.  Either that or he's desperate to get extra nurses on the floor!  I don't think it will be too bad since we are familiar with the computer system.  The only real new thing is the Emar - electronic MAR & having to scan the patient for each & every drug you give them.  They are really advanced as far as medication dispensing.  They have a robot that pulls the drugs automatically each night rather than a pharmacist.  It prevents medication errors.  I'm interested in seeing how it works. 

We also signed up for ACLS today.  The class is at the end of Sept.  They offer a prep class also & we signed up - figure anything to make it a little easier.  This hospital is great - the courses are free, the books don't cost us anything as long as we give them back after the course is over.  The other hospital charges you for the books & makes you pay $75 for the course.  They will reimburse the $75 if you pass, but who knows how long it takes to get that money back.  Plus the new hospital pays $1 more an hour once you are certified.  Our old hospital doesn'thave any incentives. 

I have computer class from 8 to noon tomorrow, then I work from 7 pm to 7 am.  I plan to get some sleep on Friday during the day - especially if it is raining out like they are predicting.  Then it's time to catch up with Aaron.  I'm looking forward to it!  I'll write more after the storm has passed.  :)

Saturday, August 20, 2005

Relaxing day

Not too much is really going on at the moment.  It feels like I haven't worked in ages when really it's only been 4 days off.  I'm not scheduled to work again until Thursday it is a nice break.  Orientation starts Monday at the new hospital.  Weird to think that a year ago on Monday, I was just starting my final semester of nursing school.  My how time flies!

I do have an update on one of my past patients - the unstable guy that came up from the ER still complaining of chest pain.  I think it's under the title "14 mg of Morphine."  I ended up sending him to ICU & he was in the process of having a heart attack.  They did a cardiac cath a day later & it showed 100% blockage of one of his vessels in a location that is not accessible for surgery.  Not exactly sure why it's not accessible, but that's what the report said.  He ended up going home a day or two later because at this point, all they can do is manage it with medications.   I wish I could go back & find that ER nurse that thought the guy was faking.  I'd like to hit him upside the head.  :) 

And another update in my life - I recently got back in touch with someone that had been a roommate of mine back in the 90's & one of my best friends = otherwise known as Aaron.  We had a falling out about 9 years ago & I totally stopped talking to him.  I had the urge to get in touch with him & this week I was able to do it.  We've been emailing & chatting on the far so good.  We'll catch up sometime for drinks or dinner.  I'm just hoping to reestablish the friendship, cause he was always a good friend to me. 

It's a rainy, stormy day here in central Florida - just the type of day that makes me want to stay indoors.  My sleep schedule is still really messed up.  I've only been able to sleep for about 2 or 3 hours at a time.  Not really sure what is going on with that - guess it's just one of the drawbacks to working at night & trying to switch to a daytime schedule.  Even after 8 months of working nights, I haven't been able to figure out what works for me as far as sleep goes.  Such problems I 

Ok, I've bored you enough......good-bye!

Wednesday, August 17, 2005

Common sense isn't very common!


Another week of work done & over with. What a hectic week it was too - I think it may have been one of the most chaotic weeks yet. At the beginning of every shift, it was a mess - either the day nurse was running behind, problems with patients, multiple discharges, multiple transfers, multiple admits - you name it, it was happening. Why is it always at the change of shift when this stuff happens?

Gina & I were split up again on different floors. When I asked to switch floors, the reply was NO. Whatever! I get report, only 4 patients instead of 5, which is always nice. 3 out of the 4 are ones I have to keep a close eye on & of course my alert & oriented patient is leaving in the morning. Sigh - wish they could all be like he was.

He came in for chest pain over the weekend & had a cardiac cath done which showed a couple of his vessels were blocked & he either needed stents or heart bypass surgery. Our hospital is not equipped to do either, so he was going to be sent to another hospital to have the procedure done. I had to transfuse 2 units of RBC's...not a problem. Veryyyyyyy pleasant gentleman. I am beginning to favor these cardiac patients. Give me middle aged males with chest pain any day of the week.

My second patient was a gentleman that had been in for 2 weeks & had 2 chest tubes. He was a rather quiet guy, but also rather reckless. He was mad that we took his foley catheter out - most patients want it out right away, this one wanted it back in so he wouldn't have to urinate on his own. Lovely. I thought for sure he was going to end up "accidentally" pulling out one or both of his chest tubes. He was always moving around & was probably sooo tired of me constantly checking on him to make sure everything was ok. I don't like chest tubes - they just seem so odd to me. I know they work, they do what needs to be done - but the concept is still a weird one for me. Not to mention my fear if one did get pulled out. Luckily he was put on med-surg status the next day & transferred off the floor.

My third patient was a 92 yr old man with abdominal pain. We had suspected it was kidney stones or something going on with the kidneys. When I assessed him, he complained of nausea & pain. So I gave him 12.5 mg of Phenergan & 1 mg of Dilaudid. It took care of the nausea & pain, but it also made him act a bit odd. He was obsessed with his hearing aid. He'd take it off, change the battery, fumble with it & put it back on...over & over & over again. And if it wasn't that, he had me searching for his hearing aid case - which as it turns out, wasn't even at the hospital! It felt like that movie "Groundhog Day".....I'd leave the room, only to be called back 10 min later & go through the whole routine again. That's the thing with Dilaudid - you never really know how it's going to affect your patient's mindset. As it turns out, the GI doc & the surgeon were arguing over this patient's diagnosis. GI doc was saying it was an ileus & needed surgery.....the surgeon was saying it was a fecal impaction (ugh) & just needed a few nursing interventions to remove it (ughhhh). My second night with this patient - the orders were "Soap suds enema, check for fecal impaction & remove if able, Dulcolax suppository q6hour until you get results." Ughhhhhh! For those of you that aren't familiar with "check for fecal impaction" - it basically means stick your finger up the patient's butt & see if you feel any kind of blockage - if so, try to remove it (ughhhhhhh). I lucked out, my clinical leader did most of that...I just couldn't do it, not that I couldn't physically do it - mentally I just didn't want to go there. Not yet anyways. Needless to say, he was negative for any fecal impaction that we could reach. The suppository worked though - so no ileus. The surgeon was correct. However, this patient did have kidney stones & required surgery. I declined to take him back the third day as I already had a post-op patient coming back to me & didn't want to care for two confused, disoriented post-op patients. The sad thing though...this gentleman didn't make it back to my floor. He ended up going to ICU after the surgery because his COPD worsened his condition & they couldn't take him off the vent. I'm curious to see if he recovers.

My fourth patient was a handful. An older male who only primarily spoke spanish (put that on the list for me to learn). He was in for gallstones, but needed to be medically cleared by the cardiologist for surgery. He also has a history of dementia & clearly knew a little english - well, the bad words in the english language. He was fine the first night I had him - cooperative, took his medications, allowed us to take vital signs...not a problem. However, he didn't sleep at all! In fact, that first night - none of my patients slept. It was a strange night.

Anyways, the second night with this patient was not so wonderful. He was very defensive, didn't want us near him, tried kicking the tech while she was trying to put on the blood pressure cuff. Of course he'd tense up & we'd get a false blood pressure reading. It took 3 or 4 of us to contain him just to get his blood pressure. He was calling one nurse a "ho", telling me not to "f" with him, yelling things out. I just had to laugh - not at him, just at the situation. We put restraints on his ankles so he couldn't kick us & eventually had to put restraints on his wrists because he was trying to punch. He wanted to bite, so needless to say - he didn't get his PO medications because I wasn't about to put my fingers near his mouth. Plus I wasn't sure he'd even swallow them if I did get them into his mouth. He had his moments of being really nice, so I took the restraints off for a few hours. Then he went back into this odd behavior. He was cleared for surgery & had it done Tuesday early evening. He was back to the floor by about 8 pm & moaning out in spanish "Oh my god." I didn't know if he was in pain or what the deal was. His heart rate was between 130 & 170 - I didn't like it. I called his admitting doctor, got an order for Lopressor 5 mg IV. I gave him that - it had really no effect on his heart rate. So I thought maybe pain was causing the high I page the surgeon. He happens to be in ICU, peeks his head around & says "I ordered him pain medication, Lortab 5 mg PO." I said "the patient is somewhat lethargic & he has a swallow evaluation for tomorrow, so I don't feel good about giving him a medication by mouth." He replies "If he can't verbally tell you he's in pain & he can't swallow, then he gets nothing." How rude! I said "His heart rate is between 130 & 170." He replied "It's not pain that's causing it, it's his a-fib, control his a-fib & you'll control the heart rate." Then he went on to tell me how he does this type of surgery all day long & most people go home & the pain isn't that bad, etc. I've had my gallbladder removed - the pain is bad if you have no pain medication. Oh well, my next resort was to give the patient some Digoxin to try to get a handle on the a-fib. That helped a little...brought his heart rate between 90 & 130 which they tell me is normal for someone with a-fib. All I know is that I had him the previous two nights & was not dealing with a heart rate that high, but ok....if neither his admitting doctor nor his surgeon is that concerned about this heart rate, then why am I so concerned? As long as they were both very aware of his present condition...and I charted it, that's all I needed to feel ok with the situation. I kept checking on him, would hold his hand, rub his arms & forehead because he seemed so alone. He was no longer moaning & he slept a lot of the night, but I still felt the need to give him some emotional support.

The second night when I got to the floor, it was a mess. The day shift nurse was running around frantically, transferring my chest tube patient to med/surg & she had a new admit who had been there for over an hour that she hadn't assessed. I told her not to worry about it, that I would do the assessment & fill out all of the paperwork. I had to assess him anyways & she was already running way late. He was a very pleasant gentleman who came in with what else = chest pain. I'm telling you.....the majority of chest pain complainers are very pleasant people. We clicked immediately, got through the assessment & the 39408304 questions we need to ask the patient. Got him situated & off to bed he went. No c/o pain through the night - gotta love these patients!

I also got another new admit about an hour later...take a guess at what his diagnosis was.............chest pain. Ahhh, another wonderful patient. He also had been experiencing numbness on his right side so he was also being examined for a possible CVA (stroke). Just needed the neuro doc to clear him for a stress test. Got through the assessment & the 39408304 questions that needed to be asked & off to bed he went. No complaints of pain through the night which was a blessing since the other two I had kept me busy most of the night between the hearing aid routine & the punching & kicking.

The other nurses on the floor were getting slammed with discharges & admits. It was ridiculous - why does this always happen at the beginning of shift? I don't think the ER should be allowed to transfer a patient between 6:30 & 8:30. Give us time to get report & see our other patients before you start adding more, right? Common sense isn't very common!!!!!!

My third night was ever more of a mess - one of our nurses forgot she had to work. How do you forget you have to work??? So we had to pick up her patients until she could get into work (2 hours later).

One of my chest pain guys was discharged, my other two were in surgery - so I declined taking both back...only wanted to handle one post-op. So I was given two other patients - one who was being discharged & one who was going to hospice the next day, she was on comfort measures only - which was a good thing because it was so super busy that I didn't have a lot of time to devote to anyone that truly needed anything right away.

I worked on assessing the other two patients of mine, worked on getting the one discharged as he had already been waiting for awhile (why the day shift nurse doesn't get the paperwork together when she knows he's going to be leaving....I don't know...maybe she's too busy also? Who knows?). Luckily he was a calm, patient gentleman. Got him out the door, get my post-op patient with the high heart rate back, other nurse finally shows up - give her my hospice patient, my clinical leader says "I have a new admit for you & an ICU transfer coming your way." Ahhhhhhhhhh.....give me a minute to catch my breath! I'm calling the doctors for my post-op patient to get his heart rate under control, getting report from the ER nurse & luckily the ICU transfer wasn't in a rush to be transferred - it bought me a little time to get these other things done. I take care of post-op guy - he's doing ok & I can focus my attention on the new admit.

This was a gentleman that had a history of CVA's & TIA's who came into the ER because his speech was delayed. He was able to think fine, but took a few extra seconds to say what he needed to say. He was veryyyyy pleasant & quick-witted. I was going through the assessment & the 3908103 questions I have to ask on the assessment form & one of the questions is "Have you ever fallen at home?" His reply "The last time I fell, it was for my wife 35 years ago." Awwwwwww!!!!!! Is that adorable or what? And on top of that - his admitting orders were basically nothing - an EKG for the AM & a neuro consult. That's meds, no tests, no labs. Kinda scary though - what kind of admitting doctor doesn't order anything for his patient? Not a doctor I would want to have! I passed onto the day shift nurse the meds this patient is on at home & he would definitely need them ordered, but since he only takes them in the morning - I saw no need in waking the doctor up at night to get the order. This guy was a sweetheart.

I can't say the same about my ICU transfer. Luckily he had been downgraded to PCU status while in ICU, so they started all of the PCU paperwork over there = less work for me to do. :) He got over to me between midnight & 1 am. I was told during report that he was in restraints because he has an NG tube & will pull it out if I give him the chance. He was in for a CVA (stroke) & it had done damage. Well, during the transfer over to my floor, he had somehow managed to pull out the NG tube even with his restraints on. So we put those mitt type restraints on so even if he was able to reach anything, he couldn't be able to grip it & pull it out. He didn't like it. I had also been told during report that when this patient is given Haldol - it knocks him out for a long period of time & the generous ICU nurse had given him a dose about an hour quote the nurse "He should sleep all night for you." Famous last words! The guy barely slept a wink. He kept yelling out & would tell me to take the NG tube out, take the gloves off, he had to go to the bathroom. If he said it once, he said it 100 times. As soon as you would give him a reason as to why we couldn't do any of what he was asking, he'd ask the question again. It took me a little time, but soon enough I saw that reason wasn't working with this patient. I gave him 1 mg of Ativan hoping that would relax him. It didn't really have much of an effect - at least not during my shift. Watch - he probably slept all day.

That was my week of work - nothing too gross (except the fecal impaction check), nothing too gory, nothing too stressful. I was either in an exceptionally good mood or I'm just learning to deal with the craziness of working in a hospital & having to react to the unexpected - or maybe both. I wasn't frustrated or agitated at all. In fact, I probably laughed more than usual. Maybe I'm learning to not take it so seriously - all you can really do is the best you can do & if that's not enough, then too bad. It's the reality.

Tuesday, August 16, 2005

"Code Gray"

Gina got to call her first "Code Gray" last night. Code Gray is when you need extra manpower to help contain an out of control patient or family member. She had a patient in his late 20's that overdosed on cocaine & some other drugs. I guess he started throwing his heart monitor around the room & was quite volatile. I am working on a different floor this week, so when the nurses on my floor heard the code gray called...I jokingly said "It's probably one of Gina's patients."

I decided I had to go the room to lend a hand. Nahhhh, not really...truthfully I went to see the line-up of men that showed up to help out. Hey, I'm single, what can I say? I'm entitled to some entertainment while at work, aren't I? :)

Sunday, August 14, 2005

Crabby Old Woman

Crabby Old Woman

What do you see, nurses?
What do you see?
What are you thinking
When you're looking at me?
A crabby old woman,
Not very wise,
Uncertain of habit,
With faraway eyes?
Who dribbles her food
And makes no reply
When you say in a loud voice,
"I do wish you'd try!"
Who seems not to notice
The things that you do,
And forever is losing
A stocking or shoe?
Who, resisting or not,
Lets you do as you will,
With bathing and feeding,
The long day to fill?
Is that what you're thinking?
Is that what you see?
Then open your eyes, nurse,
You're not looking at me.
I'll tell you who I am
As I sit here so still,
As I do at your bidding,
As I eat at your will.
I'm a small child of ten
With a father and mother,
Brothers and sisters,
Who love one another.
A young girl of sixteen
With wings on her feet
Dreaming that soon now
A lover she'll meet.
A  bride soon at twenty,
My heart gives a leap,
Remembering the vows
That I promised to keep.
At twenty-five now,
I have young of my own,
Who need me to guide
And a secure happy home.
A woman of thirty,
My young now grown fast,
Bound to each other
With ties that should last.
At forty, my young sons
Have grown and are gone,
But my man's beside me
To see I don't mourn.
At fifty once more,
Babies play round my knee,
Again we know children,
My loved one and me.
Dark days are upon me,
My husband is dead,
I look at the future,
I shudder with dread.
For my young are all rearing
Young of their own,
And I think of the years
And the love that I've known.
I'm now an old woman
And nature is cruel;
'Tis jest to make old age
Look like a fool.
The  body, it crumbles,
Grace and vigor depart,
There is now a stone
Where I once had a heart.
But inside this old carcass
A young girl still dwells,
And now and again,
My battered heart swells.
I remember the joys,
I remember the pain,
And I'm loving and living
Life over again.
I think of the years
All too few, gone too fast,
And accept the stark fact
That nothing can last.
So, open your eyes, people,
Open and see,
Not a crabby old woman;
Look closer . . . see ME!!

Remember this poem when you next meet an older person who you might brush aside without looking at the young soul within...we will all, one day, be there too!

Saturday, August 13, 2005

Hurricane Charley anniversary

One year ago at this time, I had fled from my house over to Julie & Shawn's because Hurricane Charley was on his way. In some ways it seems like it's been longer than a year, but at the same time, it doesn't seem like it's been an entire year. I've been in Florida a very long time...about 25 years. Hurricane Charley was the first major hurricane I've ever dealt with (or at least remember dealing with). When Hurricane Andrew hit back in 1992, I happened to luck out & be in Cancun, Mexico at the time - that hurricane extended my vacation free of charge for 3 more days! Anyways, back to the anniversary of Hurricane Charley. It was the most destruction I've ever seen. Luckily I only had one tree fall although the power was out for days. Hopefully we won't have a repeat of last year - 3 major hurricanes within 6 weeks.

I went out with Julie today to see the movie Monster-in-Law. It was cute even though I'm not a fan of J. Lo or Jane Fonda. After that we had the slowest dinner ever at The Olive Garden. All we ordered was salad & breadsticks - I swear it took about a half hour for the waiter to get it to our table. Oh well, what can ya do?

Not much else really going on. My sleep schedule is all messed up. I don't even really have one - just catch a few hours whenever I get sleepy. Why bother getting back to a day schedule when I have to work the next 3 nights?

I've gotten hooked on watching the latest tattoo shows...Inked & Miami Ink. It's making me want to get a tattoo, but I have no idea what to get or even where to put it. It would have to be something small & non-gawdy (lol). No rush.

Friday, August 12, 2005

14 mg of Morphine

I am such a  My night was a little crazy, but I love it.  When I got to work, I saw that the day clinical leader had given 3 (out of 5) of my patients to other nurses.  What the heck???  So I ask her why I am not getting some of my patients back.  She says "Well it's only fair that everyone gets new admissions tonight & that's why I gave your patients to others - it allows for you to get at least 2 admissions."  What????  Does that make any sense?  So I try to at least get 1 out of the 3 back & she gives me the same b.s. answer.  The whole reason I work 3 days straight is so that I am able to get my patients back - because I am familiar with them & they are familiar with me.  Luckily my night clinical leader understood my reasoning & gave me one of my patients back.  The other 2 were going to be discharged anyways.  Turns out the one I got back, I ended up transferring her down to med-surg anyways.  Oh well!  So much for that.

My other two patients I did get back were patients I had for the last couple of nights.  One has a DVT in his right leg.  Not much to say about him other than at one time his heart rate had jumped up from 85 to 135 instantly.  I went to check on him (this is why I love telemetry - you know when your patient is up to something).  He got out of bed to walk around & go to the bathroom.  I had just been through this discussion with him the night before - about how he's on strict bedrest because moving around like that could send the clot in his legs up to his lungs & he could die rather quickly.  I don't think he understands just how serious it is. 

My other patient was a 44 yr old woman admitted with chest pain, but had a history of migraine headaches.  She had been nauseous & vomiting the first night I had her.  I got some Imitrex & Phenergan - both helped quite a bit.  Well, last night they weren't helping.  She was continuing to vomit even with 25 mg IV of Phenergan.  I called the doctor to figure out what to do.  He ordered 75 mg of Demerol IV.  I repeated it back to him because it seemed like a high dosage.  He said "yes."  So I asked my clinical leader about it & the nursing supervisor.  They advised me to give 25 mg first & see how she tolerates it.  Well, it made her dizzy & even more nauseous.  Wonderful.  I wasn't going to continue to give her Demerol.  The last thing I needed was a disoriented patient vomiting everywhere.  She was sweet though.  She kept calling me "Miss Jennifer."  I really wanted to help her, but I was running out of alternatives.  I hope they figure out why she is feeling this way. 

My new patient was a transfer from med-surg.  She was admitted with cancer & needing chemo, but soon they found she had multiple PE's & a DVT...not to mention that the cancer had metastized to her liver, lungs & pancreas.  Not good at all.  I had to restart her on Heparin.  6 hours later her PTT is 166 (therapeutic is 60 to 90). the doctor.  I felt like that's all I was doing last night.

The highlight of the night was my new admit.  I received report from one of our terrible ER nurses.  I swear they are clueless down there.  I'm not sure if it's because the way the department is run or if the nurses down there just aren't all that bright.  I feel like all they want to do is dump the patients on whoever they can.  Half the time they can't even give you a halfway decent report & the other half...they totally mislead you.  My patient was a 46 yr old male in with chest pain.  EVAC gave him 4 Nitro SL tablets...didn't relieve his pain.  While in the ER, he was given 14 mg of Morphine within a couple of hours (gasp)!!!!!  You would think that would knock him out, but nope.  He was still rating his pain at a 7.  Technically he shouldn't be able to come to our floor until he was stable, but our ER doesn't seem to grasp the concept of stablizing a patient.  So I get report & as the ER nurse is rounding the corner on our hallway, we heard a loud awful noise.  My clinical leader said "What's that noise?"  I said "That's my new patient."  The poor guy was vomiting everywhere!  All over himself, all over the bed & all over the paperwork with his orders written out.  Lovely!  We get him to his room, clean him up somewhat...he continues to rate his pain at a7.  3 more Nitro SL 5 min apart...gets his pain down to a 5.  He is continuing to vomit.  Not good signs!  I called his cardiologist, got an order to send him to ICU for unrelieved chest pain.  I love the ICU...I love that they are the place that I can take a patient in distress.  Not that I like dumping patients on anyone, but I know they are in good hands when they make it to the ICU.  I'm curious to see what his second set of enzymes will be. 

My night was busy, but in a way I like it because the time flies by.  As I was leaving, another patient's (not mine) heart rate was sustaining 200 for about 20 minutes.  The guy was asymptomatic.  His blood pressure was normal, he was speaking, said he felt was bizarre.  You could see his fast heart rate through the veins in his neck pulsating.  I didn't stick around to see what happened with him.  I was too tired.  I have two nights off & then back for 3 more nights in a row. 

I got a call from my new manager at the other hospital.  He is sooooooo nice.  I swear it feels like dating - things are so wonderful in the beginning, everyone is so pleasant to one another & then reality sets in.  Things aren't what they were promised, you see more of the bad than the good, etc.  Anyways, the new manager was making sure everything was ok & how excited he was that both Gina & I would be working there soon.  What a difference from our current administration who lectures us about being unreliable.  I'm still trying to figure out my schedule.  I'm leaning more & more towards going full-time at the new hospital & part-time where I'm at now.  There is just so much b.s. at my current hospital & the excuses are getting old quick.  I'm not ready to quit, there are still some aspects that I like as well as some of my co-workers.  Now I just need to decide if I want to go part-time with benefits (requires working 6 days a month) or part-time with no benefits (requires only 2 days a month).  It takes 60 days for benefits to kick in at the new hospital.  Do I want to go 2 months without health insurance?  I don't know.  I'll figure it out later.

I had another patient this weekthat annoyed me.  It was just a weird vibe I got from her.  37 yrs old, admitted with chest pain.  She was in the same room as my N/V/migraine patient, but fled rather quickly when that patient started to vomit.  So we got her another bed in a different room.  She was a jumpy anxious woman.  Gave her Ativan PO.....didn't do much for her.  She was complaining about too much noise.  I offered her the opportunity to move to a private room.  She refused.  I think she was one of those that just liked to complain.  Later she complained of chest pain.  I asked her to describe it.  She replied "When I lay on my left side like this, it hurts."  Ummmm.....then don't lay on your left side like that!!!!!!!!  I tell her to reposition herself & see if the pain is relieved.  She states it is better.  About an hour later, she complains again of chest pain & noise.  I offer her the pain med that has been ordered.  She replies "That didn't do anything for me."  She goes on to say "I'm not a drug seeker, but morphine works really well for me."  Ummmm, ok...interesting how she knows this.  I knew the doctor wasn't going to prescribe her morphine - she couldn't even describe the pain, her cardiac enzymes were all negative & had no signs or symptoms of pain - other than her words.  We ended up getting her Lortab.  Again, it wasn't strong enough.  I put oxygen on her, EKG was done...perfectly normal sinus rhythm.  I try to be tolerant & understanding, but something was just off mentally with this woman.  I couldn't tell whether it was anxiety related or just plain weirdness.  Turns out I wasn't the only one that got that strange vibe.  The cardiologist ran a stress test & it was negative.  He immediately signed off from the case.  As she was being discharged, she began to complain about pain & wanted a prescription for morphine.  It wasn't going to happen.  They sent her out the door - the cardiologist wanted nothing more to do with her.  Can't say I blame him!

I'm getting sleepy - time for a little nap!


Tuesday, August 9, 2005

A sign?

I saw not only my manager this morning, but also the director of the department - not usually a good mix.  The reason for the meeting...calling in more than twice in a two month period.  I got the lecture about how it lets down the unit when I'm not there on a scheduled day & how now I'm viewed as unreliable.  This is one thing I don't like about management - not just at hospitals, but practically anywhere.  They only take the time to talk to you when it's about something negative.  It doesn't matter if you are doing 3904820934 good things, if there is one negative thing - they will zero in on that.  Oh well, that's the way it goes.  I simply listened to the lecture, signed the paper that puts me on probation until November.  When that was said & done...I asked "Who do I talk to about going part-time here?"  They were shocked.  I love my manager - she is really, really nice.  The director is nice, but I really don't know much about her.  They just stared at me.  So I went on to say that I am planning to work at another hospital to gain more experience.  The director asked what type of experience I was wanting.  I said "cardiac."  There were a few more words exchanged, but they couldn't argue with the other hospital being a major cardiac hospital as opposed to ours - we ship anything serious over to that other hospital because we are not equipped to handle anything like that.  My manager said she'd talk to human resources about it.  I hope I didn't make things worse for myself.  I just felt the need to be honest & upfront rather than letting the rumors get around.  They can't fault me for wanting to get more experience.  They seemed stunned though. 

Anyways, I came home & took a nap as I'm working the next 3 nights in a row.  I started thinking that maybe this is a sign to go full-time at the cardiac hospital & reduce my hours greatly where I'm at now.  I don't want to make that decision until I see what it's like on the job at the new place.  I'll use the month of September to base my decision.  On that note...I need to go start getting ready for work.  It's about to storm here.  Hopefully it will be over with by the time I have to leave.  Have a good night!

Monday, August 8, 2005

Uh oh

I got a call today from my manager's secretary. My manager wants a meeting with me. Uh oh! Gina got the same call. All we can think is that maybe the new hospital called our manager as a reference & she is probably wondering what the heck we are doing going to work at another hospital. Either that or using too much PDO (paid days off) time. My meeting is at 9:15 in the morning. The suspense is killing me!

I went into the new hospital & got all the paperwork done & got signed off from the health nurse. Orientation is in 2 weeks. I'm looking forward to seeing what it's like at this new place.

Did anyone see Six Feet Under last night - the episode where they buried Nate? sad. I love that show. My other fascination right now is Big Brother. Is everyone voting for Kaysar to get back in the house? If not, you better!

That's about all for now!

Sunday, August 7, 2005

Easy come, easy go

I got a call from the other hospital informing me that since I don't have a full year of nursing experience, they can't hire me on as "per diem" (higher pay, no benefits).  Instead he offered me a full-time or part-time position.  The pay is lower...around $23-24 per hour which is basically what I'm making now at the hospital I'm at.  Sigh!  Oh well, the good news is that I am not too, too far from having a year of experience.  Just depends on what they consider the anniversary of one year - is it from the date I was hired as a nurse or is it from the date that I passed the nclex & officially got my nursing license?  We're talking about a 60 day difference.  Regardless, it's something to look forward to if this new hospital works out.  If not, there are plenty of other hospitals out there to explore.  So now the decision to be made I remain at my current hospital full-time (3 days per week) & work at the new hospital once or twice a week?  Or do I go part-time at both places?  I guess in the beginning I'll just work one or two days a week there to see if I like it.  The thing that stinks is that working one or two days extra at my current hospital would result in overtime pay, while working at this other hospital keeps me at the base pay.  I am grateful to have the opportunities & to be making the wages I am, but I also know I need to be careful as to not get burnt out from working too much.  So time will tell & I truly believe that God will lead me to where I belong. 

I had an ok week at work this past week.  Gina & I were on the same floor although Gina kept whining about feeling sick the entire first night (ya baby Gina!). 

I only had 3 patients the first night - it was nice!  One is in with pancreatitis/cholelithiasis (sp).  Basically he has gallstones so he'll need his gallbladder removed, but they also suspected that he might have a stone in his common bile duct therefore causing pancreatitis.  They did an ERCP - no stone nor infection found.  So who knows what was causing his liver enzymes to be really out of normal range.  I believe he was going to have surgery yesterday or today if his enyzmes had improved.  The surgeon on the case is a great one.  If I ever need surgery, he's who I would want operating on me.  He was badmouthing the gastro doctor.  I just have to laugh at how these doctors talk about one another.  While he was talking to another nurse & I, he got a phone call from a patient of his that told him her primary doctor left a message on her answering machine saying her cancer had spread to other parts of her body.  What kind of doctor leaves that type of message on an answering machine???  Needless to say, the surgeon was also badmouthing the primary doctor.  I'm beginning to wonder about these "primary" doctors.

My second patient had an MI a couple days earlier & was a transfer from ICU.  He was very anxious to get home.  It's like he had no clue of the seriousness of his condition.  He was refusing any invasive testing or procedures...he just wanted to go home.  When I got there, he says to me "I feel like I have a sore throat starting & also a post-nasal drip.  Get me an aspirin, dissolve it in water & I'll drink it."  I told him I couldn't do that, informed him I need a doctor's order to distribute any medications."  He accused me of being resistant & unhelpful.  I offered him hot tea, soup, tylenol, etc.  He asked for mouthwash - I got a bottle of it but on the label it said "alcohol free."  He said he needed Listerine - wanted me to go & get him some.  I told him we don't carry it here at the hospital.  He thought I was lying to him.  So he says to get him a bottle of rubbing alcohol.  As if!  I finally get him to take some Tylenol & drink some hot tea, then he went to bed. The next night I came in & he starts telling me about an FAA warning - that pilots are not allowed to eat or drink anything with aspartame in it because it causes memory loss.  I'm looking at him like "Why are you telling me this?"  He wants me to inform the hospital that all of their products should be aspartame free.  Ok sir, no problem.  Why he was still in the hospital, I don't know.

My third patient that night was a 59 yr old man that came into the hospital mid-July with an intestinal blockage.  They did a hemicolectomy to remove the blockage.  As a result, he had a surgical infection that turned into sepsis.  To make matters worse, he aspirated while eating & that turned into a code blue.  Poor guy!  I had to do a dressing change on his abdominal wound.  It amazes me that they don't sew these wounds up.  Once I got all of the 4x4's out of it, I was wondering what exactly I was looking at.  You could see his internal organs.  I'm surprised they don't fall out!  I redid his dressing that night, but the next night we applied a wound vac as he was having a lot of fluid draining out.  I think the wound vac is really neat - amazing how it works & how it looks.  Through the night I was watching to see how much drainage there was & was surprised there wasn't all that much considering how drenched his previous dressings had been.  That all changed when I got him up to use the bedside commode.  The wound vac fluid container filled up in about 10 minutes!!!!  I was rather impressed. 

The second night I also had another patient...a 24 yr old male that came in with a blood sugar over 700 = DKA...otherwise known as diabetic ketoacidosis.  While in the midst of this, he also had a heart attack.  He was an ICU transfer & well on his way to recovery.  He only spoke spanish.  I am going to have to make an effort to learn some spanish in order to communicate with some of these patients.  I didn't spend a great deal of time in his room because I couldn't communicate with him.  He had a cardiac cath done that day which was negative.  I had a spanish speaking nurse tell him that if he wants anything, to call for us.  I also made sure he wasn't in any pain & that the cath site looked good & his pulses were fine. 

It was another week of having no patient care tech to help out & not even a secretary to help with orders.  I'm beginning to think I have the right to add these other jobs to my resume:  nurse/patient care tech/unit secretary/transporter/furniture mover, etc.  Our meetings at the beginning of the shift are a joke/waste of time.  The information they are telling us isn't even accurate.  Not to mention it delays us getting report from the day shift.  My first night - I was in report until 7:45 pm.  That's way too long.  They don't even want to let us know what patients we are getting until 7pm.  So I get there at 6:30 & am supposed to just stand around until 7.  Waste of time! 

I have started doing something I swore I wouldn't ever do.  Last year as a PCT, I noticed the nurses looking at the obituaries to see if they recognized any names of past patients.  At the time, being a PCT, I barely even knew the patients names, much less be able to recall them at a later date.  That is different now - I do know my patients names & my memory is usually pretty good.  While looking at the obits, I saw that the lady I had written about a couple of weeks ago with the stroke & high heart rate passed away last Monday.  I sorta knew that she didn't have a lot of time left.  Oh well, at least she's in a better place now. 

Today also marks a year since the murder massacre in Deltona (just a few miles from my house).  For those of you not familiar with the story, last year 6 people were killed by 4 guys with aluminum baseball bats & knives.  They broke into these people's home around 1 am & slaughtered all 6 of them, one so bad that they couldn't even identify her with dental records.  Sickos!  The reason they did this = an X-box game!!!  I'm glad they were able to catch them quickly & they are now in jail.  The trial starts in January - hopefully they'll all receive the death penalty & never be allowed back on the streets.  If you want to read the full story, here you go:

I'm finding that working nights really screws up my sleep schedule.  I had a hard time falling asleep last night so I took a couple of tylenol pm around 1 am.  I ended up sleeping the entire day!  Now it's 12:30 pm & I'm wide awake.  Oh day I'll figure it out.  Maybe I'll run up to Wal-Mart & do some food shopping.  I'm so much fun, aren't I?  :)

Tuesday, August 2, 2005

Add another hospital to my resume

My interview went wonderful!  I got the job.  So did Gina.  We'll be working on the same unit/same floor.  In fact, the manager seemed pleased that we work well together & has no problem if we want to work the same nights.  How refreshing!  We both will be working PRN/per diem & the starting rate is $31/hr plus differential.  I can't believe it!  9 months out of nursing school & we'll be making over $40/hr.  The floor is similar to PCU where we're at now.  It's considered a cardiac floor but it consists of telemetry, post-surgical patients (non-cardiac) & overflow of med-surg.  We each get our own laptop/cart with meds in it.  The floor always has at least 2 techs.  The scheduling is pretty flexible, they pay us to take ACLS (mandatory) & other classes if we want.  It's just amazing how different it is compared to where we're at now.  I cannot wait to see what it's like.  I go back Monday to go over all of the necessary paperwork plus get my photo ID.  Then they'll give us more info regarding orientation & scheduling.  We should have done this sooner!

Now the hard part - approaching the hospital we're at now & getting them to be flexible with our needs.  Ideally I still want to remain there part-time in order to keep my benefits & to not burn any bridges.  I am checking out getting my own health insurance policy & simply going per diem at both hospitals.  That seems like the best option for me.  However, until that is set up, I need to remain part-time in order to keep my health insurance.  I'll make the call tomorrow & see what happens (fingers crossed). 

I'm going out tonight to celebrate with William.  It's his 40th birthday a double celebration!!!