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!


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