Tuesday, November 29, 2005

"No more blood pressures..."

Yes, you read it correctly...no more blood pressures.  That was an order I received from a doctor the other night.  I had a patient whose blood pressure at 8 pm was 198/92 and her heart rate was 115.  She was sleeping & had already received pain medication, so I knew it wasn't her activity or pain level that was messing with her vital signs.  So I call her doctor...tell him the details, he orders Lopressor 25 mg.  I give her that, let her sleep for a couple of hours & recheck it around 11 pm.  Her heart rate is good...in the 70's, her blood pressure is now 202/90.  I recheck it...same reading.  I call the doctor again, he orders a Catapres patch & says "Do not take any more blood pressures tonight."  Huh???  You don't want me to recheck her blood pressure?  "No, NO MORE blood pressures on this patient tonight.  Hold them until the morning."  Nice doctor, isn't it?  He just didn't want to be bothered again.  Sorry, I didn't follow his order...I did recheck it around 4 am vitals, it was still elevated, but a little better 185/77.  I definitely made sure to document his exact words. I wasn't going to get in trouble for not reporting a high blood pressure on a patient whose normal bp doesn't run that high.  Obviously something was going on with her.  Granted she was 95 yrs old & a DNR, but that doesn't mean I want her dying on my shift.  So far I have not had any patients die on me, I would like to keep this trend going.

My other patients were ok...I felt like I was working in a psych ward in a nursing home.  I think dementia has to be one of the saddest conditions I've ever seen...simply because nothing you say or do will affect the way your patient is behaving - however, that didn't stop me from trying to reason with my patient.  :)  She would not stop yelling out...she was calling her daughter's name, then the name of the woman that takes care of her at the nursing home, then she was pleading for water - which I gave her often & finally it was "helpppppppp meeeeeeeee."  All night long.....didn't matter how much Haldol or Ativan I gave her, the results were the same.  She did not sleep for one second.  She was in restraints because she would attempt to get out of bed, pull out her foley, pull out her IV.  By the end of the shift, I also was resorting to saying "helppppppp meeeee." 

In addition to those two patients, I had two combative males that required a sitter.  Did I also mention that on this floor....it was just me & one other nurse?  That's it.  I handled these guys fine......one wanted his sleeping pill & pain medicine, once he got that, he was cooperative & the other one just wanted to be left alone so he could sleep.  Not a problem.......sweet dreams.

I got my 5th patient around midnight...a woman that had checked herself out AMA two days earlier.  Not a wise decision when you have a DVT (blood clot).  She was pleasant as can be...I had no complaints. 

I'm not feeling too good today...not sure if it's the weather or pms or if I'm fighting off some kind of cold or flu.  I just feel blahhhh.  Luckily I'm not scheduled to work until Sunday.  I go back to a full-time schedule for a few weeks.  I don't like feeling blah.  Maybe some chocolate chip cookies & milk will make things better, right????

Hope everyone had a wonderful Thanksgiving & got lots of Christmas shopping accomplished!

Wednesday, November 23, 2005

Tony Stewart - Champion once again

Woo hoo....what a wonderful Sunday it was watching Tony Stewart wrap up a great season & take home the championship trophy/title.  It's nice to see how much he has matured & isn't out of control off the track.  Don't get me wrong, I love when these guys get mad at each other & act out, but at the same time...it's nice to see them act like men & handle their conflict with words rather than temper tantrums.  Now they're off for 2 1/2 months....I get my Sundays back.  Which means.....back to work for me!

Yep, going back to my Sun, Mon, Tues work week...at least through December.  There is a lot of change coming up.  One good thing - they are starting to focus on computer charting.  They have formed some type of team that will practice with it first so that all the issues can be ironed out prior to all of us using it.  So it's probably at least a year before we get our hands on it.  On top of that....the manager of my unit & the director of my unit have both resigned.  That means new management which is kinda scary.  Obviously there will be changes, I'm just hoping it's good change, not bad.  There is already a rumor that they are not going to allow overtime anymore.  That doesn't bother me too much as rarely do I ever have the urge to work overtime.  It also seems as though they have hired many, many agency nurses & as a result, we don't get the offer for bonuses too much anymore. 

It's so strange though...to go into work & the majority of the people working are agency.  There was one night I went in & didn't know ANY of the day staff.  I felt like I was in the wrong hospital.  I worked Monday night & spent part of the night helping a new agency nurse.  I didn't mind that....it actually showed me just how far I've come in just a year.  I am so very comfortable at this hospital & I truly think it's because of the atmosphere.  Yeah, we have our problems...but as far as teamwork, it is #1.  Even with all of the new agency people...we all jump in & help one another when someone needs it.  That is so opposite of what I experienced at that other hospital.  I felt like I was all on my own & that wasn't a good feeling. 

I am finally off of probation for calling in over the summer.  And come January...I can go per diem = more $$$.  I am working this Friday because they are desperate & offering a $150 bonus just to come in.  I couldn't resist.  I've had the last couple of weeks off & it has been nice.  I've been working on organizing my own house & also working on fixing up my rental house.  The time flew by.  Other than Friday, I'm not scheduled until a week from Sunday.  I also took the week off between Christmas & New Years.  It is so nice having the flexibility to choose when I want to work. 

Monday night went pretty well.  I started off with just 3 patients.  One little old lady who came in with a diagnosis of CVA.  She had extreme right sided weakness & half the time I couldn't understand what she was saying to me.  I could tell she was frustrated.  It reminded me of that ER episode where the woman has the stroke & they showed you what it was like from her viewpoint.  This patient's blood pressure was high, but I expected it to be as in the past I've been told by doctors that they prefer a higher than usual blood pressure when it is stroke-related.  However, at one point her heart rate went up to the 150's & her blood pressure was 190/94.  My clinical leader & I looked through her chart and noticed in the doctor's progress notes that the cardiologist had listed his "plan of care" for her & it included Lopressor & Norvasc.  However, he never actually wrote the order for those medications.  So I called him, he said he didn't realize he forgot to write the orders...got her the medications & eventually her heart rate & blood pressure improved.  All was good.

My next patient was a 75 yr old man in with COPD exacerbation.  He seemed perfectly healthy to me.  His wife was at bedside & remained there the entire night - sleeping in a chair next to his bed.  Earlier in the night, their son came out & asked me if I knew any of the test results.  I told him the doctor would be the one to discuss test results with his parents.  He understood...did I mention he was a cutie?  Sorry, yes...even at work I do notice these things.  Later when I was talking to my patient & his wife, they expressed to me that they've been married for 50 years.  WOW!  10 children later & here they are.  They were both very sweet. 

My third patient was a mess...in with urosepsis, UTI, uncontrolled diabetes & pneumonia I believe.  His temp was 102.9 when I came onto shift.  Needless to say.....he was receiving Tylenol every 6 hours.  I managed to get his temp down to 101.3 & that's where it stayed for the rest of the night.  Kinda hard to get the temp down when he had a raging infection that needed to be controlled with antibiotics. 

Around 11 pm, I got my 4th patient.  One thing about our hospital...it seems like they are always moving the patients to different rooms.  This one was a transfer from our second floor PCU.  He came in with chest pain R/O MI...only 50 yrs old (my favorite kind of patient).  He was scheduled for a stress test the next morning & after getting him some food & Ambien...he was out for the night.  His cardiac enzymes remained negative...so I was happy.

The night was dragging by very slowly.  I was actually glad to get my 5th patient to give me something to do.  I got him around 3:15 am.  A 40 yr old with chest pain R/O MI (again, my favorite kind of patient).  His cardiac enzymes also remained negative.......some food for him & off to sleep.  That was my night in a nutshell.  Uneventful & calm. 

I'm spending Thanksgiving at my parents house...looking so forward to it.  I have my brother & his two kids at my house right now.  As much as I like having them visit, I also like having my house to myself.  I'm not sure I could ever marry & have kids.....I like my own space too much.  Oh well...never say never.  I have what I would call a blind date tonight.  I want to go, yet I don't.  We're just meeting for drinks & see what happens.  Wish me luck! 

Have a Happy Thanksgiving everyone!!!!!!!!!!!!

Friday, November 11, 2005

Happy Update

Just a quick update on my puppy dog.  He is doing much better.  I was worried he might get dehydrated so I gave him some Powerade & lots of water last night.  I don't know if that did the trick or what.  He seems like he's back to himself now.  I don't know what he had wrong with him & I realize that time with him is limited due to his age, but I'm extremely happy that I get more time with my buddy.  :)  Thanks to those of you who wrote me with well wishes - I appreciate it.

Wednesday, November 9, 2005

Still undecided

My puppy dog isn't any better or worse today.  I am constantly trying to decide whether this is a sign to have him put to sleep.  I've been crying on & off all day today just thinking about life without him.  He's laying at my feet now & looking at me like "What's wrong?  Why ya sad?"  Ugh, this is so hard.  :(  Needless to say, I'm glad I'm not scheduled to be at work this week.  I would be so distracted & wondering how he's doing & feel like I'm abandoning him. 

I spent part of the day with my parents & one of my brothers.  It was nice being around them.  They are being as supportive as possible, but they aren't connected to him the way I am.  They'll be back tomorrow.  I need to make a decision.

I got a call from another hospital that I applied at.  I should return the call, but I'm just not up to it right now. 


Tuesday, November 8, 2005

Sick puppy dog

After working last night, I came home to find my dog not feeling too well.  I don't know if he has some dog flu or if it's old age setting in.  He's 12 years old.  My dilemma for the past couple of years with him is...when do you know it's time to say good-bye?  He's been sleeping on my bed all day & night...not hungry at all.  His nose is really warm as well as the bottom of his paws - I know that means he is sick or running a temperature or something.   I have no idea what to do for him.  On top of that, arthritis is setting in & he's having a difficulty walking.  However, he is still very alert (while awake) & with it mentally.  So how do you know when it's the right time to make that decision to say good-bye?  I've had him since he was 5 or 6 weeks old & just thinking of losing him makes me cry.  He's been with me the majority of my adult years...my baby so to speak.  Through all the good times & the bad times, he's been the one constant in my life.  He's there day in & day out.  Ugh, I don't like thinking about this stuff.  ;(

I had a good night at work.  One patient was a 67 yr old female in with a COPD exacerbation.  She was upped to a 50% venti mask & that caused her to have numerous nose bleeds.  On top of that, her heart rate would climb to 130-140 for no real reason & then go back down again.  I ended up calling her doctor around 3 am to make him aware of her heart rate & nose bleeds.  His reply "That's fine."  I asked "You don't want to do anything about her heart rate?"  His reply "No, that's fine.  I'll see her in the morning."  Ugh, I hate replies like that.  She was a sweetheart - kept praising me (who wouldn't like that).  She wanted to speak to my supervisor to let her know how wonderful I am.  I ended up getting her some "Share" cards.  It's basically a card you fill out when you want to compliment someone.  It is nice to be appreciated. 

My other 3 patients were men.  One had a stroke & was so utterly confused.  You couldn't even talk any sense into him.  So I stood there & listened to him & each time I told him I had to get back to work, he'd start to cry.  So I'd stand there a little longer while he repeated everything going through his mind & then he'd start to cry again.  I felt for him, but there was nothing I could do.  Well, except to give him a sleeping pill.  Some people might not agree with that, but this gentleman would not have gotten any sleep without medical intervention.  His mind had been racing - kept telling me he had to get TO the hospital.  I'd tell him "Sir, you are at the hospital right now."  He couldn't comprehend that. 

My next patient had a cardiac cath done earlier in the day & they found his circumflex was 80% blocked = transfer him to a different hospital for cardiac intervention.  I had to arrange his transfer.  He was also confused.  Coming on to shift, I found him wandering in the hall.  I took him back to his room, reoriented him...he was ok.  Later in the night...like 4 am, again he was wandering in the hall & eating a banana.  Where he got it from?  I don't know.  He was saying he was on a boat & could feel the waves moving below him.  Ummm, ok.....back to bed.  This time I put on the bed alarm so we'd all be aware if he were to get out of bed again.   EVAC showed up a couple of hours later & the transfer was made.

My last patient was a 79 yr old gentleman with the diagnosis chest pain R/O MI.  I don't think it was an appropriate diagnosis as the man had no chest pain at all - not even prior to coming into the ER.  He hadn't been feeling well & felt like he was having trouble breathing so he went to his VA clinic.  They in turn gave him a prescription for nitroglycerin tablets & sent him to another clinic to get a chest x-ray.  He went to the other clinic - they couldn't get him in until the afternoon - so they sent him home.  Nice - the man is having trouble breathing & they send him home.  On his way home, he fills the prescription & takes 3 nitro tablets when he gets home.  I don't think he had any clue how nitro works.  Needless to say, his blood pressure bottomed out & he was having syncopal episodes, so he called 911.  This gentleman is 79 yrs old & still works as a barber.  Not so much because he wants to, but because he has to in order to pay his bills.  Sad....79 yr olds should not "have to" work. 

It was an easy night.  The time did fly by, I am still tired & heading to bed after watching Nip/Tuck.  That show is so bizarre, but I can't stop watching it.  I'm off now for 2 weeks.....I have a feeling it will fly by.  I have some decisions to make regarding my puppy dog.  :(  Right now I think I'll just cuddle with him & hope he's feeling better in the morning.


Sunday, November 6, 2005

Tired yet not sleepy

I'm so tired, yet not sleepy.  I've been up now for nearly 24 hours straight - only because I woke up early this morning.  It was a good day - I totally surprised my niece with Libby Lu's.  We never made it to Build-A-Bear.  I'll have to plan that for another time.  I can't believe she's nearly 9 yrs old.  I was in the delivery room (standing next to the doctor no less...lol) when she arrived into this world.  Time flies...way too quickly.

I came home to find a message from my hospital, desperate for help.  They even offered "call-back pay"...whatever that is.  I don't know if it's the $100 bonus or time & a half or what.  Regardless, it didn't matter as I was busy celebrating my niece's birthday tonight.  They also said they need help tomorrow night.  I haven't decided yet whether I will pick up the shift or not.  I'll see how I feel after getting some sleep today. 

One thing I forgot to mention in my last post...the strangest thing I've ever encountered so far in my nursing experience.  It is regarding the 49 yr old man with sepsis.  When I came into work last Wednesday evening, two women were in the room with him.  I figured it was family members or friends...so I left them be while I went to check on my other patients.  As I was walking by his room, I noticed the lights were off & the curtain was somewhat drawn.  That got my curiosity.  I stopped & listened.  There was one woman on each side of his bed & they were waving their hands all around & chanting about cleansing his cells & nourishing his body.  It definitely seemed like some sort of odd religious ritual.  I'm all for spiritual hope & I believe in God, but this was beyond odd.  I was not about to walk in that room, however, our respiratory therapist is a brave one.  I saw her go in for a minute & come right back out.  I asked "What is going on in there?"  She was a little freaked out.  She said "They are doing a seance or some kind of weird spiritual stuff!  I had to get out of there quickly as it was quite bizarre."  Just when you think you've seen it all...lol. 

I also had an 89 yr old man two nights earlier that continuously praised me for allowing him to have the best night of sleep he's had in years.  I didn't do anything.  He was basically falling asleep from the time I started my shift & slept until about 6 am.  Other than doing an assessment & giving him meds...I simply didn't bother him.  He insisted on giving me a hug & he followed it up with a kiss on the cheek.  I had some extra time that morning, so I sat with him for about 20 minutes & listened to stories of his past while holding his hand.  He reminded me of my grandfather. 

I'm exhausted, I need to get some sleep.  Ciao!


Friday, November 4, 2005

"Let's Make a Deal"

There are some nights that I go into work & feel like I'm in a version of that show "Let's Make a Deal."  Do you want what is behind curtain #1 or curtain #2?  Decisions, decisions.  I worked Monday night, then went into work Tuesday night...fully expecting to get my patients back.  Instead, my name is not even on the schedule...hmmm.  I go talk to the charge nurse & she says "Well, I have a proposition for you.  Would you be willing to work in ICU tonight if we give you one stable patient or we can ask someone else & you can have your patients back?"  Huh?  ICU??  I've never worked a day in my life in the ICU & they want me to float there when they are understaffed?  It wasn't sounding like a good deal to me, plus I wasn't buying the "stable patient" dialogue because I know if the patient were truly stable, they would have been downgraded to PCU status rather than remaining in ICU.  However, the thought of having only ONE patient as opposed to FIVE was a good one.  Hmmm....what do I do?  I ended up saying no, I wasn't comfortable with being in the ICU...I have no training in there whatsoever, not familiar with their equipment nor the drips that might be going for this "stable patient."  Basically I opted for what was behind curtain #2 (my patients back).  It was a good choice as I ended up only having one patient when I took report in PCU.  We had 4 nurses instead of 3 & most of my patients had been discharged throughout the day.  

The patient I did have ended up being an ICU transfer.  His situation is a sad one.  A 49-yr old man that had hip surgery this past August.  Everything was fine, sent home, good to go.  Except....infection set in & took over his body.  He was admitted on Oct 20th with sepsis & renal failure.  He could barely move, skin breakdown on his heels & a stage 2 ulcer on his buttocks.  His heart valves are infected as well as his brain.  He is still with it mentally - to a degree.  At times he hallucinates, other times he reflects back on the life he used to know.  He would start crying & saying "I wish I could have my life back."  Ugh, so heartbreaking.  He has 3 young kids & a wife.  I can't even imagine what they are going through watching him in this condition.  He receives dialysis on Mon, Wed & Fri.  He's in constant pain throughout his body.  Other than giving him his meds & turning him every 2 hours, I found it difficult to really do anything more for him.  I did spend some time talking to him, but didn't really know what to say when he would start crying.  I knew it wasn't appropriate to tell him he would get better because I don't know if he will get any better.  What kind of words of hope do you give when the prognosis is unknown?  I managed to discover that something simple like ginger ale perked him up - so I made sure he had some anytime he wanted it.  It's not much I know.  

I got my second patient about 3 hours later.  A 59-yr old man with chest pain.  He was so cute...he obviously has a wife that is very organized or he has a bag ready to go to the hospital.  He arrived to the floor with a little suitcase type bag which had pajamas, slippers, robe & even a headset to listen to the tv & a radio.  It cracked me up - he was the sharpest dressed patient I've seen in awhile.  He was self-sufficient.  His only real complaint was a migraine headache. 

Needless to say, I had a lot of time on my hands that evening.  I didn't get my third patient until about 4:30 am.  Another chest painer.....a 64 yr old woman.  She was feeling nauseous - which I thought had been from the 6 mg of Morphine given to her in the ER.  She began to have chest pain about an hour later.  I gave her one nitro sub-lingual and 2 more mg of Morphine.  The pain went away but the nausea came back.  I called the doctor & got an order for Reglan...gave her that & it was now change of shift.  I totally expected her to be ok, but when I came back the next evening...she had a heart cath done during the day & was scheduled to be transferred to another hospital that specializes in cardiac surgery.  Three out of four vessels leading to the heart were needing repair.  Of course the hospital she was being transferred to was the hospital I quit from last week.....ahhh, so ironic.  :)  I received a call from the supervisor at that hospital who just happened to be someone I had met while working there.  He often joked around with Gina & I...he was supportive of us being there & also knew the b.s. that we were getting.  So here he is on the phone, giving me a room number for my transfer.  I say to him "Do you know who this is?"  He says "Hmmm, Jennifer, Jennifer......the Jennifer who left here last week?"  I said yep.  He told me I should have asked to be transferred to a different unit.  I told him it didn't feel like we had any options.  He was cool about it all.  Around 10:30 pm, EVAC arrived to transfer my patient. 

I'm skipping around, but basically my week went like this:  Monday night I had 5 patients - all relatively stable with no real difficulties except for one gentleman that had what we thought was a GI bleed.  He had that "GI bleed smell."  Any of you in healthcare know what I mean.  It is one of the worst odors ever.  They assigned him to another nurse on Tuesday night & I was fine with that.  Tuesday night I had a total of 3 patients.  It was a good night.  Wednesday night there were only two nurses on the floor....I started off with 4 patients, the other nurse got 5.  My chest pain lady was transferred around 10:30 pm, so I was down to three patients.  I got my fourth patient around 2:30 am. 

He was kind of strange.  Admitted with abdominal pain, CHF & COPD.  Any time I would ask him a question, he'd laugh this strange little laugh.  I'm thinking "What's so funny?"  His heart rate on the monitor had gone up to 140....good indicator that my patient is probably up to no good.  I go to check on him & he's sitting on the side of the bed attempting to get up.  I ask "What are you doing?"  He said he had to go to the bathroom.  Ummm, sir, you have a catheter - it's there so you don't have to get up.  I manage to get him back in bed & his heart rate goes down.  I tell him to stay in bed, that if he needs help - press the call button. 

I got my fifth patient around 5:30 am.  A 91-yr old man that I would not have believed was a day over 70.  He looked great.....only medical history was both hips were replaced & arthritis.  Only medication he takes at home is a daily vitamin.  He rattled off about all of his family members that were in their 90's or over 100.  His diagnosis was hemorrhagic stroke.  Hopefully he'll be ok.

Practically everyone I ran into at work was asking how it was going at the other hospital.  I told them the truth about what happened & again...they were all supportive.  It was a nice reminder that who you work with is very important.  It makes a real difference.  They put me on the 2nd floor & Gina on the 3rd floor.  That's the only thing that irritates me...how they constantly separate us.  Oh well, what can you do? 

I'm off until Monday...yay!  Actually, Monday is the only day I'm scheduled for the next two weeks.  I may pick up more shifts, but then again, it would be nice to have a break.  We'll see how it plays out.  My niece's 9th birthday is next Friday, so I'm taking her out tonight & tomorrow to celebrate.  Libby Lu's & Build-A-Bear...here we come...lol.  I need to get moving...need to get to Target & buy her some gifts. 

Have I mentioned that I love having my work week done in 3 days?  It's nice having 4 days off (or more) every single week...it really is.  :)