Thursday, December 8, 2005

I should be napping

It's been a pretty good week so far.  I worked Sun, Mon & Tues nights and will be going in tonight for some overtime - so I should be napping - but I wanted to post on here first.

My week went well...Sun & Mon nights I had the same exact patients both nights - I enjoy that.  Makes it better for both myself & the opposed to having a different nurse each & every shift.  It also makes getting report short & sweet.

I started off in report being told about my first elderly man with dementia that was angry & would yell things out continuously.  He was in for pneumonia I believe...I had no problems with him at all.  The first night he started off sitting in a chair, got him into bed & he slept the entire night with absolutely no anger or yelling out.  What can I say - I have the magic  The second night, he would keep asking for coffee - even if you just gave him a cup.  Sad to see how the mind sometimes works...or doesn't work properly.  By the third night, he was downgraded to med/surg status & I transferred him around 9 pm. 

My second patient was an elderly woman in with CHF.  She is probably one of the sweetest patients I've had so far this year.  She happens to be a retired RN.  She was improving greatly each day, but the smile on her face said it all.  When I showed up Tues night, she was looking for me & was so happy to see me.  I like when I can make a connection like bring a smile to a patient's face is the best reward, if you ask me.

My third patient was also in with CHF.  This gentleman just cannot catch a his early 50's...he's had heart problems, got better....then found himself with back problems....had spinal reconstruction surgery - thought he was on his way to recovery only to find out he now has lung cancer.  Monday night he was feeling depressed about his life.  I took some time to chat with's difficult to try to cheer someone up with all that he's been through, so I simply encouraged him to express how he was feeling.  The next night when I came in, he said hewas feeling a lot better - that he woke up with a new outlook & his spirits were lifted.  I was glad to hear it.  He also was downgraded to med/surg status & as much as I didn't want to give him up as a patient, I transferred him to med/surg around 10:30 pm. 

My fourth patient - he was amusing.  He came in with syncope - kept passing out at home.  He blamed it on taking Levaquin, but as they ran the tests, it showed that it wasn't a reaction to medication.  I had time on Sunday night to actually spend time with my patients (as opposed to tons of paperwork) & I was concerned about him because he kept stating that he just didn't feel right.  I've learned enough to know that when a patient says things don't feel right - to listen to them.  So I pulled up a chair as he sat bedside.  He was saying he felt like he was going to pass out.  However, he was able to talk & talk - I learned all about his life over the 3 nights that I had him.  We joked, we talked, we looked out for one the third night, he was trying to swap his blueberry muffins with me for some  His admitting doctor came in Tuesday morning & asked me "Is this patient ready to be discharged?"  I told him "No, he's having trouble with his left leg, is having difficulty standing, complaining of feeling like he's going to pass out & he's short of breath."  The doctor said "Are you looking for reasons to keep him here?"  So much for advocating for my patient.  I told him I'm just answering his question.  He turned & said "I don't care, I'm discharging him to a nursing home."  Then he went to talk to the patient, came back out & said "You're right, this patient is not ready to be discharged."  At least he was able to acknowledge when he was wrong - unlike some people I know <g>.  Anyways, this patient had a stress test on Tuesday & it was positive.  The cardiologist wanted to do a heart cath & possible heart bypass surgery.  The patient wanted a little time to think it over.  Tuesday night his neurologist wanted to do a CT of the brain.  I informed the patient & he got upset - said he had bad memories from the past & did not want to be put through that again.  I told him that was fine....he has the right to refuse any tests.  So I informed the neurologist, cancelled the test & informed the pt it was all taken care of.  He continued to tell me about his fears about CT's & MRI's.....I told him he didn't have to convince me - I'm on his side & I understand his apprehension.  Later I went in there & he told me he had been dreaming about our conversation.  I told him that surely he must have better things to dream about.  :)  I hope everything turns out ok for him.  He was a sweetheart.

On Monday night, I was given a new quote the ER... "we wanted to get him out of here before he coded."  The gentleman came in on bipap & everyone was telling me that once the pulmonologist saw him, he'd probably be transferred to ICU.  Luckily it was 6 am when I received this patient, so by the time I got done with the admission paperwork & assessment, it was time to go home.  Later I found out that rather than going to ICU, the family decided to go with hospice.  I chatted with the hospice nurse for a little while - they truly are angels here on earth.

Tuesday night I got 2 admits also.  Another one that seemed like he belonged in ICU....his pH on arrival to the ER was 7.1.  I believe they say anything under 7.0 is I was concerned about receiving this patient.  Respiratory worked with him & got his pH up to 7.4 by the time he made it to my floor.  He was fine through the night, no problems to speak of.

My other new admit was in with pneumonia, recurrent falls & hyponatremia.  His sodium level was 127.....normal is 135-145.  Needless to say, he was on the confused side.  He kept calling me "boss."  As the night progressed, the more confused he became.  I should have given him some saltine crackers to help with that sodium level, but I didn't think about it at the time.  He kept removing his heart monitor.  I'd go in, put it back on, explain to him the importance of it...he'd say "Ok, boss" & 10 minutes later it would be off again.  I couldn't see restraining him over that, although the heart monitor is very important.  I left it for the day shift nurse to decide what she wanted to do. 

I ended my shift with getting a flu shot - I don't want to get sick this season.  I know many say that the flu shot doesn't do squat, but I have gotten them the last 2 years & have not been sick at all......I'm hoping to keep that going.  Although I probably just jinxed myself by writing

Anyways....I'm going back for more tonight & maybe even Saturday night - it's hard to pass up the overtime $$$ as well as the bonuses - wish me luck!

No comments: