Thursday, December 22, 2005


Everyone ready for Christmas?  I have spent the last few hours wrapping presents.  Next year I'm teaching my niece how to wrap so she can do it all except for the presents I buy for her.  I used to enjoy wrapping presents, but now...I just want to be done! 

I had a good week at work...busy the first 2 nights, but my third night was a piece of cake.  I've come to appreciate nights like those because they are so rare.  Actually looking back, Sunday night was a lot of work & I wasn't too happy.  My rooms were all spread out down the hallway.  I prefer them to be together...not just because it makes it a little easier, but I think the patients would appreciate it more seeing the same faces over & over rather than multiple people coming in & out of the room. soon as I reported to my floor, I was told "Oh nooooo, you have "that" patient."  Not exactly the words one wants to hear.  I was told he was yelling & screaming the night before, he was punching & kicking to the point of needing to be put in wrist & foot restraints.  He has alzheimer's & Sundowner's...meaning he doesn't really sleep at night as well as being beyond confused. 

My second patient is a 95 yr old woman in with altered mental status.  I've had her as a patient before & she has definitely gone downhill.  In fact, I had her for 3 nights straight & it seemed she was getting worse as time went on.  At 95, what is there really to expect?  There are exceptions, but most people don't make it to 95.  Add into it that she also had c-diff & a UTI....her body was having a rough time fighting the infections.

My third patient was also someone I've had in the past.  He was in with pneumonia, but also had some anxiety issues going on.  Nice gentleman, just worried way too much about things he didn't need to worry about.

My fourth patient - well, he was awaiting discharge.  Actually, we were waiting for him to urinate before we could let him leave - since he had a foley in earlier.  Any nursing student knows...can't discharge until you see some, fun, fun.  About an hour later he was good to go. 

At the same time, I was orienting a med/surg nurse to PCU.  My unit is so short-staffed that they are requiring med/surg nurses to be flexible & to fill-in when we need them.  She was nice, a quick learner...she'll do fine.  After all, I oriented her to the unit!!!!!  :)

I got a new admit around midnight...a 52 yr old male that became disoriented at home.  His blood pressure was 214/110 upon arrival to the ER.  So I ask the ER nurse...what did you give him for his blood pressure?  Answer:  nothing.  Ummm, why not?  Reply:  We thought it would go down on it's own.  Now I have to say...our ER has been slammed the last month - every single day & night.  This week was even worse - to the point that all of our beds were practically full & they had PCU nurses in the ER taking care of patients that were awaiting admission.  Which basically means...they are too sick to send home, but we are too full & have no beds they spend a night or two in the ER awaiting a bed to become available.  Not a lot of fun, I'm sure.

So I admit this gentleman, take his blood pressure & it's something like 170/105.  I'm not a happy camper.  I end up giving him the blood pressure medication the doctor ordered in the ER but the patient had never received.  Off to sleep this patient goes, can't blame him for being tired after spending 12 hours in the ER. 

I get another new admit around 5:30 am.  This time a trach patient with pneumonia.  I was dredding it.  I just am not comfortable with trachs....there are a few things that can creep me out....a hole in someone's neck is one of those things.  This gentleman worked with asbestos years ago & developed cancer of the throat as a result of that.  That's why he had a trach.  Very, very nice man...I just couldn't understand most of what he was saying.  Not to mention when he'd try to cough up phlegm through his trach opening.  That just gags me.  Don't know if I'll ever be comfortable with trachs. 

Another thing that grosses me out....fake eyeballs or even stories about how someone lost an eye.  I just instantly feel pain.  I mention this because a patient I had a couple of weeks ago had lost an eye when he was a child.  Someone acidentally poked his eye out with a stick...eww.  Definitely gives true meaning to that saying "Don't do that, you'll poke an eye out!"  On top of that, he had a fake eyeball & the day nurse was telling me about how she helped him take it out & clean it.'s turning my stomach now as I recall her talking about it.  That same night, Gina got a patient who had no eye at all....just an empty socket.  She tried to get me to go look at it...but no way......sorry, can't do it. 

Ok, back to my first patient...the one that I was told was unruly & out of control.  I go in to assess him & he's sleeping.  I'm not dumb.....I let the man sleep.  Who am I to wake him up?  Luckily the family also hired a private sitter to spend the night in his room.  I had no problems with him at all.  He's actually a very smart man...went to MIT, was an engineer...very smart cookie.  My only problem...getting him to take his pills.  He wouldn't do it.  I tried putting them in pudding so he could swallow them all in one scoop.  He told me to leave well enough alone.  I came back later when the tech was taking his temperature...after she was done, we talked him into trying some pudding & finally got his pills into him.

By the morning, I was writing out to the clinical leader which patients I didn't want back the next night.  Not because I had a problem with the patients, I just didn't want to have my rooms all spread out again.  Luckily it worked out well.......I kept 2 of my patients & got 2 new ones.  One patient I didn't have back was the 52 yr old & I am so glad I missed out on that one.  At the beginning of the shift, I heard him yelling & swearing at his wife.  He's furious that the doctors aren't telling him why he became disoriented....he wanted instant answers.  He was yelling at the nurse, he was ranting & raving.....just way overdoing it.  No wonder his blood pressure is so high.  Personally I think he was flipping out because he hadn't had a cigarette in over 24 hrs.  Smokers tend to get a little nutty when they are forced to go cold turkey. 

Anyways, that's about it in a nutshell.  My 95 yr old patient is still alive, but I swear I was hearing what would be referred to as a "death rattle."  It was just a bizarre noise she was making, not to mention she was shaking.  There was nothing I could do to improve her condition or her comfort level.  With someone like that, you're basically playing a waiting game.  The respiratory therapist is convinced she only has a few days of life left...we shall see.

I had today off, but I think I will put in a night of overtime tomorrow night.  One of the clinical leaders called me Monday morning & was basically begging me to pick up some shifts between now & Jan 1st.  I need to figure out what nights I want to work...all next week will be shifts offering bonuses.  I sorta wanted to take the week off, but it is hard to pass up the money they are offering.  I'll play it by ear.  Enough about me.........hope y'all are done Christmas shopping & enjoying time spent with family & friends.  To the nursing students that read my journal...hope you had a great semester.  Rest up & enjoy your time off.  January will be here soon enough.  :)




No comments: