Sonic Boom

Yesterday as I was getting ready for work - I heard the space shuttle's "sonic boom" as it was reentering the earth's atmosphere.  Living here in central Fl, we used to hear that noise quite often.  I hadn't heard it in a long time though - it is an amazing sound.  I'm glad the astronauts made it home safely & that the shuttle is still in one piece. 

Work has been going well.  I put in 4 days this week.  It's been an interesting week to say the least.  It's funny what patients will try to get away with.  I had one gentleman that when I first introduced myself, he began apologizing & telling me all the help he would need for me through the night.  Mostly helping him in the bathroom & wiping his butt & putting cream on him down there cause he was sore.  It was a bit too much from someone that was capable of walking to the bathroom on his own.  So I reassured him, told him we'd be working as a team tonight & whatever he needed, "we" would be there.  We being myself & the male tech that was working.  Well, no sooner did the male tech introduce himself did the patient suddenly become self-sufficient.  It was a miracle!  He was able to take care of himself in the bathroom.  Imagine that.  The next night I had him as a patient again & we had another male tech...sure enough, this patient was able to do for himself again.  It's not that I mind helping out, but when people that are self-sufficient take advantage of the situation - it can be irritating.  Needless to say, he was discharged home within a few days & is totally self-sufficient...lol.

It was a week in which I began to question my role in nursing.  Are we truly there to help heal?  Is what we're doing making these patients better?  I don't know.  I mean I see them feeling better & getting discharged - but is it because of anything I've done?  Am I simply going through the motions?  I don't really have the answers.  I had a couple of patients in which it made me thankful that my health is pretty good compared to what they are going through.  It makes me sad to see so many suffering, but on the other hand - some of the suffering comes from what they do to themselves & others are simply born with it.  I'm rambling here & probably not making much sense. 

I had a patient last night who had Coumadin (blood thinner) ordered.  No PT/INR had been done that day & I saw that when she came in 2 days ago...her INR was 2.9.  Normal range is 2.0 to 3.0, so she was at the top end of normal.  I decided to have it rechecked before giving her the dose.  Good thing I did as it came back 4.2 so the medication was held.  It was a reminder to always follow your gut instinct & make sure you know the lab values on stuff that is important.  The doctor for some reason the night before insisted the patient receive like 4 times her usual dose of Coumadin & the nurse gave it without having the INR checked.  It's a reminder that you have to cover your own butt in certain situations - don't take the doctor's order as a "must do."  Sometimes they do make mistakes or they order things that aren't necessarily good for the patient.  So you have to be on guard - otherwise you could not just lose your license, you could be sued...and worse...you could cause harm to another person.  There are so many flaws in healthcare that you really do have to be your own advocate.  I see & hear so many stories of things gone wrong and that could have been prevented.  It's scary. 

Ok, time to change the subject - it's getting way too serious & depressing for the holidays with that stuff that I wrote above.  I am off now until January 7th...well, that's my next scheduled day, but I'll be picking up shifts here & there.  My goal in 2007 is to pay off my car.  I have 2 years of payments left....something like $15,000 or so...but I am determined to pay it off....hopefully by June.  I don't usually set goals, so I'm trying something new here...lol.  The hospital is short-handed as usual, so there will be plenty of opportunity to make some money to achieve this goal. 

I hope everyone has a safe & happy holiday season! 

9 shifts in a row

Ok, the new record is 9 shifts/nights straight. I had thought about going back tonight, but 2 things stopped me. Mostly my niece wanted to spend some time together & also because the hospital was very shortstaffed tonight & I have a feeling it would probably end up with 5 patients & no tech. I'm too exhausted for that....need to re-energize. Not to mention there is no incentive to volunteer to work. I wish they'd rethink that.

Last night was my toughest of them all...not that it was that tough. I actually had it very easy with my patients over the last 9 nights...they had very few medications & slept during the night rather than being on the call bell every 10 minutes. Last night I had 5 patients...I was familiar with 3 of them from the night before. Those 3 were stable...a gentleman recovering from respiratory failure - he was downgraded from ICU, another gentleman with a pacemaker malfunction - his battery was dying, but he had it repaired that day by the cardiologist & my third patient was that woman I wrote about in my last entry regarding her amylase & lipase...she's still waiting for it to get within normal limits so she can have her gallbladder removed.

My new patients were 2 more males. One with sick sinus syndrome & syncope. His heart rate would average in the 50's, but drop to the 30's & jump up to the 120's instantly. More than likely, he was going to end up with a pacemaker. His heart rate/rhythm was causing him to feel dizzy &/or faint. Luckily he came to the hospital & he'll have it taken care of.

My last patient was a very sick older man. He had been admitted with a pleural effusion & he had a history of esophageal cancer. It has metastasized to his brain & they were running tests to see where else it is. He's been in the hospital for about 3 weeks now, but this was my first night with him. I had been told that 3 doctors had discussed with the family DNR status & hospice. The family was not about to give up hope...they wanted every test run first. I met with them last night & it's sad seeing them hurting - I know it's a heavy decision to make. They said good night to me & I went in to assess this gentleman. He was not looking good at all. I didn't even need my stethescope to hear how junky his lungs sounded. I gave his prescribed dose of Lasix & got him a breathing treatment. His eyes were open, but no real response from him. He looked tired....very, very tired. He had a peg tube, so I gave the rest of his medications & hooked him back up to his enteral feedings. I checked his 02 sat which was amazingly 94% considering he sounded so very congested. I tried talking to him, but it didn't do any good. I got no response, so I left him to rest for awhile. About a 1/2 hr later, the respiratory therapist and the PCT came to me & said he's non-responsive. At this point, he was still a full code...but I so did not want to see him go through the trauma of a code. I went in to assess & he looked the same to me as he did earlier. The resp. therapist was attempting to suction him & he wasn't responding to her efforts. Earlier he had been making noises & trying to fight against the suctioning.....now, nothing. I had brought my clinical leader in earlier to let her get a baseline assessment also....because we had a standing order to send him to ICU if necessary. I called her & she came in & agreed that he was very sick & needed to be in ICU. She told me to hurry, because the respiratory therapist was predicting he will probably code sometime during the night...so the sooner we got him to ICU, the better. His 02 sat had dropped to 91%. I called the Dr.to inform him of the change in status. He was ok with the transfer to ICU, told me to contact the pulmonologist for further orders. Inbetween that, I called report to the ICU nurse who was veryyyyy unhappy about receiving this patient. I didn't understand why she was giving me an attitude. After giving her report, she told me to call the pulmonologist before bringing the patient to her. So I called him & I got a lecture about how sick this patient was & how I need to convince the family of making a decision to make him DNR....to clarify what measures they want taken & to explain to them that if it goes as far as putting him on a ventilator, he probably won't come off of it. I told him ok, I would do that. Luckily my clinical leader took that upon herself to do so I could work on getting the patient to ICU. So she's talking to the family on the phone, I'm calling the ICU nurse to give her the update. Now she's insisting I keep the patient until the ABG results come back since the doctor ordered an ABG. I told her no, the doctors want him transferred regardless. Grrrr...I did not understand her attitude reagarding this patient. I get off the phone with her & I'm listening to my clinical leader talk to the family & try to gently explain about the ventilator. The family wants all measures taken - they are not ready to give up yet. My clinical leader had tears in her eyes & she's a very experienced ICU nurse who I'm sure deals with this all the time. She said the wife sounded so upset. It's hard to make these decisions, I know. So we transferred him & he was stable over there...not that he improved at all, but at least he was able to be observed more closely...as his condition should be closely observed.

I stayed at 4 patients the rest of the night. I had no midnight or 6 am meds to give. My patients did not press the call light at all. They're so good to me...lol. I'm heading to bed now...I have lots of Christmas shopping to do tomorrow...I want to get it all done...hopefully...or at least most of it.

Happy Monday!!!

Setting a record

Yawn!!!!!!  I'm sleepy.  I've worked the last 7 nights straight & am scheduled for tonight & tomorrow night also.  It's a new personal record for me for the amount of nights worked in a row.  I'll probably continue to work through next week...makes me feel less guilty about taking 2 weeks off at Christmas...not to mention the money.

Luckily my patients have been very stable for the most part & I've had it easy.  I only had one critical incident in which the morning labs revealed a 6.9 potassium level.  Normal is 3.5 to 5.  Anything above 5 is definitely not good.  6.9 is very, very bad.  The doctor prescribed an amp of calcium gluconate, an amp of D5,10 units of regular insulin IV as well as a nebulizer treatment.  I had never heard of that "cocktail" before, but damn...it works quick.  I pushed the meds at 6:45 am & they rechecked the blood at 7:05 am & her potassium had gone from 6.9 to 5.3.  So I learned something new about how to get the potassium out of the bloodstream & back into the cells very quickly.  I'm hoping this patient goes home today.  She is a drug seeker & the doctor wrote no narcotics allowed for this patient.  Then he also wrote for a strict diet since her potassium had been so high.  Needless to say, she was not a happy camper. 

The rest of my patients have been wonderful to care for.  I've had one for the last 7 nights.  Poor lady...she has pancreatitis as a result of her gallbladder not working properly.  The gallbladder needs to come out, but they can't do that until her amylase & lipase (pancreatic enzymes) return to normal....only they aren't returning to normal.  They started to come down, but all of a sudden they are going back up.  She went 7 days/nights without eating (doctor's orders).  They finally started her on PPN.  She just wants to go home...she's young, in her early 40's.  She has a good attitude about it though.  I'm kinda getting attached to her...in the sense that I want to see her get back on the road to recovery & be at home with her family.  Maybe there will be some good news when I get back to work tonight.

I also had one of the sweetest patients ever & he wasn't even trying to be sweet....I think that's why I think he's so sweet.  He's 90 yrs old, totally self-sufficient!!!  He said to me the first night I admitted him with chest pain..."I hope I don't bother you too much."  Gotta love a patient that doesn't think you are their personal slave.  He'll probably go home today though...so I'll most likely have a whole new group of patients.  Hopefully my nights will continue to go well. 

Ok, I'm off to get some sleep.  Hope everyone is doing great!

 

Not a new nurse anymore

Where oh where has the time gone? I'm approaching my second anniversary of graduation from nursing school. It's official...I'm not a new nurse anymore...lol. It was confirmed when we got an email regarding this head to toe assessment seminar that is happening this coming Thurs & Friday at our hospital. The email said that they are only paying for certain nurses to attend...mostly the newer nurses & that they would be contacted personally so they would know who they are. I wasn't contacted...so I guess they are confident that I am fine with my assessment skills & thus I no longer fall into the "new nurse" role anymore. We can still attend the seminar if we want, but I really don't want to. Not that I don't think it is helpful & beneficial....but two 8 hour days going over assessment info??? No thanks. Besides, I'm working Friday night so it wouldn't work out anyways schedule wise.

Speaking of work - I just can't get into it. I've taken too much time off...lol. I did work this past Wednesday. It is so simple now with the computers...hours of charting only take minutes now. It's wonderful. I had 4 patients that night who all wanted to pretty much be left alone to get some sleep. I'm fine with that...I think they are sleep deprived at the hospital anyways with all the interruptions. I was planning to work this weekend also...but thus...I didn't.

My patients...one was a 23 yr old who has had her period for approx. 2 weeks. I guess this is common for her although the doctors don't know why. As a result, her H&H dropped to 6.0 & 17 = really not good. Needless to say, she received 3 units of red blood cells. My next patient was someone with kidney failure & she should have gone home that evening except that she is unable to even stand up, much less walk. Her insurance won't pay for rehab & the doctor didn't feel comfortable sending her home if she couldn't take care of herself. So they were planning on arranging home health care the next day. My third patient slept pretty much the entire shift. She has cancer all over & the edema is taking over...3+ pitting. She didn't even want to move, didn't want to be bothered, didn't want anything to eat or drink. What am I going to do other than allow her requests? My fourth patient was a new admit that I volunteered for. A male in his 50's with respiratory issues. I figure usually the younger the better & he was pretty stable. He had one episode in which he needed a breathing treatment, but other than that...he slept. So it was an easy night that went by so very slowly.

Tomorrow I'm gonna go watch the Chicago Bears football game (Go Bears!!!). Monday night I have a volleyball tournament. So I may work Tuesday night. I'm not scheduled so I'll play it by ear. I am definitely working Friday, Saturday & Sunday....I think that is when I'll go for working a bunch of days in a row & make up for all this time I took off. Ahhh, the flexibility of part-time...I love it.

I hope everyone had a wonderful Thanksgiving holiday. I spent mine at my parents home with about 30 other people...mixture of family & friends. That day & Christmas Day are my favorite days of the year...because we all get together. The time goes by too quickly though. I guess that's how it is the older I get.

Thanks to those of you who gave me camera advice. I did end up getting the camera I ordered & I like it. Of course I'm having buyer's remorse which is what I usually have anytime I buy myself something expensive. I will keep this though - I've needed a camera & digital is the way to go. It is a great deal....Polaroid I733...$149. It goes up to 7 megapixels & it's pink for breast cancer awareness. I got it at Wal-Mart.com....so if anyone wants a great camera & an awesome price...there ya go. Now if only someone had warned me to buy rechargeable batteries...lol. :)

I feel like my journal has been boring lately...I haven't had anything major going on with any of my patients. I'm knocking on wood while typing this...lol. Not that I wish for a crazy shift, but something interesting would be nice. We shall see...

A week off

I've been off for the last week for a couple of reasons.  One being...I've been sick.  I started out with a scratchy throat & next thing I knew I was achy & tired.  Now I have more of a head cold, but a little more energy...so I think I'm getting better...hopefully.  I don't want to be sick on Thanksgiving. 

The other reason is one of my friends broke her foot.  I took her to the doctor & have been helping her out a little bit.  She's supposed to get a cast put on it next week...after the swelling goes down.  Poor girl. 

My schedule this week is pretty light unless I decide to pick up some shifts.  So far I'm only scheduled for Wednesday night.  Have to prepare for shopping madness this weekend.  Well, staying away from it.  I hate the crowds & hoping to do some shopping online.

I forgot to end my last entry with one of my favorite things so I'll have two in this entry.  The first being...Emmitt Smith.  Anyone that watched Dancing with the Stars knows why.  He was spectacular.  Enough said.  My other is hot chocolate on a cold morning.  Is there anything better?  :)

 

Divided up week

Last week was the first time I divided up my nights at work. I worked Sunday night, Tuesday night and Saturday night. I much prefer working 3 in a row - it's just easier to stay in that frame of mind & on the proper sleep schedule.

I already wrote in my last entry about Sunday night, so I'll try to remember Tuesday night. Nothing really stands out...hmmm. I'm telling you...my memory is shot...lol. Ok, it's coming back to me. It was what some would claim a busy night for me, but yet I didn't feel busy. Right before I got to work, one of my patient's signed out AMA (against medical advice)...so I was automatically down to 3 patients. They changed the assignment a little so that I would have 4 patients...a new admit waiting in ER. About 20 minutes later, I'm discharging one of those patients. Right after that I got my new admit, took care of her admission & off to bed she goes. Ok, so back to 3 patients...no problem...with the computer charting, it takes very little time to complete the necessary paperwork for charting & I'm looking for stuff to do to pass the time.

Around 11 pm, I get a fax report of a test one of my patients had done. The results were negative & according to my doctor's orders, this patient was to be discharged if the results were negative. I run it by my clinical leader because my patient is now sleeping & it's after 11 pm. She says "If the order says to discharge, you have to discharge." So I hesitantly go into my patient's room, wake her up & give her the news. Luckily she was thrilled with the idea of going home - she said "You just made me the happiest person." Whew...didn't think she'd be that thrilled about being woken up & kicked out of the hospital. So it takes about 10 minutes to discharge her and I'm down to 2 patients. I can't even really remember much in detail about them. I know one was a man with congestive heart failure that was improving. All he wanted to do was sleep. My other patient - in with chest pain & just wanted to sleep also.

I was told I was getting another admission & that was before I had even discharged the last patient. No problem, something to pass the time. I don't remember her diagnosis, but she was another one that simply wanted to sleep since it was after midnight. About the same time as all this is happening, the hospital decides our hallway floors need to be cleaned. It's a pain in the neck because we aren't allowed to walk on it & it's just a mess that lasts for hours. So there I am at about 2:30 am, with a laptop in my new patient's room & I'm charting in the dark while she sleeps because our nurses station is a mess due to the cleaning of the floors. Talk about an all-time low!

It was actually a blessing in disguise. I volunteered for the next admission even though it could have gone to another nurse. I was told it was a confused patient that was a handful. Due to our floors being cleaned, we couldn't take the patient at that time...darn...lol. Now it's after 5 am & the ER is not happy we have delayed taking this patient. That made me wonder about this patient....how bad is she that the ER can't wait to get her out of there? Finally the floor are done around 6 am & I get report. The ER nurse brings the patient around 6:30 am - which I think is ridiculous...hello, shift change starts at 6:40. I end up just taking the patient's vital signs, make sure she's comfortable in bed & give report to the oncoming nurse. This confused patient though...oh boy...it's not so much that she was confused as she was just in her own world. When she spoke, she sounded like Marge from the Simpsons. She was very unique...I'll take that over some confused person that is yelling or hitting.

So after 2 discharges & 3 admits all in one night...I was glad to go home. I went out Wednesday night with 3 of my best friends...we all went to high school together - that's how far back our friendships go. What is that...like 25 years or so. One of them I've known since I was born. It was nice being able to just kick back, relax & catch up with each other. We stayed at the restaurant for nearly 4 hours!

Thursday night was spent celebrating my niece's 10th birthday. She was so excited & so happy. Friday was spent carrying on the celebration & taking her shopping at her favorite clothing store "Justice" & also over to Libby Lu's for a makeover & some new boots. I can't believe she's 10 already. Where does the time go?

Friday night I went to the county fair...I haven't been there in years. I forgot all of the junk food they sell there...but it is good...lol. They had tons of rides & the usual livestock, but they also had tigers. Beautiful tigers...I love looking at wild animals. I think next month I'll take my niece & nephew to Disney's Animal Kingdom. I haven't made it over to that park yet.

Saturday night I worked...only I wasn't a nurse that night. I was the unit secretary. They rotate the nurses into that role when they are fully staffed & I didn't mind one bit. I had 8 admissions to do, but it wasn't bad. I don't really care for ICU admissions because it's so different than PCU...but I was floated around to whoever needed help with their admissions. The rest of the time I sat & chatted. It was great.

I'm trying to buy a digital camera...the one I want is either backordered or overpriced on Ebay. It's a Polaroid I733...it's pink...for breast cancer awareness. Wal-Mart was selling it for $149 which is a great price for a 7 megapixel camera, but they are back ordered...grrr. Anyone have any other suggestions regarding a great digital camera? I was hoping to have one before Thanksgiving next week.

I've got volleyball tonight & back to work tomorrow night...ahh, the life of a nurse...lol.

An Amazing Outlook

Hmmm...what to write about??? I worked Sunday night...another easy night. It's starting to scare me a little...like am I just having easy nights or am I just more relaxed at what I do? Probably a combination of both. I did have one amazing patient...amazing in the fact that he has cancer & it's spreading & he has totally accepted that fact. He still has a smile on his face. Perhaps it's the age??? He's in his early 70's, feels he's lived his life & will accept what God gives him. He has a very supportive family which is good to see...sad knowing what they are dealing with, but inspiring to see how they band together to make life a little easier for him.

At the opposite end of the spectrum, I had a woman in her mid 80's that is ready to just let go & give up on life. She is refusing to eat...wants life to be over. I managed to get her to smile & to drink a little bit of Ensure...but you can't make someone do what they don't want to do. I tried to keep her as comfortable as possible.

I had volleyball last night...we won again & we only had 4 players. I have work tonight, then I'm off until Saturday night. My niece's b-day is Saturday...so we're celebrating a little early...Thursday night...as she'll be with her mom on Saturday.

Tony Stewart won again this past Sunday...I'm loving it. Speaking of loving it...I think I'm gonna end each journal entry with writing about something I love or enjoy...today since I just mentioned him....I'll say Tony Stewart. Even though he didn't make the "race for the chase"...he isn't giving up. He's still driving hard & having fun with it even though the best he can do this year is finish in 11th place. He is starting to remind me of Dale Earnhardt Sr...the way he dominates on the race track & can stir up trouble very easily yet still walk away with a smile. Only 2 races left in the season. :( Go #20 & #8.

7 Nights Straight

What a week! I worked 8 out of 9 nights....7 of them in a row...12 hour shifts. I haven't even calculated the hours I put in...hmmm, somewhere around 105 hours give or take. I set a personal record for myself. It wasn't bad at all & I absolutely love the computerized charting. What a difference it makes. Luckily, I was able to pick it up pretty quickly & charting is so very quick & simple now rather than hours of handwriting.

I had another pretty smooth group of patients. They were all stable for the most part. I had a lady in her late 80's that was going into v-tach now & then...but according to the cardiologist - what do you expect for an 80-something year old heart? She was asymptomatic with it...so no worries.

My only patient that really stood out was what we call a "frequent flyer." She's in & out of the hospital on a regular basis. This was my first encounter with her & hopefully my last. She was in with CHF and on fluid restrictions & all she wanted to do was drink & drink & drink. I tried explaining to her the purpose of fluid restrictions & why the doctor prescribed that - but she didn't care. That's the part that frustrates me...people doing the opposite of what is best for their care...WHILE they are in the hospital...lol. If you don't want to comply...why did you even come to the hospital? She loved me the first couple of nights, but when I stood my ground on the fluid restrictions...I think I lost points. Oh well...that happens sometimes. I'm not there to make friends, I'm there to help them get better, right?

I'm debating about whether to work this weekend or not. The money would be nice, but so would some time off. The county fair starts tomorrow....so maybe I'll go check it out. I'll decide later. Have I ever mentioned I love the flexibility of my job...haha. :)

My week started out wonderfully after seeing Tony Stewart win yet another race. Go #20!!! Dale Jr. stillhas a shot of winning it all. Only 3 races left. Go #8!!!!

It's finally getting a little cooler out, I love the time change....feels like winter is coming. Less than 2 months until Christmas...woo hoo. This is my favorite time of the year...Thanksgiving & Christmas.

Hope everyone had a great Halloween & that you have a wonderful weekend!

Taking a Breath

I only have a minute...as I'm on my way to bed this morning. I've worked 5 nights this week...tonight will be my 6th. I'm tired, but it really hasn't been bad at all. My patients have been relatively stable. I'll go into more detail when I have the time...just wanted to say hi & have a great weekend!

Not So Bad

Well.............computer charting is not so bad.  The night started out a little rocky for the agency nurses as they were having a hard time signing on (I was the only staff nurse on that part of the floor out of 7 nurses), but I was in like flynn.  Much, much better than handwriting.  I'm not sure I'm documenting everything correctly, but I did my best. 

It seems like our hospital is back to having very few staff nurses & 75% travelers or agency nurses.  So many new faces & names, I can't keep track.

I managed to stay at 3 patients for the night.  We were told it would remain like that for 2 weeks...but not even 6 hours into the shift, some nurses were getting a 4th patient.  Supposedly next year, our new budget shows that we will only have 4 patients maximum.  I'll believe that when I see it.  Watch, we'll end up with 6.

Anyways...I had one patient that I really can't say much about.  It's a very sad case...a simple procedure that went very wrong.  The reason I'm not comfortable writing all that much about it on here is because I feel that a lawsuit will be brought forward & I wouldn't blame the family one bit if they make that choice.  Therefore, I'm not writing anything regarding specifics....just in case.

My second patient was an elderly man with a history of dementia.  He was a handful.  He was wonderful when he was sleeping, but so off the wall when he'd wake up.  He'd start yelling & telling very odd stories.  Like the first time, he kept trying to wake up the person he was sharing a room with - so much so - he'd throw his pillow at the guy.  He was demanding that they make a movie together.  It was like dealing with a 2 yr old.  Eventually he went back to sleep for a few hours - I went on break, only to have another nurse call me & say I need to get back, my patient is attempting to jump out of bed.  I get back & he's at the end of the bed saying he is an inspector & he needs to inspect the building immediately.  He was convinced it was about to fall apart at any moment.  There was no talking sense in to him. It wasn't too long before he fell asleep again.  Dementia is a sad disease - he truly believed everything he was saying. He was in with a UTI and sepsis, but seemed to be improving medically.

My third patient was an older lady with pulmonary embolisms.  She was very independent, didn't want to be bothered & would call me when she needed me.  I love those kind of patients. 

So yet another pretty easy night.  I have volleyball tonight & more than likely back to work tomorrow night.  I need to get some overtime in to rebuild my savings account so I can take some time off at Thanksgiving & Christmas.  Hope everyone has a happy Monday!

Today's the Day!

October 22nd = the day my hospital switched over to computer charting...ahhhhhhhh. The day I've been waiting for. I hope it's a smooth transition & that it beats handwriting hours & hours of charting. Maybe now, my writing hand won't look so deformed with the calluses...lol.

Supposedly we are only supposed to have 3 patients each during this transition period. I'll believe it when I see it. Rumor is...there will be chocolate everywhere....lol. Such healthy rewards! We always know something not so great is up when there is chocolate around.

I'll let ya know how it goes!

Off Topic - Sheriff Daniels

It wasn't supposed to end this way. It was supposed to be a great evening....a fun way to raise money for charity. It was the 5th year this fundraiser was held. "The Battle of the Badges" was the name & it entailed the local Sheriffs gathering at a race track - all in fun. They raced old school buses - mostly for raising money, partly for bragging rights.

Something went terribly wrong that night. Sheriff Chris Daniels bus was hit from behind. Somehow he was ejected from the bus & was run over by his own bus as well as the bus that originally hit his bus. By the time anyone could get to his side, he was already gone. Just like that.

His funeral was held today - it was televised - it was touching. I didn't know the Sheriff, but I've seen him enough times on tv to know who he was & how good of a Sheriff he was. I still can't believe he died this way.

October 14th = the day he was born & the day he died...on his 47th birthday.

R.I.P. Sheriff Chris Daniels

The Last Name Sounded Familiar

I worked one day this week...whew, I'm exhausted.  Ahhh, not really...lol.  I'm resting up for all of the overtime I'll be putting in the next 2 months.  We go "live" with our new computer system on Sunday.  I went ahead & asked to be added on that night - partly because I want to be there when everyone is "new" at it & trying to figure it out and partly because there is a rumor we will be given pizza & chocolate all night long...lol.  Is there a nurse that doesn't like chocolate???  Heck, is there a woman that doesn't like chocolate????? 

I had another good, easy night.  I had 4 patients and was due to get a 5th, but luckily we never got the call from ER for anymore admits.  Two of my patients were women & every time they had to use the bathroom, they'd call me for assistance.  That was fine with me, I'd rather help them than risk a fall - especially since they both had to drag their IV poles with them.  We had 4 male nurses on the floor last night & by the end of the night, they were saying "Why do your patients always call you when they need to go to the bathroom?"  I jokingly replied with "It's a girl thing, we like to go to the bathroom together."  They laughed.  I like my co-workers, they are so easy to get along with. 

I also had two male patients who were sharing a room.  One was as silent as could be, the other - he more than made up for the other one being silent.  He talked & talked & talked.  One time when I was walking by, I saw our respiratory therapist in there talking to him.  Well, he was talking to her, she was just listening.  I could tell she wasn't able to get out of there so I said "Hey, can I talk to you for a minute?"  She walked out of the room & kept thanking me the rest of the night.  It's not that we don't like talking to patients, but we need time to do our job also.  I went back in later & he had on "Dancing With the Stars."  We bonded over that...lol.  I told him to let me know who got kicked off.  About a half hour later, the PCT says "Your patient wants to talk to you about Dancing With the Stars."  He couldn't wait to give me theresults which ended up no one being kicked off last night. 

It was a simple night for all of us.  As I was giving my 6 am meds to one of my female patients...I stood back & watched her take them.  She's a woman in her 60's who has lung cancer.  Her blood pressure was extremely low when she was seeing her doctor that day so he sent her over to the hospital.  The last name sounded very familiar to me.  She's been to the hospital numerous times because of the cancer.  I still couldn't place her - she didn't physically look familiar to me.  Then she turned on her tv & watched the shopping network...it all came back to me.  Months ago she had been sharing a room with a patient I was assigned to.  I remember the tv always being on the shopping network.  I also remembered that her husband was always at her bedside - catering to her - such devotion.  I found out last night during report that her husband passed away not too long ago.  How heartbreaking.  So as I stood back & watched her take her pills, I thought about how much I take for granted.  Here she was struggling just to pick up a pill & swallow it...so very slowly, I had to split the pills in half for her.  It took her about 5 minutes to take 2 pills.  I don't want to say I felt sorry for her, because sorry isn't the right word.  I sort of wished I could make everything better for her, but I can't...it's not possible.  That's the part of nursing I don't like - with some patients, you'll never be able to improve the quality of their life.  You'll never be able to have them smiling or feeling happy - no matter what you do.  So I did what I was able to do - treat her the best way possible, make sure her every need was tended to & that if she needed anything, I would be there to help during the shift. 

It's another weekend with my niece...her birthday is getting close, not that I need that as excuse to spoil her...lol.  Have a good weekend everyone!

Called off

I worked Wed, Thurs & Fri last week. I was supposed to work Sat night also, but they called me off. I was happy, mostly cause I was tired & could use the extra sleep. I'm probably the only person that is thrilled when they get called off. :)

I had another easy week - it's sort of scaring me because it has been so easy. I didn't have to call a doctor at all the entire week. My patients were stable and alert & oriented...except for one on my last night. I'll get to her later. Another patient came in with dehydration, admitted to med/surg...well they ended up overhydrating her...so much that she went into pulmonary edema & transferred to my floor. We ended up giving her Bumex (diuretic) round the clock - the poor lady - I don't think she slept for more than an hour at a time with as much as she had to void. She maintained a great attitude through it all. She kept calling me her angel. She couldn't wait to introduce me to her family. She was being discharged on my last night & as much as I was happy to see her leaving because that meant she was better, I sort of wanted her to stay another night. It's rare to get a patient with such a great attitude.

We had another female patient on the floor that was the total opposite. She thought we were there to cater to her every need & normally I don't mind helping, but when they overdo it - it makes me want to do less & it wasn't even my patient. I don't like drama & I especially don't like when a person that is perfectly capable of taking care of themselves, sit back & ask for you to do what they are able to do. That's one of my pet peeves - people that take advantage of the system & would rather remain or pretend to be sick just so that others will take care of them. I see it at the hospital, I see it in patients that go home. I guess they like the attention &/or they are just too dang lazy to do things for themselves. They milk the system, but it ends up that they are mostly hurting themselves because the people helping will tire of it eventually & they'll be left to fend for themselves & not be able to do it. I couldgo on...but I won't. I'm sure anyone reading this knows exactly what I mean.

On my third night I got report on a woman in her 90's that was pretty much in a coma & the end was near. Her family had been contacted & told of this change in her condition...their response = call us when she dies. I try to understand what kind of family can do that to their family member, but I'm unable to understand it. I don't know how they can live with themselves knowing they had an opportunity to be with her, but choose to let her die alone or die with only the hospital staff around. Perhaps they can't handle being there or they think it will be much worse than it is...I don't know. It seems cold-hearted to me, but that's probably because I am not afraid of death....not a peaceful death anyways. Her heart rate was in the mid-30's, low 40's when I took over care & it remained there through the shift. Her breathing was getting more labored & for some reason they were filling her with fluids & she had practically no urine output. I turned off the IV fluids - she didn't need them. Her skin looked like it would pop like a balloon if you stuck it with a needle - she was third spacing. The family wanted us to give her morphine, but I didn't - she wasn't showing any signs of being in pain & her blood pressure was like 65/30. Morphine would have just pushed her over the edge & I wasn't going to be the one to do that. Her K+ (potassium) level was 6.4......I was surprised she made it through the night. I have a feeling she probably passed away sometime during the day shift. I'll find out when I go back.

This is the final week of handwritten charting. We switch over to the computer system on Sunday. I'm debating about whether to work that night or not - I have a feeling it's gonna be a mess. They did listen to Gina & I and came up with a report sheet so that change of shift won't be so difficult.

I got a flu shot last week also - I haven't been sick in a few years now...which is amazing, but just in case...I don't want the flu either. That's the nice thing about being in healthcare...all of your immunizations are free...lol.

I've been relaxing today - it's overcast, the temperature is getting cooler...finally feeling like fall. I have volleyball tonight & after that I may see "The Guardian." I'll see how I feel after volleyball. Hope everyone had a great weekend & also hope you have a good week.

"You're An Angel"

I heard those words repeated often this past week & you know what....it never gets old & I never get tired of hearing it.  If anything, it reminds me of just how much you can impact another person's life.  I think I was actually getting spoiled with all the compliments!  I also got plenty of hugs - probably the most ever since I got into nursing. 

It was a relatively simple week & you know what...I'm actually enjoying working the weekends...lol.  Who would've thought?  Of course I can't tell administration that because they don't want their staff happy.  They would probably ban me from working weekends if they knew I liked it...seriously!!!  What I enjoy most about the weekend nights.....absolutely no doctors & no administration around.  It's fantastic. 

Wednesday & Thursday nights were hectic - I don't think I actually sat down until after midnight to start my charting.  Friday & Saturday made up for it - I had everything done, charted & completed by 10 pm.  The only drawback to having everything done so early is that the time ticks by so slowly.  But the good thing about it - I actually got to spend some time with my patients taking care of them & not just zooming in & out of their rooms to catch up with everything. 

The patient that stands out the most for me was an older gentleman that came in with a hip fracture.  He had fallen out of bed at home & broke his hip.  Hopefully he'll fully recover & go on to live out the rest of his life...but the odds are against that at his age.  I read somewhere that something like 50% of the elderly pass away within 6 months of having hip or knee surgery.  I'm not quite sure why that is...blood clots maybe, I don't know.  He was pretty much out of it when I took over his care as he had received a strong dose of morphine right before shift change.  His wife stayed the night & I actually learned a pretty darn good tip from her...she had a muscle cramp in her calf in the middle of the night so she asked me for a packet of sugar.  She swallowed the sugar and within 60 seconds, her muscle cramp was gone.  She also told me about her doctor telling her that if she or her husband get a low blood pressure reading, to put some salt in their hand & a glass of water in the other hand...lick the salt (like doing a tequila shot) & then drink the water - it raises the blood pressure according to her.  Trust me - I'm not giving out medical advice here whatsoever, just sharing what she told me.  I don't know if this actually works or not.

The next morning the surgeon came in, scheduled surgery and by the time I came back Thursday night, he was just getting back from surgery.  He was pretty much out of it.  I reassured his wife I would keep a close eye on him, told her to call me anytime - even if it's 3 in the morning.  Which she did & I'd give her an update on how he was doing.  Little by little he was improving.  I think he must have thought I was a crazy nurse - practically everytime I interacted with him, it was to get him to take his pills that I had crushed & mixed with apple sauce.  I always had a spoonful of apple sauce to feed him...the poor guy had to wonder what was wrong with me.  I was either making him eat apple sauce or talk to me.  I don't think he minded though - I got a smile out of him every now & then.  Hopefully he's recovering well & maybe even out of the hospital by now - I hope. 

I think out of the 4 days, I only had to call a doctor one time & that was just for some Benadryl.  I almost had to call for my fractured hip patient.  His heart rate was constantly jumping up to the 140's - even on a Cardizem drip.  I'd wait it out because it would also drop right back down to 80 for no reason.  Every time I was about to give up waiting for it to drop & had my hands on the phone ready to dial - I'd look at the heart monitor screen one last time & his heart rate would be back in the 80's.  Every single time!  They ended up starting him on Digoxin & that did the trick. 

It's been a good weekend...Tony Stewart won the race on Sunday even though he had run out of gas.  He just coasted to the finish line to take 1st place...woo hoo.  That means I owe my niece a trip to Libby Lu's.  I told her at the beginning of the season that anytime Tony Stewart wins - she gets rewarded.  Lucky girl.  I played volleyball last night & we won again.  We're undefeated.  I am so glad I got back into playing.  It feels good.

My sleep schedule is still really screwed up - so I will go finish watching some movies I got from Netflix.  They have really good rates & the movies get to my house quick.  A lot better than Blockbuster. 

Hope everyone is having a good week.  I can't believe it's Tuesday - it feels like a Friday to me. :)

Do you miss me???

I've missed you!  It feels like it's been a long time since I've journaled anything.  That's because I haven't been back to work.  I've truly enjoyed having the last 9 days off.  I start back tomorrow night for 4 nights.  Have I ever mentioned that I love the flexibility of my schedule?

I had been debating about whether to work more days this week, but I have had the opportunity to catch up with my friends, my family and have some down time to just relax & have fun...so I took advantage of it.  I have to say that as much as I don't like being locked in to working weekends, I am glad it has allowed me to get back into playing volleyball.  I have been playing volleyball with the same team on & off for the last 15 years.  I stopped playing after I graduated from nursing school almost 2 yrs ago & started working every Monday night.  I didn't realize how much I missed it until I started playing again - not to mention the great work-out it provides.  So until the end of November, I will be playing volleyball on Monday nights rather than working.

I don't have anything to post about work related stuff because I haven't been working.  Hopefully I'll have something to tell you by Sunday. :)  Have a great week!

 

Learning Lesson(s)

Ahh, back to the beginning of another week.  Still feels odd to be off on a Sunday & Monday.  In fact, I didn't even know what day it was today!  So much for me being alert & oriented.  :)

I put in 4 days straight.  It wasn't too bad until the last night because we had no tech & 5 patients each.  It's just too hard because the majority of our patients are older & more needy.  Between patient care and paperwork...we are exhausted.  Not enough time in a 12 hr shift when we don't have a tech to take care of the patient's basic needs. 

I did receive a patient Friday night around midnight being admitted with a DVT (blood clots) in her left arm.  She was started on a Heparin drip in the ER.  When I went to check out her labs before getting report, I noticed they were still pending.  I thought it was odd that they were admitting a patient without knowing the majority of her lab values, but I assumed (lesson #1 - don't ever assume) that they must know she is stable & therefore ready for transport to our floor.  So I get report & am told she's diabetic & that they didn't have time to do an accuchek in the ER (how long does it take for an accuchek?  60 seconds?).  I said I'd check it when she got to the floor (lesson #2 - insist they do it prior to transport while the pt is still in the ER). 

Before the patient even makes it to the floor, I get a call from lab saying her stat PTT is 166.  That is extremely high for someone on Heparin, much less someone that was just started on Heparin & supposedly that is the baseline.  Next call from lab...the patient's blood glucose is 606.  Ugh...this is like deja vu from a couple of weeks ago in which the blood sugar went ignored.  She gets to the floor & I immediately turn off her Heparin drip and place a call to the doctor...who of course is not the same doctor that admitted her just an hour earlier.  I get the doctor on call who knows nothing about this patient.  The patient has an insulin pump & the admitting doctor had marked "no"on the medication reconciliation form to her using it.  I have no idea why as usually when a person has a pump, they are pretty good at regulating themselves.  Why she didn't ask for an accucheck in the ER, I don't know, but regardless, it wasn't her responsibility.  It should have been checked in triage or at the very least, by the time she got a bed in the ER. 

Anyways, so now I'm on the phone with the doctor who is asking me why the other doctor marked no to her using her own insulin pump.  As if I'm psychic or just know everything.  I tell him I don't know, that it's simply marked no without any explanation.  His next question was "What did the patient have to eat today?"  Huh?  Who cares....her blood sugar is 606 at this moment.  I tell him I didn't know, that I hadn't asked her (who asks that anyways?)  His reply "You really should have the answers to my questions."  Oh how I wanted to hit him upside the head with the phone...grrr.  So he tells me to give her some insulin now, change the sliding scale and don't recheck her blood sugar for 6 hours.  Nice...such quality care I swear!  He's ready to hang up & I'm like "Wait a minute, she's also on a Heparin drip & her PTT at this moment is 166."  So he says hold it for 2 hours & repeat the PTT...if it's greater than 80, hold for another 2 hours or if it's less than 80, start at 15 units/kg/hr.  What a strange order!  Turns out the PTT drawn wasn't a baseline...it was drawn after the patient got a Heparin bolus....grrrrrr, the ER nurse started the patient on Heparin prior to getting a baseline PTT or CBC even though the protocol clearly states it at the top of the page.  Luckily the patient was tolerating both conditions rather well.....very lucky for the ER.

I talked to my clinical leader & asked if I should write up an incident report.  She was saying no, that she'd talk to the ER clinical leader about it.  She did call her & it was the same general excuse "we're really busy down here."  Which is fine, I understand that...but compromising a patient is wrong, I don't care how busy you are or what department you work in.  What would have happened if I had allowed the PTT to go unnoticed/untreated as well as the extremely high blood sugar?  I would expect to get in trouble for it as well as the hospital has to be made aware that if the nurses & doctors are that busy that critical lab values are being ignored, then it's time to do something about it rather than end up with a lawsuit &/or the guilt of harming a patient.

I had her again the next night, blood sugar still a little high, but in the 300's-400's...working it's way down & she was managing it with her pump now.  Her Heparin was therapeutic at 8 pm, so I put in an order for the next PTT 6 hours later or 2 am...fully expecting I'd have a result by the latest 2:45 (lesson #3 - don't expect anyone other than yourself to stick to time lines).  The lab didn't draw it until 3:05 - so much for timed studies.  I check the computer around 3:30...it's not even been received in the lab yet.  What the hell?  4:00 comes & goes, I finally decide to take a lunch break only to have someone come in the break room & say "Lab called, they say your PTT is greater than 200, do you want the test repeated stat just to be sure that is correct?"  It's now 4:30 am.  I say "yes, of course" because how could it be therapeutic to now suddenly over 200?  So again, I expect that STAT means quickly (lesson #4 - my definition of STAT is not the same as others).  It's now 5:00 & no lab tech in sight.  I call the lab dept & she doesn't know anything, they are short-staffed (shocking) & says she'll try to page the lab tech.  At that point I give up depending on others & turned off the Heparin drip just to be safe even though I knew it would probably throw off the lab result as it only takes an hour or two for Heparin to get out of the system.  Lab finally calls me at 6:05 to tell me the PTT was 156...so I'm glad I did turn it off. 

I was internally debating about whether to write up incident reports.  Looking back, I definitely should have...because how is the hospital supposed to know this stuff is going on if it's not reported in writing to the higher ups?  How are any changes going to be made if they don't even know it's a problem?  So that's lesson #5 - report, report, report even if it means someone else might get in trouble. 

I had a really sweet patient that was very complimentary towards me.  He was asking me how long until I turn 20...lol.  I told him I'm nearly twice that age.  He thought I was lying.  Ahhh, so glad I look younger than my age...lol. 

I am playing volleyball tonight...yay.  Haven't done that in nearly 2 years.  My hospital called again last night desperate for help because they were short-staffed.  I hope the administration sees that relying on agency nurses to fill in the gaps because they readjusted the staff nurses schedules isn't working out the way they had planned.  I plan to go back to Sun, Mon & Tuesday nights after this schedule is over (beginning of November).  I've heard everyone else that they asked to work weekends fussed & bitched & got out of it.  So it's basically me & mostly all agency & travel nurses.  I like the travelers though...because at least they are around for a few months (or longer) & you get to know them.  Agency...ehhh, not my favorite - they don't know anything about the hospital because they don't get an orientation.  So a lot of it is helping them figure out all that they need during the shift.

Laterrrrrrrrrrr!

Why be mad?

I don't have all that much to write about today.  I started back at work last night.  It was busy, I think I was on my feet the entire time between 7 pm and midnight.  I discharged one patient and got 2 new admits as well as having 2 other patients.  Somehow I managed to keep up with all of the paperwork and was actually looking for things to do to waste away the night.  We're encouraged to give baths, but I am in total disagreement regarding waking a person up in the early morning hours to bathe them.  Personally, I think sleep is more important.  We wake them up enough through the night with vital signs, respiratory treatments, medications and blood draws not to mention the numerous times if a lead from the telemonitor comes off.  So unless they really, really need a bath, I opt for sleep.

I'm not going to even go into the patients I had last night.  There is nothing that really stands out other than I don't understand the attitude one gets when they are admitted to the hospital.  Did you not come to the hospital because you were experiencing a problem so severe that it caused you to seek help?  Why are you mad that the doctors want you to stay the night and run some tests to see what caused the problem?  Both of my new admits were pissed they had to stay the night.  The thing is...you don't have to.  It's not a prison, you can leave if you want...you do have that option.  I realize the hospital is not a lot of fun, but neither is having a problem that worries you so much you seek medical help.  Rather than be mad, be glad that you live in a country that allows you to freely seek medical help.  Be glad that there are resources around you that want to ease your mind & find out what is wrong.  Basically, be thankful for your blessings.  They could very well be the reason that you see another sun rise.

I did pick up another shift tonight - so it's time to go get ready for work.  Have a good night y'all. 

Something cute...

It's Sunday & so very weird that I'm not sleeping in preparation for working tonight...because this is the week my schedule has changed due to being forced to work every other weekend.  I am not scheduled until Wed, then Fri & Sat.  I just might like having the beginning of the week off.  :)

I had my youngest niece & nephew from Friday night to Saturday afternoon.  I took them out to lunch & as I was paying, my 7-yr old nephew Magnus says to me "How do you make your money?"  Before I could answer he says "Oh, that's right...you save lives."  It was so cute! 

I went out last night with Kelly - we had some awful drinks & saw an awful movie, yet still managed to have fun.  I ordered margaritas...but what I got was nothing close to tasting like a margarita.  We saw Talladega Nights - simply because there is nothing else to see.  It was dumb. 

And to take it a step further, my favorite Nascar driver missed the race for the chase.  Darn it!  That's ok, I still love Tony Stewart anyways.  Next year he'll do better.

Hope everyone's having a great weekend.  Peace!

 

 

 

"Code Gray"

Another work week finished up by Wednesday - this is why I prefer to work Sun, Mon & Tuesday nights....so that I've got the rest of the week off. However, due to our new manager, I am being forced to work every other weekend for the next 2 months (at least). Well, unless I finally get motivated enough to leap into travel nursing...I'm still working on it...lol...that's my excuse! So for now, I will try working at the end of the week rather than the beginning. Who knows, maybe I'll like it. I am going to get back into playing volleyball with my friends on Monday nights.

I went into work Sunday evening only to find out I wasn't on the schedule...again...grrrrr. The charge nurse told me she would keep me, that I could be the unit secretary until 11 pm & then she'd send one of the agency nurses home & I could take over that nurses patients. Being the unit secretary on a Sunday night is beyond boring...because we rarely see a doctor in the building (other than the ER doc) on a Sunday evening. I got a call from the charge nurse about 20 min later saying one of the nurses didn't show up & I could take her patients. So I go to that floor & the clinical leader is telling me about one of the patients: "He's out of control, he is threatening to hurt people, rip off body parts of anyone that gets near him, swearing, yelling" and she followed it up with "Whatever you do, don't go into that room alone." Lovely...I'm thinking I should have just gone home when I found out my name wasn't on the schedule. This guy sounded like a lunatic!!!

So I get report from the day nurse & she tells me he just started acting like that when they tried to get him to go from the chair back to bed. He didn't want to go back to bed. Guess what - as far as I was concerned, he could sit in that chair all night long if he wanted...especially if it made him happy. He came to the hospital because he passed out at the nursing home & they wanted to rule out a stroke.

I had 3 other patients in addition to him. I had a male with a hematoma in the abdomen, he also had expressive aphasia (he had a stroke yrs earlier & was unable to speak...he could make noises & a couple of words like yes or ok, but that was about it). Another patient with an infection in his leg as a result of a fem-pop bypass. He also had a MRSA infection in his blood. He was really sick & weak. My last patient was a man that had a right knee replacement who was also confused...but at least he was pleasantly confused. They put him in the room with the lunatic. Nothing like having two confused people in the same room, right?

My assessment of the first patient was done from afar. He was yelling, he was moving his arms & legs and he was asking appropriate questions - he also knew who he was & where he was. As soon as I came in the room he was saying "Oh noooooooooo." He was afraid I was going to make him get back into bed. I assured him that he was welcome to stay in the chair if he wanted. He had wrist restraints on, so it's not like he was going to go anywhere or fall. He kept demanding to have his pants & shoes. The tech & I finally gave in...handed them to him in which he put the pants halfway on (since he couldn't stand up) & he put on his shoes. It was kind of comical to walk in & see that...but hey, he was happy....so I was happy. I managed to get him to take his pills, we gave him a snack & before I knew it....he was telling me jokes & stories. He didn't want me to leave the room! I was kinda cracking up inside comparing the description I had received of him & comparing it to how he was behaving now. Later on in the night, he pulled out one of his IV's. So the tech was giving him a bath & I got him some warm blankets, wrapped him up & he was so very comfortable & just smiling. I was thinking "Wow, I really have the right touch! He's nothing like they described earlier."

Welllllllllll, I threw that thinking right out the window the next night. He had turned back into the lunatic. This time instead of wrist restraints, the day nurse simply had a posey vest on him. I wasn't comfortable with that because he looked like he could slip out of it at any time. He started yelling at the change of shift. The day nurse told me to get his evening dose of Seroquel (antipsychotic medication). I got it, but I was pretty convinced no one would be able to talk him into taking it & I was right about that. When I got back to the room, the day nurse had called a Code Gray (an emergency request for extra manpower). I don't know why she did that because he was still fully restrained with that posey vest on. About 15 people showed up...mostly men. A Code Gray generally works to settle down an out of control patient, but in this case, it made my patient even more confused & agitated. I felt bad for him. Eventually most of them left & I was told to forget the Seroquel, give him Haldol IM (injection). So there was 4 of standing there looking at him while he yelled at us - we were trying to figure out how we were going to give him a shot. They were telling me to put it in his thigh, but I knew that was not going to work. I decided to get behind him in the chair & they would hold his arms & I'd inject him in the arm. I was worried he'd flail around & I'd end up jabbed with the needle...but he was so busy yelling at them, that he didn't even notice me behind him nor did he even feel the injection (what can I say...I'm good...lol).

We then make a decision to move him closer to the nurses station because there were only 2 nurses (me & another) on this unit. We try to tell him what we're doing & he just continues yelling about who knows what. He was already in a chair that had wheels on it, so as they started to push him to the door, he was trying his hardest to stop them by pushing back with his feet on the ground. They turned the chair around & then raced him down the hallway into the new room. It may sound awful, but I could not stop laughing....it literally looked like some type of race they were competing in & the poor patient...the look on his face like "What are these women doing to me?" It was priceless. I decided to leave him alone in the room & watch him from the nurses station...hoping he'd calm down. The respiratory therapist went in to give him a breathing treatment & the patient told him he was f'n useless & to get the hell out. The resp therapist came out saying he gets the same treatment at home from his wife. It was funny.

I'm noticing that now my patient has taken off his gown & is making a really good attempt at getting out of the posey vest. I say to the other nurse "I think we should put the wrist restraints back on him because if he gets out of that vest & is loose...who knows what will happen." So I call my clinical leader to assist us & while we're in there...he's yelling...then starts trying to punch & kick. I called another Code Gray. From that point we moved him (with a lot of assistance) from the chair into bed & put restraints on both his wrists & his ankles so he couldn't punch or kick us. I called the primary doctor to get him something more for his agitation. I really felt bad for my patient as he knew he had no more control & gave up yelling at me & was saying "Please let me out." I can't even imagine all that was going through his mind. The primary doctor asks me what the neuro doc said. Well, I didn't think to call the neuro doc as stroke had been ruled out and the conclusion was this patient had dementia. He gives me an order for Ativan. I call the neuro doctor to see if he wanted anything different....instead I got a lecture that agitation is not a neuro problem & that I shouldn't have been calling him. He orders the same thing & then asks me why this patient hadn't gotten his Seroquel. Ummm, what part of "This patient is out of control & very combative did you not understand?" So he tells me to give the Ativan & just give him the Seroquel later when he calms down. Well, that Ativan knocked him out the entire night. Not another word out of him...he slept through vital signs & even when the lab tech drew blood. I was relieved that at least he was at rest.

That second night was an easy night...both myself & the other nurse only had 2 patients each the entire night until 5 am when we each got an admit. It was a different story on Tuesday night....same nurse & I...only this time we had 5 patients each & no tech....grrrr. Well, we did get a tech around 2 am = Gina, but by that time, we really didn't need any help & she'd disappear for long periods of time anyways. It was the beginning of shift that was so busy & where we could have used the extra help.

My patients were not too bad to take care of...I liked them very much, but their medical conditions scared me. I think at any other larger hospital, half of them would be in ICU rather than PCU. I just had this uneasy feeling that at any time, they could take a major turn for the worse. That was the main reason I didn't go back tonight for overtime. It's not bad when you have 1 or 2 patients that are critical, but when 4 out of the 5 have major issues....the stress gets to me....especially when it's respiratory issues.

One patient was my new admit from the night before...he is at the hospital quite often for respiratory distress. He was on 5 liters of oxygen & sooooooo out of breath. His respirations were labored, you could see his abdominal muscles were doing all the work & he was shaking non-stop. He said he felt fine, but he definitely did not look fine. Another patient was one that just had a new tracheostomy. I don't like trachs...at all. I don't like any "ostomies." I don't know what it is, but I feel pain in my throat area when I see trach. This guy was coughing non-stop & I was worried something was going to get stuck in his trach. I called the respiratory therapist in to have her assess it. He did have a big ol mucus plug (ick...just the word mucus kinda grosses me out...see, even nurses do get grossed out) in the trach. Luckily. the respiratory therapist cleaned it all up even though technically...the nurses are supposed to do it. Which makes no sense to me...why can't the respiratory therapists do it? It is a respiratory issue.

Another patient was a new admit with congestive heart failure. He was a sweetheart, we got along great. I knew he was aggravated from being in the ER for so long & they were super busy down there so none of the patients were getting any food. He was starving, so I made it a priority to get him some food. He was happy. A little shortness of breath, but overall ok for the most part.

I still had the patient from Sunday with the hematoma in the abdomen. He was easy to care for as he mostly slept. I also had a female that had breast cancer & a right mastectomy. She was in the hospital because of nausea, vomiting & diarrhea from chemotherapy. This poor lady had the worst skin breakdown I've ever seen (not including pressure ulcers). The skin on her thighs & peri area was pretty much non-existent...it was so red & so raw & cracked, she cried when she moved her legs. I had to clean her up since she was having diarrhea & my heart was breaking listening to her cry from the pain. I talked to my clinical leader & we decided it would be best to put a fecal bag on her so the diarrhea wouldn't continue to hurt her where the skin was so raw. I tried my best to calm her & make her feel better, but I don't think it was really working. Even the inside of her mouth was all broken down & sore. The poor lady...so sad.

My confused man had been sent back to his nursing home. I don't know how those nurses that work at nursing homes do it. They really are special people to be able to endure dealing with alzheimer's & dementia....not just endure it, but also be able to develop a good relationship with their patients.

Someone commented earlier about my post with the ER nurse. I never intended to make it seem like I am anti-ER nurses or anti-ER department. I know they are super busy down there & don't have the same priorities that I do. I am against nurses that don't do the basics - which is to at least know your patient's labs & why they are at the hospital. As well as against doctors that also don't follow up with critical lab values. 671 is an extremely high glucose level & for it to go unnoticed by every medical professional that saw him before I spoke up about it...it's just wrong. We are lucky he had no ill-effects as a result.

This has been a good week....I've gotten so much positive feedback regarding my journal....thanks y'all. :)

A new season of Nip/Tuck has begun = strange, strange show, but I can't stop watching.

I had dinner this evening with one of my best friends...Maria. We met when we were about 13 yrs old & have been best friends ever since. It's kinda neat to look back & see how many people come in & out of our lives and value those that are here to stay for a lifetime.

Just Can't Believe It

I worked Sunday night & like I usually do...I was checking out People Magazine online around 6 a.m. for the latest stories & gossip...only to find out that Steve Irwin aka The Crocodile Hunter had died. I was stunned. I still can't believe it...even after being drawn to the tv throughout the night last night (at work) & seeing CNN talk about him non-stop as well as replay interviews & episodes they had with him. He was so likeable & charming and had the most amazing enthusiasm & energy for not only interacting with wildlife animals...but allowing us to get a glimpse of things we would never encounter in our own lives.

I just can't believe he's gone. :(

Tributes

I got the most amazing email the other day from a gentleman named Joe. With his permission, I want to share it with everyone...

Hi Jenn,

My name is Joe; After I retired from an Occupational Health career with the State of New York my wife and I decided to move to Florida (where else). That was 4 years ago. Anyhow, I spent some time volunteering at our local Wildlife Park but had this passion to return to bedside nursing.

At 59 and after 30 years away from clinical nursing I decided to take a 200 hour refresher course, a 35 hour IV Therapy course and my BLS. After completion, I interviewed with a local hospital and got the job. I have been there a month and I can honestly say that most of my fears about returning have been eliminated (the only thing I fear now is doing a female Foley)

OK, the reason for this email. About 6 months ago I started reading Allnurses.com and came accross a post of yours that had your journal website attached to your signiture. I got so hooked reading your entries that I went back to your original journal entry and read every one of them. I have got to tell you, it was your words that got me back into nursing and I am forever gratefull to you for that. You are so easy to read, both smart and funny...very funny. I learned so much from you...

Well anyhow, I posted all of this on the allnurses website (my first post on that site). I can't remember the Subject line but it had "Jenns Journal" in it. It lasted about 4 hours before it was pulled. When I asked why they told me it was because it looked like I was promoting your website...uh. The email said that a moderator had to review it.

Just let me say again Jenn, thanks so much for your inspiration. My wife would also like to thank you because I out of the house more often, lol.

Oh ya...Go JR. He came in a strong 3rd last nite at Bristol.

Take care,

Joe

Thanks, Joe. Your email put a smile on my face. :)

Rainbows & crying wolf...

On my way home from work this morning, I saw a beautiful rainbow in the sky. Rainbows amaze me - I love looking at them. They are a good reminder that in order to see the rainbows in life, you have to endure the storms that come your way .

I am sooooooooooooooo tired of newscasters. If I hear one more thing with the word Ernesto in the story, I will scream. They have blown this tropical storm out of proportion. News coverage began on Saturday. I'm not talking just a little update here & there, I'm talking that 99% of the newscast was all about this storm. This is the problem when it comes to hurricanes - newscasters blow it out of proportion so much that people don't believe a word they say. Even with 7 hurricanes in 4 years, I still don't believe them because they don't really know anything until about an hour before the storm is about to hit. However, just like most trainwrecks in life, it also gets to the point that you can't help but watch. Then the stress sets in because you begin imagining the worst....until reality strikes again to remind you that weather forecasters are only right like maybe 1% of the time.

It is raining here...but is that uncommon? Nope. Besides, Florida needs the rain. And it allows me to see the rainbow. :)

Ok, my tough 2 days at work...yep, that's all I'm working this week - well besides the computer class I have to take tonight for 8 hours. I can't complain, my patients were relatively easy to care for. I learned a little bit...way more about tapeworms than I ever really wanted to know. I've seen one of my patients get news that is devastating - her lung cancer has spread to her bones. Once it gets there, it's all pretty much downhill. She started out a little grumpy (who can blame her), but I charmed her & took time to talk with her. I still don't really know what to say when someone gets news like that. I find it's better to try to get them to express how they're feeling, because I know nothing I say will make a difference.

I had some interesting conversations with a couple of docs. The first one....my patient was on Heparin, her PTT (lab test) came back at 154 = extremely high. Protocol says to stop the Heparin immediately & call the doctor. So I did...at 5 am. I could tell I woke him up...but so what...this is a critical lab value. I tell him the PTT level & he says "Well, what does the protocol say to do?" As if I had never bothered to follow it or something. So I tell him "Stop the Heparin & call the doctor & here I am...talking to you now." It's like he didn't know what to do & was hoping the protocol would give him a clue. His wise answer..."repeat the PTT in an hour & follow whatever the protocol says to do." Ummm, ok.

My second doctor incident was regarding a patient I just got report on last night. He had been there for a week, had a surgical procedure when he came in & everything was going well - until 2 days ago when it seems he had a stroke as he has the facial droop & is unable to move the right side of his body. They ran some tests & it is looking like a stroke. Welllllllllll...no one has bothered to talk to the family about what is going on. All they know is that their once fully functioning family member is now unable to move the right side of his body. His speech is slurred & they want to know why. They were point blank asking me if he had a heart attack. I was able to tell them no, that his heart is ok. I can't tell them the real test results because the doctor has not talked to them regarding what's going on. So they ask me for the doctor's phone number. I give them his answering service number & tell them to call during the day because it's unlikely they would hear back from him at night (it was after 9:30 pm). About an hour later I get a call from the doctor. He says "This is Dr. so & so"...I said "hello Dr., let me find out who called you." Because 99.9999% of the time a primary doctor calls at night - it's because someone has paged him. He says "No, no one paged me." I say "Oh, ok." He says "You know, you really should take the time to find out why I'm calling." My response "Ummmm, ok." Have I mentioned that I really can't stand this doctor to begin with??? He goes on to tell me that a family member called & wants to know why. Well....wouldn't it make more sense to call the family member & ask them why??? It irritates me how some of them will avoid the family & their questions. I told him they basically want to know what is going on with the patient, that they don't understand what is going on because no one is telling them anything. He asked me how the patient was doing & that was that. Who knows if he ever called them back.

Ok, time for me to get a little sleep before computer class tonight. Peace all!

Blood glucose of 671

I had computer training on I-Connect this week. I'm not sure what I think of it overall. What I don't like though is becoming 100% reliant on a computer. Our trainer told us we no longer need kardexes, report sheets or MAR's (med sheets). I think that's insane. I plan to keep using my report sheet. I prefer to know what's going on with my patient by just glancing at the info on my report sheet rather than scrolling thru a computer trying to find the info. I caught on rather quickly, many people did not. It's gonna be a mess whenever we do go live. Supposedly the date is October 22nd, but I get the feeling it will be pushed back.

I worked on Sunday - but don't remember much of anything about my patients. It's that short-term memory loss! I worked again last night. I had a patient in his early 60's who will be told today that he has stomach cancer. I don't like knowing information that my patient doesn't know. He was so happy & friendly last night & all I could keep thinking is he has no clue what he's about to be told today.

I also got a new admit diagnosed with chest pain. I looked up his labs before I got report from the ER nurse. I noticed his blood glucose (sugar) level at noon was 671. Wow...not a good number. This is basically the way report went with the ER nurse around 8:30 pm...

ER nurse: I have a patient for you being admitted with pneumonia.

Me: Pneumonia? I thought it was chest pain.

ER nurse: Oh, well maybe it is, yeah...pneumonia & chest pain & possibly even asthma.

Me: Asthma?

ER nurse: Yes, I think so.

Me: You think so? What do the orders say?

ER nurse: They say chest pain & asthma exacerbation.

Me: What about pneumonia?

ER nurse: Oh, I guess he doesn't have pneumonia after all. We also gave him Tylenol for a fever.

Me: How high is his fever?

ER Nurse: I don't know, let me check. Oh, it was 99.1. I guess we didn't give it for a fever, must have been some other reason.

Me:

ER nurse:

Me: So has the blood sugar been addressed?

ER nurse: Why would it need to be addressed?

Me: Because it was 671 at noon when he came in.

ER nurse: It was?

Me: Yes, did you not look at the labs?

ER nurse: No, I don't know, I just got this patient at change of shift.

Me: Did the ER doctor not address it?

ER nurse: I guess not.

Me: Don't you think it should be addressed before the patient comes to the floor?

ER nurse: Well, the admitting doctor saw the patient too.

Me: The admitting doctor did not notice the very high blood sugar? (and the fact that the patient has been admitted 5 times in the last 6 months for elevated blood sugars)

ER nurse: I guess not. I'll recheck it & cover it.

Me:

That was how it went. Isn't it sad that the floor nurse (me) who has not even layed eyes on the patient nor spent one minute conversing with him knows more than the ER nurse who is caring for him? Or even more about the patient than the doctors that are treating him? She brings him to the floor, says his blood glucose was 384 & she gave him 10 units of regular insulin. Ok, I'm a sucker, I believed her. I decide to give the insulin a little time to work & recheck his blood sugar about 45 min later. It's now 462. Just for those of you who aren't sure what the normal range for blood sugar is...it's 70 to 99. Anything over 400 requires a stat lab draw & a call to the doctor. So we order a stat lab draw...which they come & draw right away.....yet takes an hour to get a result - that's only because I kept calling & bugging them to give me a result so I can call the doctor. Their reading was 447. So I call the doctor...or more like the doctor on call for the doctor that admitted him. I explained the scenario. He orders 5 units of regular insulin IV now. Ok, should I do accucheks on him more often than AC & HS (before meals & right before bedtime)? No, stick with the AC & HS accucheks. So that means I'm not supposed to recheck his blood sugar until at least 6 a.m.????????

I'm not comfortable with that so I have my patient care tech recheck it 2 hours later. It's now 432. Ok, slight decrease, but I still wasn't thrilled at that number...only now I'm stuck. I can't call the doctor & get more orders because I wasn't even supposed to be rechecking it. I run it by my clinical leader, she isn't sure what to do. I decide to give it a little time & hope that it continues to go down. We rechecked it at 5:30 am & it was 226. I'll take that. I'm glad I didn't cover him with anything more as he was NPO (not allowed to eat or drink) & that extra coverage could have made him hypoglycemic (low blood sugar). He was doing fine, just a little irritated that he wasn't allowed to eat or drink anything because of the chance of having a stress test today.

I had to turn in my schedule today for the next 2 months. As I was filling it out, I was thinking "Will I even be working here in 2 months?" I'm really getting that itch to branch out & try something new. I like my hospital, but there is so much change going on not to mention I'm on the low end of the pay scale there. The plus side is that there is plenty of work & our busy season is coming up. Actually, this past week has been super busy. I'm not sure why, but we are completely full in PCU & that's something like 60 beds. I think I will get the ball rolling with a travel nurse agency & at least see what they are offering.

I'm getting sleepy.......bye y'all.