Go Eric Go!

I had a nice weekend this past weekend.  On Friday, I met up with the group of friends I hung out with in high school.  I still keep in pretty good contact with 3 of them, but one of them I hadn't seen in at least 10 years.  It was neat to get together & reminisce.  The next day I went to watch my oldest nephew play baseball. He's 18 now & a senior in high school.  I remember the days (I'm sounding old, aren't I?) of watching him play t-ball & little league.  Now he's an all-star.  He already has a college scholarship & hoping to eventually make the pros.  He is so good that the other team didn't even want to pitch to him.  They would automatically walk him...so unfair.  For some reason they felt it was safe to finally pitch to him...and he hit a home run.  Woo hoo!  Go Eric Go!  I'm so proud of him.  He has grown up & is such a gentleman.  My brother & sister-in-law raised him well.  The rest of my family was also there....my parents, my other brother, nieces & nephew.  I had a good time even though it was 82 degrees & overly sunny.  I got sunburnt!  I won't complain though.  Compared to up north...I'll take these 80 degree days.  I'm looking forward to going to more of Eric's baseball games.  Hard to believe this is his last year playing locally.  Where has the time gone? 

I spent the rest of the weekend with my youngest niece Elizabeth.  She's 9, going on 21.  We shopped, watched movies, played computer games & she confided in me that I'm her best friend...sweet.  She is my little buddy.

I watched the Daytona 500 on Sunday....yay...Nascar is back.  I would have been happier had Tony Stewart or Dale Jr. won, but I like Jimmie Johnson too...so it was alright. 

I worked last night - it was a good night.  My first patient is sort of a sad situation.  I had been warned that she is full of drama...which worried me.  The last time I was warned about a drama queen, she ended up coding & dying the night I had her.  This patient was admitted with a pulmonary embolism, congestive heart failure, chronic obstructive pulmonary disease and chest pain - now that's a handful of diagnoses!  Turns out (according to the doctors), that she is basically a drug seeker.  I was warned that she will be asking for drug meds...the doctor had discontinued all of them except for 1 mg of Morphine every 4 hours for chest pain only.  I go in to assess her & she immediately tells me she's feeling nauseous.  I look at her medications & she has nothing for nausea.  So I place a call to her admitting doctor.  He calls back & I tell him she's feeling nauseous.  He begins to tell me her background...she has been admitted to local hospitals 29 times in the past year...whoa!  I looked her up on our computer....14 times since September for misc things.  Anyways, he starts to order Zofran & I tell him she has requested Phenergan.  I always know something is up when a patient begins recommending their own meds.  He says "Ok, but it will be by mouth, not IV."  I was fine with that.  I get her the medication & she is complaining that it's not IV.  "Sorry, this is what the doctor ordered."  She tells me she won't bother me anymore tonight.  I go check on my other patients when I get alerted that this patient is now experiencing chest pain.  I go back in & reassess her....vital signs are normal, nothing has changed on the monitor...but she's laying in bed clutching her chest & moaning. 

How am I to determine whether it's real or not?  Do I get the nitro.....no, because her normal BP already runs in the mid-90's.  If I give her nitro, it will drop her.  Do I do a stat EKG?  Do I alert the doctor?  I ask the patient whether she's experienced this before.  She says "yes, all the time."  Ummm, ok.  I ask "What helps to relieve it."  She replies "Dilaudid or Demerol."  Hmmm, ok.  I informed her that the doctor was already asked during the day shift to order one of those for pain & he refused.  Her mood changes.  She says "Ok, I'll just lay on my left side & the pain will go away."  I leave & come back about 10 minutes later...she's sleeping.  That didn't last for long though.  About a 1/2 hr later, she was complaining of chest pain again.  I went ahead & gave her the 1 mg of Morphine.  Who am I to decide exactly what she's experiencing?  She had Morphine ordered for chest pain & she was complaining of chest pain.  As soon as I administered it, she was fine.  It's sad to see someone going to such extremes for pain medication.  Her pulmonologist came in early the next morning & asked "What is going on with this patient other than her wanting pain drugs?"  Apparently they are very familiar with her. 

My second patient was an elderly female that simply wanted to be left alone to sleep.  The night before they woke her up to give her a bed bath & change her linen.  They told me she was combative & mean.  Well....I would be combative & mean if you were waking me up at 4:30 in the morning for a bed bath.  I promised her that wouldn't happen during my shift.  The pulmonologist went in to evaluate her around 6:15 am & she wasn't happy.  I had to laugh...just let the lady sleep! 

My third patient was a male in his mid-40's with a huge medical history.  I don't expect people that young to have MI's, 4 stents, strokes, valve replacement, surgeries, thrombocytopenia, hep C....the list goes on & on.  He was awaiting having a heart cath done.  His platelet count was too low for the cardiologist to do it....68,000.  So I transfused 1 unit of Platelets.  The magic number we were looking for was 75,000 in order to have the heart cath done.  Wouldn't you know it....the next morning his platelet level was 74,000.  So I put a call out to his doctor, got an order for another unit of platelets & hopefully, his level was high enough by noon time when the heart cath was scheduled.

My fourth patient was a "medical misadventure."  Otherwise known as a drug overdose.  She took a large amount of Cardizem, added alcohol to the mix & then called 911.  She had been placed under the "Baker Act" - here in Florida, anytime you are a threat to yourself or others, they enact the Baker Act.  Which basically means for 72 hours, you are under constant surveillance & cannot leave until a psychologist has evaluated you & given the ok for release.  Lucky for her, the psych doctor was in the same day & for some reason did not feel she needed to be a Baker Act.  I'll have to remember her name & go back & read the psych doctor's report on her...because I don't understand how a person with suicidal tendencies is not a threat to herself.  Perhaps he felt because she was in the hospital & under surveillance anyways, that at the present time she wasn't a threat.  I don't know.  She was a little on the strange side.  She was in her late 40's & had a flat affect.  I don't know what her history was...she wasn't cooperative with giving a medical history.  Hopefully she'll get the help she needs so this doesn't happen again. 

So it was a decent night.  There was a code blue called on the Med/Surg floor.  Apparently it wasn't much of a code because the patient was already dead by the time they discoved he wasn't breathing.  That's one reason why I wouldn't want to work on Med/Surg.....you truly don't know what's going on with your patients.  Sure they are supposed to be lower risk than those on PCU....but still, they are capable of coding & the only way you know that is if you are physically in the room with them.  I like PCU with the telemetry.  You know when something isn't right as well as vital signs are taken 3 times a shift rather than 1 time a shift.  Oh well, I'm sure Med/Surg has it's advantages also...but I think I'd be constantly checking on my patients to make sure they were still breathing.  That's all for now!