Friday, April 21, 2006

3 patients each night

Another week of work completed, although I just "might" work Saturday night for some overtime.  It's been an interesting week to say the least.

First off...updates:

That code from last week in the bathroom...he passed away on Friday.  :(  He had a lot of health problems prior to the code & his family decide to make his code status DNR. 

My patient with the colon mass & perforated colon that was in ICU.  He was transferred to med/surg & will be going home soon.  His prognosis is not good, but at least he'll be able to leave the hospital. 

I worked Mon, Wed & Thurs this week.  I'm trying to remember back to Monday....hmmmm.  I recall that I only had 3 patients, which entire week was only 3 patients each night.  I really lucked out.  Anyways, let's see...Monday night...I had an ICU transfer.  A gentleman that had come in with respiratory distress.  He was slowly improving.  Not much to really say about him.  My next patient was diagnosed with obstructive jaundice.  I never heard of that before.  I believe they thought he had a gallstone stuck in the pancreatic duct & they tried to surgically remove it.  He had an NG tube set to low-intermittent suction that had plenty of output as well as an Abrams drain from the incision that also had plenty of output.  He was a quiet guy...not much to really say aobut him.  My third patient I can't even remember!  Talk about short-term memory loss!  Hmmm...perhaps it will come to me later. 

My night went smooth. I did eventually get another patient & this sort of annoyed me...not the patient, but the ER staff.  They received orders to transfer this patient to PCU at 5:10 am.  Guess what time they called report...6:25.  I wasn't even off the phone 60 seconds & they already had the patient coming down the hall on the stretcher.  How is this possible?  Anyways, they really screwed up as they had mixed up my patient's paperwork with another patient on a different wing...not good.  So half the orders were correct, half weren't.  I eventually wrote up an incident report because they were being careless.  The ER nurse tells me during phone report "The patient's blood pressure has been in the 180's since she got here."'re sending me an unstable patient?  Have you even addressed with the doctor the blood pressure?  It just seemed really careless with the way this patient & her paperwork were handled.  You don't send up an unstable patient...especially during shift change!  That's my gripe for the week.  :)

Tuesday night I went to my nephew's baseball game.  They won, but OMG...the fans of the other team were just awful.  They would not stop yelling insults at our players....they were especially attacking our catcher...yelling at him that he's on steroids & a lot of other stuff I won't even post here.  It's just wrong.  These are still kids...high school kids....but still kids.  You don't bash them during a sporting event.  I'm all for cheering for your own team, but why verbally attack the players on the other team?  I don't get it.  The principal of that school was there & he allowed it to continue.  It's just wrong.  However, we won.......yet even after we won, they were chanting "Overrated, overrated."  Ummm, helloooo...we just BEAT you, why are you yelling at us?  Very strange! 

Wednesday I returned back to work & got all new patients even though I was on the same floor as I was Monday night.  This time I had my patient that was diagnosed last week with a brain tumor...he was back in the hospital for nausea & vomiting.  It turns out that last week when he had the low heart didn't have anything to do with his heart...rather the brain tumor is growing & causing pressure in the brain that is resulting in a vagal response which causes the heart to slow down & also causing the nausea/vomiting.  It's also causing something with prolactin...I don't remember if it was causing him to produce too much or not enough as well as affecting his short-term memory.  He's the nicest guy...I really hope they are able to do something for him.  We don't do neurosurgery at our hospital & the soonest he could get an appt with a neurosurgeon was the middle of May.  Hopefully he'll be ok.

My next patient had a chest tube...the small compact one that just sits on the chest.  It's pretty neat.  I got a call from the surgeon placing orders to consult a pulmonologist & see what his opinion is on a thoracolesis &/or pleuradesis.  I was like "Ummm, excuse me?"  I had never heard of those words, much less know how to spell them!!!

My third patient was an older woman that was a direct admit from her doctor's office.  She was diagnosed with COPD exacerbation.  She made me laugh...not necessarily on purpose though.  I had woken her up at midnight to give her some medications.  She seemed confused (who isn't when you wake them up?) so I began asking her if she knew where she was.  She replied "Yes, I'm at the Vatican."  Ummm, ok.  Do you know who I am?  "Yes, you're father Jennifer."  I chuckled & asked her if I looked like a father.  She said no, but that we were there for a meeting.  I attempted to reorient her & then let her get back to sleep.  Turns out I woke her up in the middle of a dream.  :) 

We had a unit meeting earlier that night.  Those meetings are boring.  They are expecting JCAHO to be checking out our hospital this coming week..we shall see as JCAHO no longer announces when they'll be there. 

That was my night.  They tried to give me a 4th patient around 5:30 am.  A man that needed a PICC line placement.  That sounded way too good to be true, so I looked up his history & it turns out he had C-diff 4 days earlier.  I called the charge nurse & said "Do you really want to put someone with C-diff in a semi-private room?" no admit for me since we didn't have any private rooms open on our wing. 

Thursday was much of the same.  The patient with the brain tumor had gone home & in his place I got a patient diagnosed with "near syncope."  For some reason, he lost the ability to stand for a split second & fell at home.  So he was in to figure out what made him lose the ability to stand. 

My other 2 patients were the same & not much to really report on either of them.  Last night was a very slow night...I actually made the comment that it felt like we were in detention like in The Breakfast Club movie & just watching the clock slowly tick by.  We were overstaffed...we had 4 nurses on our wing & we each had 3 patients.  The other wing had 3 nurses & only 7 patients.  I'm not complaining, but slow nights are not necessarily fun nights.

That patient with obstructive jaundice....turns out it's a pancreatic mass = cancer.  Cancer that has metastized all over....again, terminal cancer.  I still think about what it must be like to be told you have a limited amount of time left to live.  I know we all have a limited time because eventually we all die, but to be told an exact number of something less than a year......just scares me.  It's of my friends works on an oncology floor at a different hospital.  She, for some reason, always knew she wanted to work in oncology.  I remember thinking that seems like such a sad place to work...where everyone has cancer.  But now I'm seeing that pretty much everywhere you work, you will have patients diagnosed with cancer as sometimes the signs & symptoms are kind of hard to diagnose at first. 

Tonight was my nephew's last regular season game & of course it was raining...figures.  They managed to play 4 innings & were winning 4-1 by the time the game was called.  They finished the regular season with 24 wins & 1 loss.  Not too shabby.  I got an invitation today to his high school graduation party in May.  I can't believe he's all grown up!!!!

I still can't recall who my 3rd patient was on Monday night & now it's driving me crazy.  :)  Byeeeeee!


fjrav said...

Congrats on being a guest editor's pick!  Check out my journal about med school sometime at

bnznipper said...

hey, I just wanted to say any nurse is an inspiration to me. I am 23 years old and I am trying to go for my RN also. I know the classes are hard and once you enter the RN program it gets harder. My husband says " go for it", I am just waiting for my children to get older. I am a CNA right now, but with a little time maybe I will be working as a RN in a hospital somewhere.

therealslimemmy said...

hi there
congrats on being editors pick

mlrhjeh said...

I am so thankful that there are nurses like you!

People are scared when in the hospital and need a caring nurse to calm them.

Good luck with your future.

Mary Louise

jckfrstross said...

have a good week:) i have added you to my alerts:)