Let me list the # of things that are all Gina's fault...lol...
1) Gina's the reason I had no breaks after 1 am this morning
2) Gina's the reason my feet are sore & my body is physically exhausted & my mind is emotionally worn out
3) Gina's the reason my hand hurts from all of the DAR note writing I had to do this morning
4) Gina's the reason I did not leave work until after 8 am this morning
5) Gina's the reason I am not making $500 in overtime tonight
Lol...told ya Gina that I'd be writing about you today!!! Do you feel honored? I'm just kidding about this being Gina's fault, but don't let her know that. What I'm referring to is last night at work. We each had 3 patients & had a pretty decent night going until we were told we would each be getting an admission. Gina got to hand pick hers...a male in his late 20's in with "pseudoseizures." We prepared his bed with seizure precautions & Gina was ready to give him great nursing care. My patient was a 90 yr old female with chest pain & anemia....I'm talking about a hemoglobin of 8.6, hematocrit of 26 I think. Needless to say, this lady needed a blood transfusion sooner than later.
So there we were...with our new admits...me thinking Gina got the easier end of the spectrum with her hand-picked patient. It couldn't be any farther from the truth. My patient arrived first....very pleasant woman. Did not appear to be 90 whatsoever. Her son was in the waiting room. I went & retrieved him so he could spend some time with her until I got the first unit of blood hanging. Then it would be time for her to get some sleep & give him the option of taking a nap in the waiting room as we are not allowed to let guests spend the night in semi-private rooms. I completedthe admission assessment, got my patient comfortable & ventured back to the nursing station only to find a lot of commotion.
Apparently, Gina's patient was giving her a very difficult time. He didn't want her assessing him, all he wanted was his pain meds & for us to leave him alone. When she informed him that she had to assess him prior to giving him meds, he started calling her some very nasty names & literally told her to get the "f" out of his room. Classy, isn't he? The clinical leader went in to speak with him & his wife, meanwhile, Gina & the other nurses are telling me that I have to trade patients with her. Huh??? I already did all the work & I like my new patient! Doesn't matter, this guy doesn't want Gina back in his room. The charge nurse & supervisor were also given an update as to what was going on. The supervisor also spoke with the patient & his wife because the patient wanted to leave the floor in a wheelchair because he was "nervous." Do they think we're dumb? It's obvious that when a patient insists on leaving the floor, that they are going outside to smoke a cigarette or whatever else they may be addicted to. So they left, we can't hold him hostage. We even tried to get him to sign out AMA. He refused. They come back about 20 min later & I'm handed a bottle of Ativan....one of his medications that he's requesting. The supervisor & I go into his room to give him some good news & some bad news. The good news is...here's your Ativan that you were requesting. The bad news....he listed Codeine as one of his allergies, yet the pain medicine he claims to take at home on a regular basis has codeine in it. Thus...we can't give it to him even though it's ordered. Let's just say he was not a happy camper. I'm silently praying that the Ativan will be enough (2 mg IV) to quiet him down & get some rest because I have paperwork to do. Along with that, we inform his wife once again, that she cannot spend the night in his room...she is welcome to stay in the waiting room. They pitched a fit. She wanted me to sit at bedside just in case he had another seizure. Ummm, hello, I'm not his private nurse. I have other patients to tend to & plenty of paperwork that needs to be completed in the next 3 hours. I am not going to sit & watch a grown man sleep. Especially one that has been acting like a total jerk since he arrived. Let me add also...that in the ER, he claimed to be having a seizure...went through the motions, but when the ER doc told him to stop it....he stopped it. Is that truly a seizure? I think not. He just wanted his pain meds. I have a real low tolerance for drug seekers. I have an even lower tolerance for doctors that admit drug seekers at 1 in the morning. Thanks Dr!
The Ativan is not enough to make him happy...he threatens me that he's going to have a seizure right now if he doesn't get his pain meds. He wasn't being rude to me though...I think he learned quickly that he was close to being thrown out of the hospital with the way he treated Gina. He was calling me sweetie & sweetheart...constantly saying my first name & being very kind. At this point, the lab girl goes in to draw blood. He refused to let her. Just reinforces my belief that he is here for drugs & not for real treatment. Why else come to the hospital & do everything you can to not get help? The rest of the staff was tired of his behavior...time to call the doctor. Remember how my first few posts in my journal related to the topic of how I didn't like calling doctors in the middle of the night? Ha...boy has that attitude changed. Now it's "if I have to suffer, than the doctor should be suffering too." :)
Luckily it was one of the nicer doctors who actually took the time to listen. I felt like I was talking to my dad & tattling on my brother with all of the things he's doing wrong. Anyways...the doctor advises me to inform the patient of his right to sign out AMA. I told him I tried that, the patient refuses to leave. I let him know about the allergy/pain med problem. So he orders Dilaudid IV 1 mg, which is what Mr. Pseudoseizure was requesting in the first place. Gotta love the patients that are so familiar with pain meds that they not only request the name, but the dose also. This is not to knock those that truly suffer from pain. In fact, I believe this guy suffers from pain also & has reached the point of being addicted to pain meds. But going to hospital after hospital in hopes of getting a quick fix rather than having a regular primary doctor irritates me. Did I mention they had tried going to our sister hospital earlier in the day which refused to treat him & instead advised him to see his neurologist...and they got mad at that request? This was directly told to me from the wife.
Ok, time is ticking away....I get him his pain med so now I'm like his best friend as far as he's concerned. He's offering me money not to clock out at 7 am, he wants me to be his nurse all day. Ha! It's now about 5:35 & I have soooo much paperwork to do as well as checking on my other patients, doing I&O's, passing meds & whatever else needed to be done. AND having to document as much as possible on the whole situation with the pain med seeker.
Ok, I can still get done on time...no problem. Umm, nope. I notice his wife is sleeping in his room. I wake her up & walk her to the waiting room which is just down the hall...not very far. She manages to fall asleep...she looked exhausted anyways. About a 1/2 hr later, he's using his call bell...he needs his wife or he'll have a seizure. My patience was wearing thin. I was in the middle of hanging Heparin so he had to wait. Two minutes later, he has his heart monitor off & he's out of bed...getting in a wheelchair & rolling out of his room. I stop him & ask him what he's doing. He said he's going to the waiting room. He looks beyond drugged up...amazing he didn't fall on the floor. I told him he had to get back in bed, that until the doctor sees him...he's on seizure precautions & fall precautions as well as bedrest only. Amazingly he complied, but then tells me "In the morning, I WILL BE GOING OUTSIDE TO SMOKE." I told him that it wasn't a good idea, that they may not allow him to come back into the hospital if he does that. He says "That's ok, I'll just call my attorney." Ok, no problem...I'm not going to argue with him. I wake up his wife & tell her she's welcome to sit in there with him. At this point, if she was willing to babysit him, then have at it. Even after telling them earlier in the night that she was not allowed to lay in bed with him....she does it anyways. At that point, it was about 6:30 am & soon to be dayshift's problem, not mine. It took me about an hour & a half to catch up on paperwork & to end my work night.
I was mentally exhausted when I came home! All Gina's fault...lol. I told her I want an I.O.U. in writing! I really did want to go back & work tonight for the overtime, but the floor was full of time consuming patients...which is fine, when you are properly staffed. But we have been short on patient care techs 2 out of the 3 nights I worked. It just gets to be too much...both physically & time-wise. I'm still debating about whether to pick up a shift on Fri or Sat night.
My other exciting entry for this week happened early on Tuesday morning. I had a new admit earlier that night...an elderly woman that had a stroke 2 months previous & as a result, has uncontrolled hypertension. Upon admission, her BP was 209/90. They gave her something in the ER that brought it to the 160's...which is fine for a stroke patient. Don't want it too low. Her son was with her & she seemed to really be with it....no deficits from the stroke other than short-term memory loss at times. Got her settled into bed & went about my night. Around 2:30 am, my tech & I decide to give the other patient in her room a bath as she needed her brief to be changed anyways. This patient screamed all during the bath so I looked over at my new admit to see if she was sleeping through this or if she was awake. She was awake, she looked really mad...as if all the noise was annoying her. I asked her if she was alright. She replied back "I feel like I'm going to faint." I wasn't expecting that answer, so I ask her if she would like a cool washcloth & at the same time I'm sitting her up so she can breathe a little easier. I get the washcloth & Gina tells me this patient's heart rate just went from the mid-70's to the low-40's. I ask Gina to get me a nasal cannula...something wasn't right with this patient. We get the oxygen flowing, wash cloth to the forehead, asking her how she feels...call for the dynamap to check her blood pressure. We can't get a blood pressure reading & she is getting more pale by the second. I pull in my clinical leader, who puts a call out to the charge nurse & I have Gina placing a call to the doctor. My patient is starting to not follow commands, eyes are closing, speech is becoming garbled...something is definitely wrong. Gina gets a direct number to the doctor..I call......and get his answering machine. Lovely! The charge nurse decides we don't have time to wait for the doctor to order ICU transfer, we move her over because she is starting to fade. I am told to call any doctor on her case since the primary is unreachable...the only other doctor is the neuro doc on consult who has yet to see the patient since she is a new admit. Needless to say, he wasn't happy that I was calling him at 3 am & didn't hesitate in telling me so. I just wanted some orders...especially for a CT of the brain to see if she was having another stroke or to figure out what was going on. He wouldn't order a damn thing! Advised me to continue to try getting a hold of the primary doctor. Gina finally gets him on the line, I take the call...the doctor is half asleep & whispering his orders. He orders the CT of the brain & then adds in "if it is negative for a bleed, start her on aspirin 325 mg PO." I'm thinking....did he not hear me say that she is somewhat unresponsive. How in the world are we supposed to get her to take PO meds if I can't even get her to open her eyes??? I figured we could deal with that later. He ordered some lab work & kept asking me "What else do we need to do?" I was partly in shock that this was even happening & partly in shock that the doctor was asking ME what we need to do. I write up the orders, talk to the ICU nurse who received my patient & I go to check on my patient. She's a little more alert, blood pressure was ok...in the low 160's, she's following commands...then says to be "Please don't let me die." I didn't know exactly what to say because I didn't know what the heck was even going on with her. The ICU nurse told her she was going to be ok, that we wouldn't let her die. I just don't feel comfortable saying that to a patient because I don't know that I can truly fulfill that promise, you know? I'm all for giving them hope, but I'm not going to lie to them either. Instead I told her the facts...that she was doing better, that we were running tests to see what was going on & that right now she is doing ok. Turns out they don't know what happened....all her tests came back absolutely normal. Luckily I have witnesses that saw with their own eyes that something was not right...it wasn't just my imagination. She was only in ICU for less than 20 hours before being moved back to PCU. I'm glad she was ok.
The last little bit of this long, long post is of course focused on my nephew & his baseball team. They played the best game I've ever seen Tuesday night. It was so exciting...first they were winning, then they were losing, then they came back at the end to win 6 to 5! It was so crowded there...standing room only. So many people cheering, it felt great. They are the Regional Champs & will be playing in the State Tournament next week in Sarasota. I can't wait. Last year they placed 2nd in the state....I really hope they win it all this year. The bad thing about it though...they are supposed to graduate from high school the same day as the state tournament. Why the school picked that day when this exact team has been in the state tournament the last 3 years straight, I'll never know. I'll let ya know how they do...wish us luck!