Sleep, sleep & more sleep

Ahhhh...I did it.....5 straight nights of work.  That is the most I've ever done in my short career of nursing.  It started out rough, but eventually became easier.  I am tired & even though I slept all day, I plan to go to bed in a little while for even more sleep. 

My week started out on Monday night.  They had separated Gina & I (grrr)...she was on a different floor than I.  Oh well...it happens.  I had 4 patients that night.  I'm trying to remember who they were...lol...that darn short-term memory loss.  Ok, one was in with kidney stones, another was sent admitted for CHF, another had been there for over a month - he has it all going on...name the problem & he had it and my fourth was a new admit in with Lymphoproliferative Disorder & possible sepsis. 

That night wasn't too bad...pain meds for the pt with kidney stones & for the patient with Lymphoproliferative Disorder.  The pt that had it all going on pretty much slept most of the time.  My CHF patient was the problem pt that night....because her heart rate was sustaining 130-140's repeatedly.  She had been in the month before with A-fib RVR & I didn't want to see that happening again.  I called her cardiologist and got an order for Cardizem 20 mg IV.  I pushed that & it seemed to take care of things....for about 2 hours.  She got a breathing treatment & her heart rate again was sustaining 160's.  Now it's midnight...another call to the doctor...another order for Cardizem 20 mg IV & start her on a Cardizem drip.  If I am unable to get the heart rate below 120, transfer to ICU.  Ok...well, how much time am I allowed to get the heart rate below 120?  I'm told to "give it some time."  Again, how much time is "some time?"  We decide to give it 2 hours.  Luckily it worked rather quickly...within a 1/2 hour, she was in the 80's & maintained that rate and her blood pressure was maintaining also.  Ok, problem solved.

Next night, I return...my Cardizem pt is now in ICU.  Uh oh...what happened?  Turns out the primary doctor came in & didn't like the way she was breathing.  She seemed to be breathing fine according to me & also the respiratory therapist...but the doctor didn't like it.  Ok, at least I don't have to worry about her tonight.  My pt with the kidney stones went to surgery....laser surgery to zap the stones.  My pt that had it all going on now has a PEG tube.  My Lymphoma pt is receiving a unit of platelets because his platelet count was 17.  And I get a new patient...a direct admit being sent to us because she had a CT scan done at her doctor's office & it shows a pulmonary embolism (blood clot) in her lungs.  Other than her thinking she was at the Hilton Hotel rather than a hospital, she was easy to care for.  She just wanted to chat a lot & have me do everything for her...but eventually she went to sleep.  Again...a not so bad night.  A little busy...but doable.

My third night started off with a unit meeting.  During the meeting, the charge nurse whispered to me "Do you want to work on the 2nd floor or stay on the 3rd?"  I tell her stay on the 3rd...because I figure I already know my patients & didn't want to start over.  Next time I'll rethink that question.  Two of my patients were discharged...kidney stone pt & lymphoma pt.  I still had the Hilton Hotel pt who now returned from CT scan with an infiltrated IV in which they injected contrast...it was not pretty.  Her arm was swollen, had to be elevated, heat applied & even though she said it did not hurt, she complained repeatedly about what an inconvenience it was for her to keep her arm elevated as well as every 10 minutes wanting me to reheat the warm cloth on her arm.  I also still had the pt that had it all going on...only know he was a little more alert & attempting to get out of bed.  He was what we call a total care....a patient that cannot do anything for themself. 

On top of that...I had 2 new patients.  2 more total cares.  I should have spoken up, should have refused one of them, but I didn't.  Reason being we had 5 total care patients on the floor & 5 nurses...yet I had 3 of the total cares.  Not really too fair, but I took report.  One patient was an ICU transfer.  She had been in a car accident last month inwhich she broke the majority of her ribs, her pelvis & her scapula.  She returned to the hospital because she had no urine output.  She ended up having dialysis twice & then her kidneys started working & during my shift...she had over 4200 ml output.  That's a lot considering she didn't even have any IV fluids running.  She was barely able to move because of the pain, yet she is allergic to nearly every pain med ever made.  So she was receiving Tylenol.  TYLENOL for broken bones!  Ugh, how is that supposed to help?  Needless to say, she was crying most of the night & didn't want to be alone.  She would call me in because she was scared.  I tried to be patient & understanding in the beginning...holding her hand, telling her she would be ok, trying to get her to tell me what she was scared of.  By the 10th time of being called in there...it was wearing me down.  She would tell me she couldn't breathe....her lungs sounded clear, her 02 sat was 98% on room air.....I'd get her breathing treatments & she wouldn't want to wear the mask.  I felt like a mother with a child...."don't do that, keep that on, stop talking & just breathe in thru your nose"....it was wearing me down....

Mostly because my 4th patient was in with pneumonia I believe & she was at risk for aspiration as well as having a history of dementia & many other things.  I had listened to her the past two nights with other nurses constantly yelling out for help.  You go in to help her & it's like she doesn't even know you're there...she just keeps yelling out for help.  She basically is in her own world most of the time.  Even if you try to calm her down, she yells even more.  The night I had her...she had just had a PEG tube (feeding tube) put in earlier that day.  I was hoping the anesthesia would allow her to sleep.  Ha...I was wrong.  Because she was NPO earlier in the day...she never received her medication to help with dementia.  Not only that...her family refuses to allow her any pain medication or any medication for anxiety or sedation.  So from about 7:30 pm until 4:30 am....she screamed & yelled "Help me, help me, help me, help me" over & over again...pretty much non-stop.  Between her & the one that was crying all night...I wanted topull my hair out. 

It was frustrating...not because of their conditions...but because there was nothing "I" could do to improve the situation.  The one yelling out would not stop yelling out until she tired herself out...which happened around 5 a.m.  The one crying would not stop crying until she wore herself out...which was on & off thru the night.  The one that was complaining about her IV infiltrating would not stop complaining...until she went to sleep.  And the one that was finally getting his strength back & would attempt to get out of bed....well, he wasn't so bad because he was calm about it all & I had a good view of his room so that I did not feel the need to restrain him. 

On top of all that....my clinical leader "tried" to give me another patient...a new admit in with hypoglycemia.  Sounds easy enough....give the pt some food & let them sleep...but when they are admitted for hypoglycemia...something is usually really wrong. Because they could feed him & send him home in the ER once his blood sugar stabilized.  They are admitted because their blood sugar isn't stabilizing.  I told her NO....I can't take another patient...I can't do it.  It's midnight, I have yet to sit down & start any charting & my patient's still have needs......not to mention 3 are total cares & 2 are on Heparin.  She agreed with me...that it would be too much & that this new admit would probably need accuchecks every 2 hours, so she gave him to a different nurse.

Turns out this new pt arrived to our floor with a blood sugar of 64......this is after he was given 3 amps of D50 in the ER & is on a D5W drip.  The nurse that got him had her hands full.  She gave him food & juice....his next blood sugar was like 52.  WHAT???  More food, more juice.....now he's 39.  She called for a stat lab blood glucose & while she was delivering that to the lab....the PCT noticed he was acting a little different.  She rechecked his blood sugar...now it's 27 & he is having trouble breathing & communicating.  A call to the doctor & he orders D10 IV drip & accuchecks every 45 min....no transfer to the ICU. Ummmm...hello....does this not sound like a patient that needs close monitoring?  On PCU, we have 4 or 5 patients at a time...so how can we spend all of our time with one unstable patient?  The clinical leader called the doctor back & pretty much insisted that he needed to be transferred to ICU for close monitoring.  The Dr. finally gave in. 

The other nurses & I rallied to get our paperwork done by the end of shift while we all tried to make one another smile & laugh during all of the complaining.  It really helps to get thru a tough shift with co-workers that you like. 

Even after that I decided to pick up another shift...only I negotiated with the charge nurse....put me on the second floor...I don't want these patients back.

So Thursday night I started off with a new batch of patients (I sound like I'm making cookies...lol).  My first one...well, she was about to be discharged in a 1/2 hr (yay!), my second one was a gentleman in with pneumonia...he did have 3 chest tubes at one time, but when I got him, he was down to 1 chest tube & a wound vac.  My third patient was in with chest pain - those are still my favorite patients because everything is so routine with them.  Rarely do things go wrong after the cardiac enzymes come back negative.  My fourth patient was a handful....a large pt with multiple abdominal surgeries & as a result....fistulas as well as a colostomy.

I lucked out that night...after I discharged my first patient, I remained at 3 patients the rest of the night.  3 patients who all they wanted was to get some sleep.  They didn't want to scream & yell all night, they didn't want to climb out of bed & fall on the floor, they didn't want to cry all night, they didn't want to complain all night...they just wanted their meds & to go to sleep.  Ahhhh, I needed a night like that.

My fifth night...same patients plus one more.  My new patient was admitted for a beta-blocker overdose.  She accidentally took 20 Lopressor 100 mg pills.  Lopressor is given to slow down your heart rate as well as helps to lower blood pressure.  Luckily she was ok....she got lots of charcoal in the ER (yuck) & was able to get up to her bedside commode by herself (charcoal moves through your system quickly).  Her blood pressure & heart rate were fine when I got her, but in the ER it had been as low as 70/40.  Again though...all she wanted was to get some sleep. 

The only eventful thing that happened last night was my pt with the fistula....well, she has the opening of her fistula covered with a colostomy bag that connects to a foley bag/fecal bag.  It was working quite well.  I get called in there because it's leaking.  Now I'm forced to take a really close look at this set-up & I'll admit...it wasn't pretty.  Even colostomies freak me out as well as trachs.  I just don't like openings in the body where they aren't normally found.  For some reason, I feel pain as though I'm the one with the colostomy or trach.  So I'm looking at her open fistula & I have no idea what to do.  It wasn't a clean sized opening like colostomies are...it was odd.  She said her daughter is the only one that changes what she had applied & she wouldn't be in until the morning.  So I asked the patient (best source usually) what she thought we should do....she said she had some paste that they apply around it because apparently...it leaks often.  So I got the paste that she had in her room & had her apply it.  I figured she knows herself  & her body best.  What a nurse I am, right???  :)    Luckily that did the trick & off to dream land she went.

I probably should have gone back to work tonight...but I was tired.  I slept all day, heading to bed now & gonna see my parents tomorrow before they leave on their 2 week vacation.  Then it's back to work Monday & Tuesday nights.  Not sure if I'll work any more than that, but it's nice to know I have a really good paycheck coming in 10 days. 

Hope y'all are having a great weekend & doing something more productive than sleeping like I am.  Peace!

 

 

I must be crazy!

All is still quiet as far as critters go...so I'm happy.  I must be crazy though....I've been working a lot this week.  I'm going back tonight for my 5th shift in a row & I'm thinking about picking up tomorrow night also.  It's all overtime at this point.  I am getting tired though...I'll go into more detail when I have some time.  I need to get some sleep so I'll be well rested for tonight.  Have a good weekend!

Back at home

I came home last night...still not feeling really good about being here, but figured I had to return sometime.  My mom & I cleaned my house on Saturday and saw that there was no real signs of any activity which made me feel better.  I just wonder when I will feel comfortable being in my own home without fear of hearing or seeing a critter.  How am I supposed to have a date over without explaining why I have a rat trap in the bathroom???  Lol.  Or why there is a towel under my door when I go to sleep at night.  Seriously...how romantic of a story is that?   Guess the lovelife will have to be put on hold temporarily...as if that's a problem...haha.

Anyways, to sum it up, we did catch 2 critters with the traps.  Hopefully it's the 2 that I saw & that there are no more.  I still have the traps out & some in the attic.  I did not go with the ripoff professional company...I didn't like his scare tactics, the price or the small print...that they would only spend 2 weeks working on getting rid of the critters for that price.  If more time was needed, more money would be needed also.  Forget that. 

It really made me think more about travel nursing.  How nice it would be to simply live in an apartment without all of the day to day upkeep of a house.  I say this as I look outside & notice that my lawn really needs to be cut, weeds to be pulled, etc.  I am so not an outdoor person.  Although even if I traveled, I wouldn't sell my house, so I suppose that really doesn't help.  But it's fun to dream.  :)

Ok, I need to call in to work to be added to the schedule tonight.  I'm hoping to work 3 or 4 nights this week...partly because I could use the money & partly so I don't have to be home in the nighttime hours.  Yeah, I'm still a chicken...soooooo...lol.  Later!

 

 

$680

$680...that's what the professionals want to "try" to resolve my situation.  No guarantees though....ugh.  Seems like a lot of money with no guarantee, you know?  On a good note...when I went back to my house yesterday, there was no signs of anymore loose in the house.  I did manage to trap the two I saw into the laundry room & bathroom the day before.  Go Jen Go!  I know of two areas where they probably have easy access to get in & out...so I'm going to have my brother seal them up & set some traps & hope that does the trick.  If not, I'll probably call another company to come in for an estimate because I did not like the scare tactics this guy yesterday was using nor the price.  I wish I could just blink my eyes & this would all be resolved.

I promise...I will get back to writing about nurse stuff next week!

Make the Connection

If you're interested...there is no cost to you at all...not even a shipping charge.  I feel it's for a good cause & wanted to pass it along to others...

By ordering a free Make the Connection bracelet kit, you will be helping to advance cervical cancer education and outreach. For every pair of bracelet kits ordered, Merck will donate one dollar to Cancer Research and Prevention Foundation, up to $100,000, for cervical cancer awareness and screening programs among medically underserved women.

https://www.maketheconnection.org/order_beadkit/default.asp

 

Quick Update

I thru in the white flag & fled my house.  I just couldn't take another night of wondering what may or may not happen.  Plus my brother was a no show (jerk)...so I packed up my dog & have gone to the beach...lol.  More later...

My Space

I finally put together a myspace page...if you want to be "my friend"....I'd be happy to have ya. 

 http://www.myspace.com/jennerizer  

On an off-topic subject....I am currently under attack...by little 4-legged creatures that are oh so NOT cute.  This is how it started...Saturday night at my house I hear my 9-yr old niece say from another room "Oh my god."  She then comes over to me & says "I think I saw a rat."  WHAT???  What do you mean "you think" you saw one - either you did or you didn't.  With that I went to investigate & sure enough...something was in my laundry room.  I closed the door & panicked - where is a man when you need one?  I did the next best thing...called my parents...as if they could do anything over the phone.  My niece & I went to sleep that night pretty confident that we contained the little creature to the laundry room...boy, was I wrong!  I made an appt on Monday with some animal control specialists...of course they can't get here until Wednesday late afternoon...grrr. 

Let's just say last night was not a good night...I came face to face with 2 of those little suckers IN MY HOUSE...ughhhhhhhhhhh.  Again, no man to be found anywhere to help me out.  So I run to Wal-Mart hoping to find some gigantic rat traps because unless these two plan on paying towards my mortgage, they aren't living here.  Wal-Mart had nothing but these little itty bitty mouse traps.  I tried to imagine one of my critters (sounds better than rat, doesn't it?) getting trapped in a mouse trap & wearing it as a piece of costume jewelry.  So I get the sticky traps...the ones that they are supposed to stick to when they step on it.  I joked with my mom that they'll probably end up wearing them as shoes & still be able to get around.  I buy 20 of them...lol, I had high hopes.  I put out about 10 of them...no need to waste the other 10 if these 10 weren't going to work.  Then I locked myself in my room with my dog & towels under the door & prayed none were in my room.  So far that prayer has been answered.  I heard noise throughout the night...either it was light thundering (it's been raining a lot thanks to Tropical Storm Alberto) or these critters are running a marathon in my house.  They are lightweights...how could they make so much noise?  My mom says they must have found a way in & want food.  Well, they came to the wrong house...I have hardly any food here.  I'm sure they are disappointed, but oh wellllllllll! 

Amazingly, I managed to get some sleep last night amidst the critters invading my home.  By the way, I don't have a dirty home.  I live in a very wooded area....lots of wildlife out there.  Unfortunately, not enough wildlife to eliminate these pesky critters.  I had a feeling they had gotten into my attic, but never did I think they'd be able to get into MY living space.  So as I'm laying in my bed this morning...not quite yet ready to see what destruction has taken place outside of my bedroom...ideas go through my head.  Perhaps I should become a cat lady & invest in some cats.  I try to picture a cat vs. rat scene...it wasn't pretty.  I picture having a b.b. gun & taking out these little suckers on my own...but then reality sets in that I'd probably miss the rat & have a ton of little b.b.'s in my walls.  I imagine moving...but just the thought of moving is not a good one.  So I reflect on all the promises made to me by the animal control specialist that is supposed to come out Wednesday afternoon & I smile....I sure hope they are able to take care of this critter regime. 

I finally get up & sneak out of my room & start to explore all the while thinking "a homeowner should not have to sneak around their home."  I go towards the laundry room...where I believe I had contained one of the little creatures.  I was one told that they don't like aluminum foil...that they won't mess with it - so wisely I had stuck some under the door to close the gap because I read they are able to squeeze through a 1/4" gap...eek.  What do I see...shredded up aluminum foil...as if they were having a party & needed confetti.  So much for that theory.  I also notice that while a couple of my glue traps had been moved, there's not a single rat stuck to one.  I'm sure they are probably laughing at me & whispering "amateur" as I walk by.  All of a sudden, I notice something on my wall moving...ewwwwwww.  See, there is a fuse box on the wall next to the laundry room door.  In order to give it a little better appearance, my mom hung a small rug thing over it...which does make it look better usually.  By usually, I mean when a rat isn't making the rug it's home.  Have I grossed anyone out yet??? 

So I watch this creature move around & I see that it looks rather confused.  I actually begin to feel a little sorry for it as it's trying to figure out how to get back into the laundry room.  Did I mention that back on Saturday night, I had stuck a large piece of glass (from an old dining room table) up against the laundry room door.  In my mind, I was building Alcatraz.  However, I failed to learn earlier that rats can climb glass.  WTF???  How do I know this...because I watched it happen last night.  I was in shock, but I screamed & scared the little guy right back into the laundry room.  Who knew that rats can climb glass?  I thought they needed something to grip their little claws with...nope.  So back to the confused one...I could tell he/she was hoping to get back to the laundry room but just could not figure it out.  I decide to open up the porch door that is right there in an attempt to chase this one out the door...only now he's hidden in the rug as he has discovered I am there.  So I get a baseball bat....I'm sure a man probably would have beat the gross creature to death, but not me...I bang the wall.....he drops to the ground...goes running to the door...yes, yes, yesssssss...stops & runs back the other way...no, no, nooooooooo.  The only place to run that way is into my guest bathroom.  I didn't actually see him go in there, but I sure enough shut the door.  I'll let the animal control specialist go in there tomorrow & see what's in there.  Then again, with my luck, that gross little thing probably dived into the toilet never to be seen again....yuck.  Do they do that??? 

I have my brother coming over at 4 or 5 to set some traps around the house.  I'm hoping there are no more, but I have lost my confidence that I am safe at this point.  I have no idea how they got in or how many there are.  It's been pretty quiet all day, they are probably resting up to stress me out later.  A smart person would pack up & head to a hotel...but not me, I'm staying.  I like to know what's going on in my house.  Plus I don't want to leave my dog behind.  So when nightfall comes...I will be once again, locking myself in my bedroom & praying it will be a good night.  Wish me luck.  I'll update later.  I can only imagine how much this is going to cost!

 

 

 

Oh...UPDATE on PICC line

Didn't want to leave you hanging...I have an update on my patient from last week that pulled part of her PICC line out.  The chest x-ray showed that it was still in a good location & the day nurse was able to get blood return out of it....so it was still good.  The patient, however, was getting more sick by the day & they eventually transferred to another hospital that could hopefully treat her condition better. 

Busy week!

Hmmm...let's see, where do I begin???  How about with the amazing concert I saw Saturday night.  It was fantastic.  They started with Tim & Faith singing "Like we never loved at all", then Faith sang for an hour, then Tim & Faith again...then Tim for an hour (yummy) and finished with Tim & Faith again.  They sang all of their duets.  My favorite is "It's Your Love."  The way they have their stage set up is perfect...not a bad seat in the house unless you have floor tickets.  I think the most entertaining part of the night was watching the older lady sitting directly in front of us (I had upper level, 2nd row seats)...she seemed to think that every time Tim or Faith faced our direction...that they were waving to her.  She'd frantically wave her hands in the air & get all excited.  If she did it once, she did it 100 times.  Ahhh, I wish I could go back...I'm kinda sad that it's all over with, but it was a great concert.

Now my nephew...he did get drafted by the Atlanta Braves yesterday...woo hoo.  The deal is though...he will train with them, but he will also go to the local community/junior college here to play baseball for his first year.  They want to see how he handles college ball.  If they like what they see, then they will offer him a sign-on bonus & take him into their minor league.  If they don't like what they see, then he gets released back into the draft next year for another team to make him an offer.  I guess this is what normally happens anytime a guy is drafted after the 20th round (unless they already completed college).  It's called "draft and follow."  They think he's got talent at hitting the ball & will make a great first baseman, but no more pitching.  Which surprises me...cause he is a good pitcher, but they want him more for his hitting ability I suppose.  Anyways....it's great news that he got noticed enough to be drafted.  We thought he'd have to put some time in at the college level to even be noticed.  Two other guys on his team got drafted also....another one with the Atlanta Braves and then we have our first round draft pick going to the Houston Astros.  He got a $1.4 million dollar sign-on bonus.  Not bad!  It's a crazy world when these young athletes are making millions just to sign a contract to play a game that they love to play....while most of us with regular jobs don't get any type of sign-on bonuses or million dollar salaries...not fair!  It will be interesting to see just how far these guys make it though.  I hope they do well.

Now for work...ugh...I put in 4 days in a row this week & I'm so exhausted today.  I only got about 3 hours of sleep because I'm trying to change back to a day schedule.  I'm taking a mini-vacation to Universal Studios Orlando this weekend & leaving tomorrow morning.  We're staying at the Hard Rock Hotel...planning a day by the pool (it better be sunny out) & then going to the theme parks on Saturday.  I think I may have to have a few drinks tomorrow by the pool...lol.

Ok, let me try to remember this past week.  Sunday is not ringing a bell...ahh my memory is not as good as it used to be.  I had 4 patients that night, no patient care tech.  My first patient...they thought had a GI bleed.  He definitely had blood in his stool, but amazingly, his H&H remained stable.  My second patient was a lot of work...a male in his early 60's with uncontrolled diabetes that ended up having to have his left leg amputated above the knee.  He was just awful as far as his attitude....very, very mean to the female nurses.  It got to the point that you didn't even want to help him because he was mean & nasty & yelling all the time.  We can only take so much of that, you know?  My third patient was someone that I know I've taken care of before.  He was in because his Dilantin level was too high.  He was non-responsive EXCEPT for food.  How is that possible???  Lol...but it was true.  He wouldn't open his eyes or even speak, but put a spoonful of applesauce to his mouth & he'd eat it right up....which is good, because it was the only way to get his medications into him.  My fourth patient was an ICU transfer.  A woman with a new diagnosis of lung cancer who had a right lung resection which required a chest tube.  I don't like chest tubes...for one, they just baffle me...I don't quite get how they work...like how sticking a tube in someone's chest area improves things.  I understand the drainage concept, but it amazes me that they can pull it out & it doesn't cause a problem.  Anyways, I was told she was confused & given 5 mg of Haldol prior to the transfer, but it wasn't helping. 

So I get her situated in her room & she already had wrist restraints on.  I ended up putting ankle restraints on also because she was trying to get out of bed.  I also gave her Ativan 1 mg IV...that didn't make things any better either.  She was anxious, restless, confused.  I had been told she pulled out her chest tube while in ICU last week & I was worried she'd do it again.  Every time she'd attempt to move around in bed, her heart rate would jump up to the 140's.  I don't know how many times I told her "stop moving"...which sounds ridiculous now...but it was the only way I could get her heart rate to stabilize.  Finally I called her doctor & got an order for lopressor & a cardiac consult.

On Monday night, I requested not to have the mean patient back.  I could only take so much of being yelled at, you know?  My patient with the GI bleed now had a cardiac consult and stress test...he had a history of cardiac problems & I guess they wanted to rule out that anything was wrong heart wise.  I still had my non-responsive, except for food, Dilantin patient.  I had the confused woman with the chest tube.  And added to my patient load was a confused older man in with pneumonia as well as another older man with a new onset of A-fib whose heart rate would go into the 140's for no reason at all who was on an amiodarone drip.  Man, looking back...that was a heavy patient load!  3 confused total cares & 2 with cardiac problems.  Luckily, we had a tech...well, at least for the first 4 hours we did.  I'm really getting tired of the short-staffing...mostly because we aren't short-staffed because we don't have the tech help, it's because they simply aren't staffing us with a tech...in order to save money.  How much do techs make in a night....maybe $120...probably less, but they sure do earn that money with all of the hard work. 

Ok, it actually wasn't too bad of a night.  My patients were mostly stable.  I think the most time consuming one was my chest tube lady.  She simply would not sleep nor stop talking.  Oh well, I made sure her restraints were in place & that a pillow was tucked in between her arm & the chest tube.  I did not want to have to deal with her surgeon should she pull that out.  The lopressor worked well...at least her heart rate was stable.  I was asking her questions to see if she was alert & oriented.  She didn't know where she was, didn't know why she was in the hospital....her response "I'm here for a little bit of this & a little bit of that."  So I then asked her about her doctor/surgeon...I asked if she remembered him.  She said yes & then said "He's a jerky bastard."  I had to laugh, because to a degree, she was right.  :)

My confused guy with pneumonia was pleasantly confused...at least that night he was.  He was really cute with the things he would say.  Luckily he wasn't making any attempts to get out of bed, although we had a posey vest on him just in case. 

The next night....6/6/06....was not a good night.  At least not for a couple of patients in ICU.  Two patients = 4 code blues in about a 2 hours time period.  And they both ended up dying.  :(  One of them had just been transferred up from med-surg & the nurse that had him on med-surg was a new nurse & this was her first code blue.  When I saw her, she was contacting the family regarding his status & she was crying on the phone.  I can't imagine what the family member was thinking as it was the middle of the night & getting a phone call from a crying nurse about your loved one.  I don't blame her at all for crying...it is stressful, but someone else should have made that phone call instead of her. 

I had all of my same patients back that night except for the one with the GI bleed & we even had a patient care tech for the entire shift...amazing!  My non-responsive Dilantin patient was starting to respond verbally.  Everything you'd ask him, he'd reply with "Yep."  He was cute.  My confused chest tube lady...same story, different day. Restraints applied, continued to be restless.  My confused pneumonia man...still confused, but staying put in bed...enough to the point that the dayshift nurse removed his posey.  I really think it should have stayed on, but those things are kind of difficult to put on when someone really doesn't want them on.  So I left it off & kept a close eye on him. 

Now for my excitement of the night...my new onset of A-fib patient.  He was no longer on the IV Amiodarone, it was switched to PO.  On top of that, when the cardiologist was in at 7 pm, the patient's heart rate was elevated in the 140's (with activity)...so the doctor ordered an extra dose of Digoxin IV as well as increased his Lopressor from 50 mg to 100 mg.  Everything was ok, until a few hours later when this patient went to sleep.  He began to have pauses with his heart.....his heart rate went from the 70's to 80's down to 26 to 35 & maintaining that low rate.  Uh ohhhhh!  Not good!  I woke him up in hopes that it would raise him up into at least the 50's....nope, didn't go up at all.  His blood pressure was at least stable, he was non-symptomatic with the low heart rate...but, I wasn't taking any chances.  Put out a stat call to the cardiologist who amazingly called back within 2 minutes (he usually takes forever to call back or doesn't call back at all).  He orders "ICU transfer & external pacemaker at the bedside."  Easy enough orders & luckily I already had this patient's paperwork all caught up.  So we transferred him to ICU & listened to their monitors beep all night because of his continued low heart rate.  Gina was teasing me that I overmedicated him.  Hey...I was following doctor's orders!  They were talking about putting in a pacemaker since his heart rate was all over the place...too high, too low.  It was a pretty smooth transfer to ICU...as usual...everyone helped.  That is the best thing about this hospital...the nursing staff is wonderful.

My fourth & final night.....it started out ok, but kept me busy at the end of it.  I only had 3 patients in the beginning:  non-responsive Dilantin guy...he was now verbally responsive & opening his eyes.  He was even saying complete sentences!  It was nice to see him doing better.  Confused chest tube woman...she was now diagnosed with having C-diff....yuck!!!!  It smells so awful as well as now having contact precautions.  And my confused pneumonia patient...who was now very confused.  When I was in to assess him...he was rambling on about how the govt is out to get him & that I had to sneak him out without the govt seeing.  He had no idea where he was or even what year it was.  I guess he was back in his military days.  I felt bad that he was so confused & it continued all throughout the night to the point that he was making a real effort to get out of bed.  Eventually I had to put wrist restraints on him as he would not stay in bed & there was no way I was getting a posey vest on him when he was agitated.  He started yelling at me "Stop fooling around!!!!!!"  Poor guy, he had been so sweet & now he was trying to kick me.  I didn't have time for that. I ended up getting Gina's patient as they were sending her to the north side because they were sending a nurse home.  He was pretty easy to care for.  Just had an elevated BP when I took vitals & had a blood sugar of 354 at 5 am. 

My time consuming patient this morning was the chest tube lady (don't you like my names for these people...lol).  She had rolled over onto her stomach to sleep & I was so worried she had pulled her chest tube out a little bit.  She was all groggy & lethargic...and soooooo sweaty.  I called in an ICU nurse to check out the chest tube status & she basically said "I don't know if there is anything wrong with it."  Hmmm...ok....next attempt...I had the respiratory therapist check her 02 sat level which was 93%...I also had her look at the chest tube.  Her reply "Oh, I'm not really familiar with those."  Huh?  That surprised me, I thought respiratory therapists knew about chest tubes.  So finally I get my clinical leader to look...she thinks it's fine...there's no drainage on the patient's gown or bed, she's breathing ok, 02 sat is decent, patient is saying she feels the same.  However, I know something is not right...the patient is neither restless nor anxious & as much as I was hoping she was simply tired & needed sleep...something did not seem right.  So my clinical leader & I are standing there staring at my lethargic patient trying to determine what could be wrong when my clinical leader says "Is she diabetic?"  Ummmm...yes.  Check her blood sugar.  Why didn't I think of that?  I'm able to think of this stuff when it isn't my patient...but suddenly I'm clueless when it is.  I asked "But she's on D5W...can you have low blood sugar when you have an IV of D5W running?"  Lab had just been in & I drew blood on her, but I couldn't wait for their results.  I got the accucheck machine & got a reading of 46.  Eeek...not good.  Then lab called...their reading was 39.  So yes, you can still have low blood sugar even with D5W running directly into your veins.  I gave her milk, apple juice & some graham crackers with peanut butter....she came back to life!  Rechecked the blood sugar about a 1/2 hr later & it was 86....much better.  By that time the breakfast trays would be served in about an hour...so I think she'd be fine. 

Now I had about 20 min to finish up all of my paperwork & I did get it all done & even had time to talk to the doctor of the patient with the high blood pressure & blood sugar.  He gets there early, so I updated him on the patient status...makes it easier for the day nurse to get the orders she needs if the doctor is aware of what's going on. 

Needless to say, I couldn't wait to get out of there.  I'm tired & hungry....and I still need to pack for my mini-vacation.  Hope y'all have a great weekend!

Wowwwwwww

I've got so much to write, but not enough time to do it (story of my life).  I'm working my 4th shift tonight, so hopefully I'll be able to catch up on here tomorrow.

First of all, the concert was GREATTTTTTTTTTTT!  Tell ya more about it later!

Now the WOW news....my nephew got drafted today by the Atlanta Braves!!!!!!!!!!  WOW!!!!!!!!!!!!!!!!! 

I've got to get to work...so more details later!

 

Not totally convinced

I only worked two days this week...I don't know why, I should have worked three...but I didn't, I only worked two.  They weren't even difficult shifts...we had a tech both nights, we didn't even get one single admission.  One night I only had 3 patients, the next night just 4.  It was an easy week...next time I will pick up an extra shift.

I think the main reason I didn't was because of what happened towards the end of my second shift.  I had a woman in her late 60's/early 70's that "had" a PICC line.  I say "had" because she partially pulled it out.  When I called the doctor to inform him (she had a dopamine drip running), he asked "Why would she do that?"  Hmmm...good question.  I wasn't convinced that this woman was as confused as she was portraying herself to be.  I had taken care of her both nights & had also taken care of her roommate last week...so I was somewhat familiar with her baseline status.  The first night I had her, her husband sat at bedside tending to her every need...totally doting on her, which is sweet to see that such men exist BUT not sweet when she was expecting me to turn into the doting person when her husband went home.  It's not that I don't like to dote, but there are limits.  I'm very giving to my patients...always asking if there is anything I can do for them, get for them, etc.  This one claimed to be nauseous after her husband left even though she was getting Reglan every 6 hours.  I asked her if she wanted some ginger ale, crackers, cool wash cloth...no, no, no.  Ok, what would you like me to do?  Her reply "I don't know, I'm not a nurse" in a real whiney voice.  Ok, well here's a wash basin, if you get sick...try to make it in there & not on the bed.  She never actually got sick, just kept spitting in it (ewwww).  She didn't sleep all that much, but was alert & oriented. 

The next night...the doting husband & the doting son are at bedside...just staring at her.  She is now laying there...barely moving, barely opening her eyes, barely speaking.  Hmmm, what's going on?  Is she deteriorating?  I know she was sick....she was supposed to be transferred to another hospital for a TIPS procedure...which is basically a shunt placed in her liver (at least that's what I was told).  The transfer was on hold because of the dopamine drip running in her PICC line.....a PICC line because she was an impossible stick.  Even the PICC line team couldn't insert the PICC line....we had to have the radiologists do it.  Eventually the husband & son go home...yet another reason I think we should have all private rooms.  9 times out of 10, it is better when a family member stays overnight with the patient...especially a patient that prefers to be doted on.  So they leave & all of a sudden...my nearly unconscious patient is now awake & attempting to get out of bed.  She went from barely moving to sitting up & getting her legs danging over the side of the bed.  Hmmm....burst of energy???  I tell her that she needs to stay in bed...that she's too weak to be getting up on her own & that it's nighttime....time to get some much needed rest.  She agrees with me...lays back down, waits until I leave the room & again tries to get out of bed.  I go back in, get her situated in bed, assess her to see if she is truly confused.  She knows who she is, where she is, what year it is, why she's in the hospital, etc.....yet will not follow safety commands to stay in bed.  Is that considered confusion?  Selective confusion???  The next time I find her sitting up, I think "hmmm, this is a good time to apply a posey vest."  Because I know if she were to truly get out of bed, she'd end up on the floor & I really did not want that to happen or go through the incident report online that takes forever to fill out.  I tell her the posey vest is for her safety, she agrees with me & lays back down.  Even though she can't get out of bed, it doesn't stop her from attempting to slide out with her legs.  I put the side rails up, she attempts to put her legs over them.  Ok, time to add in some ankle restraints.  That totally takes care of any escape out of bed attempts.  I thought for a minute or two about wrist restraints, but talk myself out of them because she hasn't made any attempts to pull at her foley cath or her PICC line.  In fact, she can barely move her right arm due to a fracture years ago & the PICC line is in her left AC.  I check on her practically every hour, she is still attempting to get out of bed, but is unsuccessful...she's not getting any sleep.  I would have thought she'd be exhausted, but nope.  I go in at 5 am to give her the next dose of Reglan & find her PICC line pulled out about 4 inches.  Ugh!  I turn off the Dopamine drip & consult with a couple of other nurses as far as what to do.  Does she need Regetine?  We don't know.  There are no signs of infiltration, but there is also no blood return.  I call the doctor, he doesn't know what to do either other than "Stop the dopamine."  Ok, obviously I already did that.  He tells me to follow whatever my supervisor wants to do in this situation.  Fine, probably can get more done with a nurse handling this than a doctor.  We decide to get a stat chest x-ray to find out where the tip of this PICC line is before making any other decisions. 

That's where my story ends...a cliffhanger...sorry...lol.  The radiologist wouldn't be in until 8 am to read the stat x-ray & since I didn't pick up another shift...I don't know what the conclusion was.  I will try to find out on Sunday when I return to work.  I have learned my lesson though...if they are behaving in a confused manner (even if you aren't totally convinced they are truly confused & simply want attention) to the point of putting on some restraints....then put them all on for safety....especially someone with a PICC line. 

I haven't heard another word about my calling in sick threat to be written up.  I spoke with a couple of other nurses that called in sick that day also & none of them got treated the way I did.  I think the person I spoke with was stressed out & took it out on me.  I hate when people do that.  It's just wrong.  It was a reminder though that I never want to work in administration...neverrrrrrrrrrrrr.

I'm just biding my time, gaining more experience & confidence before leaping off into the world of travel nursing.  There are places to go, people to see...but not until the time is right.

Now I will end this entry on an uplifting note....24 hours from now I will be sitting in an arena being entertained by Tim McGraw & Faith Hill!!!!!!!!!!!!!  That's right...the much anticipated & awaited concert is tomorrow night...woo hoo!!!  I cannot wait!!!!!!!!!!!!!!!!!!!!!