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!