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!