Friday, August 18, 2006

You know you've been working too much when...

You know you've been working too much start dreaming of work-related things.

This past week, I'd say 3 days out of 5...I've been dreaming about work stuff. Even today - I kept dreaming about getting doctor's orders over the phone. I woke up thinking "Did I get the order right??" Another night I dreamed that our hospital made a particular floor for only patients admitted with altered mental status & I was getting 5 admits. It's hard enough dealing with one or two confused patients...but five? Frightening!

I put in 4 days after being sent home on Sunday. It's been a strange week - just very strange patients. Usually when I get new patients, it doesn't take long to develop a decent rapport with them. Even with new admits, usually you can make them comfortable & they are easy to get along with. This week they've all been impossible to please, unable to develop a good rapport no matter what I did & complaining non-stop. It's like why even bother because nothing will please them.

People are starting to expect their hospital stay to be equal to a vacation at the Hilton or Marriott. One of my pet peeves is the changing of the sheets. It's very appropriate when someone is incontinent or blood or some other substance gets on the sheets...but if it's a totally alert & oriented person that is getting out of bed to use the bathroom & the bed remains spotless - what's the point of changing the sheets daily? I had one insisting that she was sleeping in filth. I looked at her like she was insane. You want to say "Do you change your sheets at home every single day?" You know they don't. I've had a patient in the past that wanted his sheets changed every evening at 5 pm. Do you do this at home???? No. Then why are you flipping out that it's not done like that at the hospital? I think they just want to get their money's worth or something. That same person that earlier said they were sleeping in filth - I'm surprised she didn't take the sheets home with her when she left. She took every cup, every alcohol pad,every thing in the room possible to take & then asked for ice water to she's at a restaurant or something. On top of that - she was asking if she could have the supplies that I had in my pocket (tape, pens, etc). Ummm....NOOOOOOO. Strange I tell you...STRANGE!

It was also the week of drug addiction. On Tuesday night I got 2 new admits - relatively young (late 40's/mid-50's) diagnosed with chest pain. Those are "usually" my favorite type of patients because the orders are easy to follow, they are 95% of the time stable & pretty good to take care of. Not these two. These two were experts at knowing how to get seen quickly in the ER & how to get the pain medication they wanted = Dilaudid. I took care of these patients for 3 days - not once did they ever complain of chest pain. One had foot/leg pain and the other had neck pain. I think they learned if they admit that in the ER, they'd be sitting in the waiting room much longer than someone claiming to have chest pain. Drug seekers are pretty easy to spot - they are the most dramatic of them all - "usually." Gina had a patient that could prove that theory wrong, but I'll talk about that later. My drug seekers would cry, shake, act like they were about to die at any moment - until they got their pain meds. Then they were quiet, calm, serene. Don't get me wrong, I find it very sad that they have become addicted to pain medications, but I think it's even more sad that they remain in denial rather than dealing with the real issues head on. The one that was crying - she'd stop crying when she learned she could only have the pain meds every 4 hours. So how real could the pain be if you can instantly stop crying? And the other one - he began referring to Dilaudid as "happy juice." Ugh. I almost got to the point where you just want to kick them out of the hospital to make room for people that really are dealing with a sickness that requires hospital care.

I spoke with the doctor of the one referring to Dilaudid as "happy juice" & come to find out this gentleman's wife went out of town & he didn't want to be home alone - that's why he ultimately came to the hospital. WTF?? That definitely sounds like some kind of psych disorder to me. Out of all the places to go when your significant other goes out of town - the hospital wouldn't even be on my top 100 list.

We had a patient pass away last night. She was a DNR (Do Not Resuscitate) - it's the first time I've seen someone pass away without anyone calling a code. It was pretty quick, she looked so peaceful. The family was called & came in to say good-bye. What I don't understand though - she has had cancer for awhile, the doctor talked to the family earlier in the day about her condition to the point that they agreed to a DNR order, had a hospice consult & she was to be transferred into their care...yet the family was shocked she passed away. So shocked that they want an autopsy. I don't know, I don't get's one thing if you have someone that is awake & talking & hasn't been diagnosed with something terminal to suddenly pass - but she's been non-responsive for quite awhile.......and they knew all of her terminal condition...yet they are shocked. Hadn't even thought of funeral arrangements. Is it denial? Do they think that if they start planning for what happens afterwards, that they somehow will cause it to happen sooner? I think they need to reflect on the fact that she lived a good life & has now moved on. I understand being sad, I would be sad too...but don't hang on to the belief that there's a mystery as to why she died. She had cancer, her body shut down - it's time to let go & grieve.

I helped the nurse with post-mortem care & I have only done that twice since I got into nursing. One time in nursing school & one time when my patient coded & died. It doesn't phase me though - like it doesn't creep me out that I am touching someone that is no longer alive. I don't know why it doesn't...I think it should. It's not like it's happened so often that I've become immune to it. I was talking to a doctor last night & he said he used to work at a hospital that had something like 750 beds & that all he did was work code blues...that was his job. Inbetween he'd eat dinner & people would be like "How can you eat after watching someone die?" It just becomes part of the job he says.

Which leads me to in the world did I end up in healthcare??? Just goes to show that you never know which direction your life will travel in or where you'll end up.

I got another new admit last night...mid-50's with chest pain. As much as I like that our hospital has finally come up with protocols - I am saddened that our ER doctor has no common sense. Part of the chest pain protocol is to administer Lopressor...either 50 mg by mouth or 5 mg via IV. This is all well & dandy when the patient has an increased blood pressure or heart will definitely allow the heart to relax because it slows down the heart rate & usually lowers the blood pressure along with it. However, this patient of mine prior to getting the Lopressor had a heart rate of 66 and a blood pressure of 96/48. Why in the world would anyone...much less a doctor say it's ok to give 50 mg of Lopressor? He didn't need it. By the time he got to my floor...his heart rate was in the mid-30's to 42. Ridiculous that it was ever given in the first place. Luckily his blood pressure was ok & that he was non-symptomatic with such a low heart rate. He was another strange one though - during the admission questionaire, he asks me "Can you tell me if I have cancer?" Excuse me? How would "I" know if you have cancer? He has a feeling he does & would like "me" to find out. Lol...what??? If he said it once, he said it 20 times..."can you please find out if I have cancer?" I told him he would have to express his concerns to the doctor as the doctor is the one that will order the appropriate tests. I also asked him why he didn't seek medical care sooner if he believes he has cancer. He had no answer. Just kept asking for me to find out if he does or not. As if we have the answer hidden somewhere in our chart.

Now to Gina's dramatic patient. This one wasn't a drug seeker, just a patient that loved to scream & cry. She would cry even if you touched her! Flipped out when they put a tourniquet on her to draw blood. Gina asked me to help her put a foley catheter in this patient. Little did I know how dramatic this woman could be. I focused on talking to her calmly, trying to distract her from what was going on, gave her my hand to squeeze, reminded her to breathe....all that went right out the window when Gina tried to insert the catheter. She started screaming hysterically "Stopppppppppp, you're killing me, I've never had so much pain ever in my life." This from a woman that's been through child birth a few times! She continued to scream as Gina & I stood there & watched her. Gina wasn't even touching her & this patient would not stop screaming & crying. She didn't even have her eyes open & continued to carry on as though we were torturing her non-stop. Gina & I looked at each other like what the heck??? It was a bizarre week I tell you!!!!!

I start computer training on Monday night. We are finallyyyyyyyyyyyy switching over to computer charting. The transition day is set for October 22nd - remind me not to work that night as I'm sure it will be a mess. I will be glad to put down my pen though - I am so tired of handwritten charting not to mention the calluses on one of my fingers. It's starting to look deformed. :)

Have a good weekend y'all!!!!


tendernoggle said...

You have a good week too, sounds like you need one! lol   I hthink the moon has soemthing to do with the wack jobs! lol

lacaza3 said...

I agree some patient are asses and think they are in the hilton...They are probably the ones who don't pay there bills...or tip etc.. LOL
I worked in plastic surgery and those patient could really  be wakko....
donna In TEXAS

cah601 said...

Definitely sounds like a full moon to me Jen.  With respect to the dying pt when Hospice was called in.......since working in Hospice for the past couple of years, I do see a lot of DENIAL with some of the families, especially if they don't sign on to Hospice earlier in the disease process.  You're doing a great job, and your feelings about WHY THE HECK AM I IN NURSING, are very normal.

am4039 said...

wow what a bunch of weird patients for sure. Like the hospital is the last place I would go if my spouse wasn't home. Hopefully next week you won't have such strange patients. Good luck.

kdrnhugs7 said...

I too am an RN and understand exactly what you're talking about! It's totally wild some days and you just want to scream for Calgon to take you away...quickly! I loved your blog and hope to read more of them since I've finally found someone who's on my same wave-link. Thanks for the laughs. (Kara)