Saturday, December 23, 2006

Sonic Boom

Yesterday as I was getting ready for work - I heard the space shuttle's "sonic boom" as it was reentering the earth's atmosphere.  Living here in central Fl, we used to hear that noise quite often.  I hadn't heard it in a long time though - it is an amazing sound.  I'm glad the astronauts made it home safely & that the shuttle is still in one piece. 

Work has been going well.  I put in 4 days this week.  It's been an interesting week to say the least.  It's funny what patients will try to get away with.  I had one gentleman that when I first introduced myself, he began apologizing & telling me all the help he would need for me through the night.  Mostly helping him in the bathroom & wiping his butt & putting cream on him down there cause he was sore.  It was a bit too much from someone that was capable of walking to the bathroom on his own.  So I reassured him, told him we'd be working as a team tonight & whatever he needed, "we" would be there.  We being myself & the male tech that was working.  Well, no sooner did the male tech introduce himself did the patient suddenly become self-sufficient.  It was a miracle!  He was able to take care of himself in the bathroom.  Imagine that.  The next night I had him as a patient again & we had another male tech...sure enough, this patient was able to do for himself again.  It's not that I mind helping out, but when people that are self-sufficient take advantage of the situation - it can be irritating.  Needless to say, he was discharged home within a few days & is totally

It was a week in which I began to question my role in nursing.  Are we truly there to help heal?  Is what we're doing making these patients better?  I don't know.  I mean I see them feeling better & getting discharged - but is it because of anything I've done?  Am I simply going through the motions?  I don't really have the answers.  I had a couple of patients in which it made me thankful that my health is pretty good compared to what they are going through.  It makes me sad to see so many suffering, but on the other hand - some of the suffering comes from what they do to themselves & others are simply born with it.  I'm rambling here & probably not making much sense. 

I had a patient last night who had Coumadin (blood thinner) ordered.  No PT/INR had been done that day & I saw that when she came in 2 days ago...her INR was 2.9.  Normal range is 2.0 to 3.0, so she was at the top end of normal.  I decided to have it rechecked before giving her the dose.  Good thing I did as it came back 4.2 so the medication was held.  It was a reminder to always follow your gut instinct & make sure you know the lab values on stuff that is important.  The doctor for some reason the night before insisted the patient receive like 4 times her usual dose of Coumadin & the nurse gave it without having the INR checked.  It's a reminder that you have to cover your own butt in certain situations - don't take the doctor's order as a "must do."  Sometimes they do make mistakes or they order things that aren't necessarily good for the patient.  So you have to be on guard - otherwise you could not just lose your license, you could be sued...and could cause harm to another person.  There are so many flaws in healthcare that you really do have to be your own advocate.  I see & hear so many stories of things gone wrong and that could have been prevented.  It's scary. 

Ok, time to change the subject - it's getting way too serious & depressing for the holidays with that stuff that I wrote above.  I am off now until January 7th...well, that's my next scheduled day, but I'll be picking up shifts here & there.  My goal in 2007 is to pay off my car.  I have 2 years of payments left....something like $15,000 or so...but I am determined to pay it off....hopefully by June.  I don't usually set goals, so I'm trying something new  The hospital is short-handed as usual, so there will be plenty of opportunity to make some money to achieve this goal. 

I hope everyone has a safe & happy holiday season! 

Monday, December 11, 2006

9 shifts in a row

Ok, the new record is 9 shifts/nights straight. I had thought about going back tonight, but 2 things stopped me. Mostly my niece wanted to spend some time together & also because the hospital was very shortstaffed tonight & I have a feeling it would probably end up with 5 patients & no tech. I'm too exhausted for that....need to re-energize. Not to mention there is no incentive to volunteer to work. I wish they'd rethink that.

Last night was my toughest of them all...not that it was that tough. I actually had it very easy with my patients over the last 9 nights...they had very few medications & slept during the night rather than being on the call bell every 10 minutes. Last night I had 5 patients...I was familiar with 3 of them from the night before. Those 3 were stable...a gentleman recovering from respiratory failure - he was downgraded from ICU, another gentleman with a pacemaker malfunction - his battery was dying, but he had it repaired that day by the cardiologist & my third patient was that woman I wrote about in my last entry regarding her amylase & lipase...she's still waiting for it to get within normal limits so she can have her gallbladder removed.

My new patients were 2 more males. One with sick sinus syndrome & syncope. His heart rate would average in the 50's, but drop to the 30's & jump up to the 120's instantly. More than likely, he was going to end up with a pacemaker. His heart rate/rhythm was causing him to feel dizzy &/or faint. Luckily he came to the hospital & he'll have it taken care of.

My last patient was a very sick older man. He had been admitted with a pleural effusion & he had a history of esophageal cancer. It has metastasized to his brain & they were running tests to see where else it is. He's been in the hospital for about 3 weeks now, but this was my first night with him. I had been told that 3 doctors had discussed with the family DNR status & hospice. The family was not about to give up hope...they wanted every test run first. I met with them last night & it's sad seeing them hurting - I know it's a heavy decision to make. They said good night to me & I went in to assess this gentleman. He was not looking good at all. I didn't even need my stethescope to hear how junky his lungs sounded. I gave his prescribed dose of Lasix & got him a breathing treatment. His eyes were open, but no real response from him. He looked tired....very, very tired. He had a peg tube, so I gave the rest of his medications & hooked him back up to his enteral feedings. I checked his 02 sat which was amazingly 94% considering he sounded so very congested. I tried talking to him, but it didn't do any good. I got no response, so I left him to rest for awhile. About a 1/2 hr later, the respiratory therapist and the PCT came to me & said he's non-responsive. At this point, he was still a full code...but I so did not want to see him go through the trauma of a code. I went in to assess & he looked the same to me as he did earlier. The resp. therapist was attempting to suction him & he wasn't responding to her efforts. Earlier he had been making noises & trying to fight against the, nothing. I had brought my clinical leader in earlier to let her get a baseline assessment also....because we had a standing order to send him to ICU if necessary. I called her & she came in & agreed that he was very sick & needed to be in ICU. She told me to hurry, because the respiratory therapist was predicting he will probably code sometime during the the sooner we got him to ICU, the better. His 02 sat had dropped to 91%. I called the inform him of the change in status. He was ok with the transfer to ICU, told me to contact the pulmonologist for further orders. Inbetween that, I called report to the ICU nurse who was veryyyyy unhappy about receiving this patient. I didn't understand why she was giving me an attitude. After giving her report, she told me to call the pulmonologist before bringing the patient to her. So I called him & I got a lecture about how sick this patient was & how I need to convince the family of making a decision to make him clarify what measures they want taken & to explain to them that if it goes as far as putting him on a ventilator, he probably won't come off of it. I told him ok, I would do that. Luckily my clinical leader took that upon herself to do so I could work on getting the patient to ICU. So she's talking to the family on the phone, I'm calling the ICU nurse to give her the update. Now she's insisting I keep the patient until the ABG results come back since the doctor ordered an ABG. I told her no, the doctors want him transferred regardless. Grrrr...I did not understand her attitude reagarding this patient. I get off the phone with her & I'm listening to my clinical leader talk to the family & try to gently explain about the ventilator. The family wants all measures taken - they are not ready to give up yet. My clinical leader had tears in her eyes & she's a very experienced ICU nurse who I'm sure deals with this all the time. She said the wife sounded so upset. It's hard to make these decisions, I know. So we transferred him & he was stable over there...not that he improved at all, but at least he was able to be observed more his condition should be closely observed.

I stayed at 4 patients the rest of the night. I had no midnight or 6 am meds to give. My patients did not press the call light at all. They're so good to I'm heading to bed now...I have lots of Christmas shopping to do tomorrow...I want to get it all done...hopefully...or at least most of it.

Happy Monday!!!

Friday, December 8, 2006

Setting a record

Yawn!!!!!!  I'm sleepy.  I've worked the last 7 nights straight & am scheduled for tonight & tomorrow night also.  It's a new personal record for me for the amount of nights worked in a row.  I'll probably continue to work through next week...makes me feel less guilty about taking 2 weeks off at Christmas...not to mention the money.

Luckily my patients have been very stable for the most part & I've had it easy.  I only had one critical incident in which the morning labs revealed a 6.9 potassium level.  Normal is 3.5 to 5.  Anything above 5 is definitely not good.  6.9 is very, very bad.  The doctor prescribed an amp of calcium gluconate, an amp of D5,10 units of regular insulin IV as well as a nebulizer treatment.  I had never heard of that "cocktail" before, but works quick.  I pushed the meds at 6:45 am & they rechecked the blood at 7:05 am & her potassium had gone from 6.9 to 5.3.  So I learned something new about how to get the potassium out of the bloodstream & back into the cells very quickly.  I'm hoping this patient goes home today.  She is a drug seeker & the doctor wrote no narcotics allowed for this patient.  Then he also wrote for a strict diet since her potassium had been so high.  Needless to say, she was not a happy camper. 

The rest of my patients have been wonderful to care for.  I've had one for the last 7 nights.  Poor lady...she has pancreatitis as a result of her gallbladder not working properly.  The gallbladder needs to come out, but they can't do that until her amylase & lipase (pancreatic enzymes) return to normal....only they aren't returning to normal.  They started to come down, but all of a sudden they are going back up.  She went 7 days/nights without eating (doctor's orders).  They finally started her on PPN.  She just wants to go home...she's young, in her early 40's.  She has a good attitude about it though.  I'm kinda getting attached to the sense that I want to see her get back on the road to recovery & be at home with her family.  Maybe there will be some good news when I get back to work tonight.

I also had one of the sweetest patients ever & he wasn't even trying to be sweet....I think that's why I think he's so sweet.  He's 90 yrs old, totally self-sufficient!!!  He said to me the first night I admitted him with chest pain..."I hope I don't bother you too much."  Gotta love a patient that doesn't think you are their personal slave.  He'll probably go home today I'll most likely have a whole new group of patients.  Hopefully my nights will continue to go well. 

Ok, I'm off to get some sleep.  Hope everyone is doing great!