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!!!

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