Mixed up schedule

I've mixed up my schedule this month from my usual Sun, Mon, Tues nights. This week I worked Sun & Mon and this weekend I'll work Sat, Sun, Mon night. It's nice to have a little variety and the patient acuity level has been high - so anything more than a couple of days can be really tiresome.

Both Sunday and Monday nights were very busy. Our hospital is completely full to the point that they are holding patients in the ER because there are no beds available. And as usual, at my friend's hospital - they are empty and calling nurses off. It seems seasonal like that - when my hospital is busy, hers is a ghosttown and vice versa. Just weird!

I started off with 3 patients Sunday night. One was very stable - she had come in with chest pain and congestive heart failure. She had a heart attack while in ICU and was recovering. There wasn't much to do for her besides assessment, medications and make sure her needs were met.

My second patient was an older man admitted with pneumonia. He had a history of dementia and alzheimer's. Patients with that history tend to confuse day with night and sleep all day while up all night. He was no different except that he would continuously yell for things - like his wife. It didn't matter how many times I went in and reoriented him to place and time, five minutes later he was yelling for his wife. Nothing can be done for that and unfortunately he kept most of the patients up all night with his continuous yelling. Finally around 4 am he decided it was his bedtime and he layed down and went to sleep. I was told that was his routine.

My third patient was very sick, but I'm not even sure she realized how sick she was. She had a tumor in her stomach removed and was on post-op day 5. The surgeon had written orders for her to walk four times a day - no exceptions, but of course the nurse before me put her off claiming she was "too busy" to walk with her. We're always too busy - when isn't a nurse busy? She asked me to walk with her at 8 pm and even though it wasn't an ideal time for me, I made sure she knew I was committed to helping her get better. She had an NG tube and a couple of IV medications running. She was weak on her feet - which is to be expected after surgery. She did well ambulating and I could tell just by not giving her an excuse or putting her off to walk later - that she was beginning to trust me.

The reason she was on our floor as opposed to the med-surg floor is because that day she had spiked a temp over 102 and they were worried she was getting septic. A few hours later she asked me if the nurse tomorrow would be as willing to walk with her as I was. I told her I would definitely make it a point with whatever nurse was coming on - that it was important to make sure she ambulates. I then asked her if she wanted to walk again and there we were at midnight walking the halls. Getting up and walking after surgery is one of the best things you can do for your body. It may hurt like hell - but the benefits outweigh the cons. Too much bedrest can do more harm than good.

I got a fourth patient right before midnight. I was a little worried as he was admitted with nausea/vomiting/diarrhea and altered mental status. I was picturing a confused person that was throwing up & going to the bathroom at the same time. He was nothing like that. He was totally alert and oriented - never had any nausea or vomiting and had one episode of diarrhea while in the ER. After the initial assessment & 3920348023 questions we ask on admission, he was content with getting some sleep for the night.

So two easy patients and two a little more intense. Not a bad combination, but it was time consuming which made the night go by quickly. I contemplated whether to refuse to take the dementia patient back again on Monday night. Mostly because it affects me when I can't make someone feel better. I decided to leave my name up by his on the board & just deal with it when I came back that night.

I went home - slept the entire day & went back. Turns out the elderly yelling man had been discharged. Yay! I still had the other three patients plus one that was admitted with a possible stroke. This poor lady - what a rough night she had. It started out when they drew blood for a D-dimer test....it's a test that checks to see if someone has a pulmonary embolism. The test isn't 100% accurate meaning just because you test positive with a D-dimer, it doesn't mean you definitely have a PE. It means that the next step is to do a CT of the chest to rule out PE. I sent her down around 10 pm for the CT only to get a phone call that when they went to inject the contrast - they blew the IV and now her arm was swollen and they were unable to do the test so they were bringing her back. Her arm was sooo swollen. I call the doctor and inform him of what happened. He orders for a Lovenox injection (blood thinner) and a VQ scan - which is another test to check for a pulmonary embolism. It's not quite as accurate as a CT, but it's doable. So I have to call nuclear medicine in because they aren't there 24 hrs a day. They come in - not happy at all with me - as if any of this is my fault. It takes them about an hour to do the test. I finally get my patient back around 2 am. The test results still couldn't tell me if she had a PE or not. It said "intermediate probability." I spoke to the doctor & he ordered antibiotics - I guess he thought it was more of a chance of pneumonia than a PE.

I got a fifth patient in the middle of all this - a woman with a GI bleed. She had been admitted during the day in the ER and while they were holding her there - she luckily had a good nurse that made sure she got 2 units of packed red blood cells. Usually the ER will get the order at say 2 pm and we'll get the patient around midnight without any of the blood transfused. I was impressed that she had gotten both units. After the initial assessment, she went to bed for the night.

It was an easier night, but still busy. My surgical patient had to have 2 units of blood transfused. She had spiked a 101.8 temp for me, but luckily the Tylenol brought it back down rather quickly. I hope she's ok. I don't like to see surgicalpatients with abnormal temps.

So I've been off since Tuesday - time flies by. I'm doing my Christmas shopping in the morning & planning to get it all done tomorrow - from start to finish. Christmas for me is about the little ones - my younger niece & nephew and they are pretty easy to buy for. I'll meet up with them tomorrow afternoon after they get out of school and I think I'm going to take them to the Scholastic Books Warehouse sale. Everything is 50% or more on sale and it's a huge warehouse. They've never been there and lately they have really been into reading - so I may as well take them so they can pick out exactly what they like.

I went out Tuesday night to this Italian restaurant and wouldn't you know it - a lady two tables down starts choking. It was impressive to see the waiter jump right in with the adbominal thrust (aka Heimlich manuever) and save her. I also saw the movie "Awake" after dinner. It was ok, but really far-fetched. Anyone in the medical field & even those not in the medical field could see how inaccurate it was...but that's the movies for you.

Hope everyone has a great weekend! Stay warm up north! Stay cool down south - I love the 80 degree temps, but I would like to see some cold weather since it is the middle of December! Careful what I wish for - I know!!! :)

Morning Prayer

Wow, I didn't realize it had been awhile since I last posted. Where did November go???

I had a wonderful Thanksgiving with family and friends over at my parents house. I guess there was about 30 to 35 people. It was the first Thanksgiving in quite a few years that I didn't have to work - so I enjoyed that.

I've been at work since Saturday night. Amazingly we have been staffed pretty good - especially since the hospital is pretty much completely full. When I left this morning, they had 3 or 4 people admitted that had to be kept in the ER because there are no beds available. This usually doesn't happen until January. Tonight is my last scheduled night for this week, but I think I'm going to pick up a few more shifts for the overtime money.

My patients have all been alert & oriented this week. It's nice to be able to have conversations with them - especially since I've been working so many nights in a row. I think they feel better having a familiar face rather than a different nurse every day & night.

I think the highlight of my mornings are when our chaplain shows up in each unit and says a prayer. I don't realize how special that is until he's away for whatever reason and the morning is quiet. It's nice to take time out to say a prayer together. It also reminds me that my shift is almost over & I can go home!

I'm definitely going to try to work more this week. I have Christmas shopping to do next week & I want to pay cash all the way.

I plan to take more vacations. That's what life is about - taking the time to enjoy it. I'll never be a work-a-holic!

Ok, time to get some rest....so I can get back to work tonight. Have a good week everyone! Stay warm up there in the north!

One of those Weeks

It was one of those weeks where the last place I wanted to be was at work. We all feel that way about work sometimes, don't we? Thursday night was the toughest - I found myself thinking negatively and not really treating my patients the very best that I could. It's not to say I mistreated them or ignored them or anything like that - I just didn't make that extra effort that I often do. The night was going by so slowly. Too slowly.

My first patient had been given discharge orders as soon as I got there. So I had to arrange transportation and verify the medication reconciliation form with the doctor and work with the social worker - discharges can be time consuming! This patient had come in with chest pain - she lives in a nursing home. I was starting to get the impression that she did not want to be at the nursing home...but really...who really wants to be at one?

My second patient was in her 90's - in with congestive heart failure. She was able to get up on her own - which still amazes me when someone is in their 90's.

My third patient - she had a blood clot in her leg and for some reason, they decided to remove the vein the clot was in. I didn't get to read much of a history to find out why they went that route, but when they took the tape off of the dressing covering her staples - her skin came off too. That was worse than the actual incision. It was frustrating to see that she was taking the attitude of not wanting to do anything for herself. She didn't want to cooperate with physical therapy so that she could start walking again, she didn't even want to use a bedpan - she'd rather just go in bed & have us clean her up rather than use a bedpan. She had a foley catheter so luckily that part was taken care of - but who willingly would rather lay in their own stool as opposed to asking for a bedpan? It's not that she wasn't capable - she was more than capable - I just don't get it. The next night she was getting where she didn't even wantto make any effort with her medications. She would have preferred I put the pills in her mouth than for her to do it herself. I wasn't having that. I have no problem assisting someone who needs help, but laziness or lack of desire isn't a good enough reason. Needless to say - she remained this way all three nights I had her. No desire to get out of bed, no desire to start doing things for herself.....BUT she was able to put on her own makeup and this bright shade of lipstick. I don't get it (shaking my head)!!!

My fourth patient - this poor man - this man had gotten a colostomy back in May because he had an intestinal blockage. Now he came back in September to have it reversed - he no longer needed the colostomy. So it was an elective procedure & our top surgeon was performing it. What could go wrong? Ummmm....everything!!! This patient has been in our hospital since the beginning of September. Through the last 2 1/2 months he has knocked at death's door a number of times - but luckily he has survived. It's scary thinking of these elective surgeries & how they could easily take your life.

This patient still has a colostomy and he has a drain because he developed some kind of abdominal abscess and he has a huge incision on his abdomen that is also giving him problems. He has had renal failure, respiratory failure...even sepsis & I admire him - because even with all that going on - he wants to get better & go home. He is getting up & out of bed, he is taking walks unlike my third patient. He was also on a ventilator while in ICU & as a result, his throat muscles are very weak so he can't swallow productively. He also has a hard time coughing - so the phlegm and saliva get built up & he starts to gag. That is not my strong point. I don't like respiratory issues, I can't stand the sound of gagging or spitting. I hooked him up so he could suction himself to help get that stuff out. With all he's been thru, I did what I could to make things better for him.

I was finally able to discharge my first patient around 10:30 and I got another one around midnight. A frequent flyer in with chest pain. The patient himself told me he's been there 50 times for the exact same thing. He was complaining of chest pain as soon as he got to the floor & what do you know - he's allergic to morphine - the pain med usually given for chest pain. On top of that - I had no order for any nitro or any pain medication. The ER nurse was agency & had no idea about pathways or what to even ask the doctors when getting admission orders. So I called the doctor around 1 am to get some medication & luckily the doctor was familiar with this patient and didn't seem too worried about the chest pain. I think he needed something for anxiety more than pain - but I gave him what I could.

I only got 4 hours of sleep on Friday, but my attitude was a little better. I was actually thankful that I am healthy, that I am able to get out of bed with no problem, that things are good. My patients were fine - no real emergencies. I did hear some sad news - a patient that was at our hospital quite often had passed away. She was only 40 yrs old, but had a lot of respiratory issues and needed a lung transplant. Even with all of her breathing issues, she continued to smoke - so although I feel sad she passed away, I have to wonder how much of an effort did she make to improve her life? I don't want to judge - perhaps she had the mindset that her days are numbered & turned to smoking for one last pleasure in life. I don't know. She was found dead at home, but for some reason they called 911 and brought her to the hospital where they ran a code and then pronounced her. I think she had just been discharged from our hospital like 5 days earlier. Sad.

My niece & nephew have been over since Saturday. I knew their mother wouldn't last taking care of them on a daily basis. They are here until Wednesday beause it's her year to have them for Thanksgiving. They'll probably be back here on Friday. It's nice having them around again. Expensive! But nice. :)

Have a wonderful Thanksgiving everyone!!!

Ahhh I don't wanna

I have been off of work since last Wednesday & I don't wanna go back. I work Thurs, Fri & Sat night this week. It's been a nice break - I finally got to spend some quality time with my niece & nephew. Guess the ex-sis-in-law was told she could go to jail for breaking a court order. I'm not sure if that is true or not - but it seems to have worked. I spent way too much money in the last few days on them, but I'm trying not to think about it too much. Just need to get back to work & find some time to work overtime.

I can't believe Thanksgiving is practically a week away. Time is just flying - seems like I say that all the time, but it's true - where does the time go? I don't feel like I'm having fun, but time is still flying by. Oh well - guess that's what happens as I get older.

My brother is doing better with his spider bite or whatever it was. Shay is getting bigger - not too much, but still growing. She got plenty of time at the dog park over the weekend. It's interesting to watch dogs - they just walk in, sniff each other & start playing. Too bad adults couldn't make friends that quickly, huh?

That's about all that's going on over here. Hope everyone is doing well!!

Should have known better

I got a call from one of my brothers on Tuesday. He said he thought he had been bit by a spider. I went to his house & checked it out - there had been some type of bite & for some reason - he squeezed it. After he did that, a lot of pain started. So when I saw it - I could see the redness. It was on his thigh about mid-way between the hip and knee. His big toe was also in a lot of pain, but that ended up to be him stubbing it & as a result had an ingrown toenail that was infected.

So I look up spider bite treatment online & it says to put cold compresses on it and for some reason - take Tylenol but not Advil or aspirin. So I run to the store & get him Tylenol as well as Benadryl, Lanacaine & Neosporin. I went to work Tuesday night & called him to see how he was doing. He said it still hurt and that he was sweating. I wasn't sure what to think, but I gave him my number at work and told him if it got worse, call me. I never heard from him so I called in around 7 am when I was getting off of work. He sounded awful and was still sweating and in pain. So I told him I'd take him to the emergency room.

The big decision was - do I take him to my hospital or to another one nearby. I wasn't crazy about my hospital because I don't think it's the best one around when it comes to ER treatment and I don't like to bring family into where I work. However, they do have this new thing where they promise you will see the ER doctor within an hour of arriving to the hospital. I was kinda curious to see if that would actually happen. Plus I checked the computer to see if there were a lot of people in the ER when I left and it was pretty much empty. So I picked up my brother & told him what all good nurses say - - "Don't tell them I'm a nurse & definitely don't tell them I work there!!!" I work nights so I knew the day staff wouldn't know me and I was just curious to observe the ER from a family member perspective rather than as a nurse. He agrees to comply with my demands. :)

We got there around 8 am & surprisingly enough, I think we were in to see the doctor at about 8:25. Not bad. Luckily we got the better of the two doctors on that day. I had recognized his name, but never met him before. The other ER doctor I recognized because I hear negative things about him from patients as well as other staff. The doctor takes a quick look at my brother's leg and toe and says "We have to open that up & drain it." Eeekk! I didn't think it was that bad, although it was looking more swollen than red at this point. I see the color drain from my brother's face as the doctor talks about numbing up the areas by sticking a needle into the areas that are tender & infected. He then proceeds to tell us how he's going to cut open my brother's thigh and attempt to wash out the infection. I'm thinking COOL!!! I don't think my brother was quite as enthused as I was. He promises he'll medicate my brother before this happens.

In walks the nurse with two Percocet pills. I think "That's it?" Pills? That should take about 30 to 60 minutes to kick in - just how long are we going to be here? About 15 min later the doctor comes back & starts the numbing procedure. My poor brother - he was in a lot of pain & I can't say I blame him. He did well though. I'm sure I wasn't much help as I kept telling him to breathe as he'd clench his jaw in pain.

The doctor waited about another 15 minutes for the medicine to take effect - only it wasn't enough medicine. He had to numb it up some more & that caused my brother some more pain. After that was done, the doctor got out the scapel to cut open his thigh. At this point, I ask "You don't mind if I watch, do you?" I don't think he expected that, but I stood up & moved closer to watch this mini-surgery. Blood gushed out - so cool - lol. The doctor was expecting pus to drain out, but there really wasn't much. He pointed out these little chunks in the blood & said that was part of the infection that was taking place in his thigh. Interesting! He continued to flush it out and then put some packing strips into the incision. He said they would pull that out in two days. Next he went to workon my brother's toe. There wasn't much to that...just cutting part of the nail out. Big deal!

I was expecting my brother to pass out at any moment, but he did well. The nurse came in to cover the wounds and went over the discharge orders. She recognized me - so my cover was blown. She talked about coming back in 2 days to remove the packing strip. I said "Can't I pull it out at home?" She said they would prefer to have him come in so they can be sure the infection is getting better.

My brother had asked the doctor what would have happened if he put off coming in. I was surprised by the answer. He said that it was obvious it was infected and the fact that my brother was shivering and sweating tells him that the infection was starting to spread systemically and that if left untreated would lead to sepsis & possible death. Dang - I should have known better. I thought it was just a minor reaction to a bug bite. Kind of like when you are stung by a bee - it gets red, swollen and tender - but after 24-48 hrs, it's better. Live & learn!

I only worked Mon & Tues night this week. It's hard to get back into being at work when I was off for 5 days. I'm officially off until next Thursday night, but I may pick up some shifts before then - I'll see how I feel later in the week.

I feel a little guilty this week - when I came in Monday night, I recognized a name on our patient board. I cringed when I saw it. I had just had her as a patient like 10 days ago. She's very demanding and needy as well as very critical about everything. The type that constantly puts you down no matter how much you try to help. For some reason she wasn't like that with me, but I have seen her in the past be very nasty to other nurses. I like to think I have some type of calmness that is contagious, but I think with her - she was simply exhausted that night. Anyways - I saw her name & said a silent thank you to God for not seeing my name assigned to her.

I talked to the nurse that did have her & she told me the patient had a stroke and was bleeding in the brain. They couldn't stop it and gave her 30 days to live. I felt sad - partly because of the negative thoughts I had just a few minutes earlier when I saw her name and partly because of her husband. Their kids no longer speak to either of them - I imagine it was because of how critical she can be. Even with her practically on her deathbed, the kids wanted nothing to do with either of them. I felt sad that this man would be all alone having to deal with the fact that he is losing his wife and for him having to see her the way she is right now. It breaks my heart.

I went out with my best friend tonight. We saw the movie "Things we lost in the Fire." It was ok. What was fun about it is that we were the only 2 in the theater - so we could talk out loud thru the movie. It was amusing. I love hanging out with Maria. We've known each other since we were about 13 yrs old & have always been there for one another. Thanks Maria!

Quick Update on Power of Addiction

Just a quick update on the patient I described in the earlier post.  Last night I was the Patient Care Tech - yes, us nurses can do practically anything...lol.  As I was taking the first set of vital signs - I noticed that a patient seemed very familiar to me.  Turns out it was the one that signed out AMA early Friday morning!

She returned back to the hospital Friday early evening complaining of nausea and dizziness.  I didn't mention who I was.  I'm glad she came back - obviously she has something medically related going on.  Hopefully they'll be able to fix it.  She did have a nicotine patch on - so no worries about her needing to go smoke. 

I just got done with a nursing skills assessment type fair - I'm tired & I have to be back at work tonight.  Hope everyone is having a happy Monday.  It's raining here by me - perfect sleeping weather.  Sweet dreams! 

 

Power of Addiction

Let me start by saying that I am so glad I have never tried smoking in my life. Not necessarily because of how unhealthy it is, but more because of the power it has over someone that smokes. The reason I'm thinking about this is because early Friday morning I got an admission from the ER - it was about 2:30 am. She was admitted with high blood pressure and an abnormal EKG. When she arrived at the hospital, her blood pressure was something like 230 over 114 - that is extremely high - especially for someone that claims they already take blood pressure medications. I didn't have a chance to see what they had given her while she was in the ER, but whatever it was - it was working as the last blood pressure they had on her was something like 134 over 80. However, when she got to the room and layed down in bed, I could tell she was visibly upset. I asked what was wrong & she started crying & telling me she was stressed out and didn't care that her blood pressure was high - that she just wanted to go home. She was in her early 50's & this is way out of the norm for someone that is admitted so early in the morning. Usually they simply want to go to sleep. She told me she had a stroke before & she didn't care. I informed her that no one would keep her here against her will - that she was free to leave if that's what she really wanted. She replied saying "I just want to have a cigarette." I informed her that would not be possible - there is no smoking anywhere inside the hospital and that she cannot leave the floor - if she does, she will not be allowed back to her room - she would have to go thru the ER again & start the process all over. She was crying even more now - saying she can't afford a hospital bill, that she has no insurance - then she asked me a strange question..."if I leave the hospital, will you call the police?" Huh? No, why would we do that. I told her there was a paper she could sign (AMA - against medical advice) & she would be free to leave. She didn't say yes or no, simply stated that she had to go to the bathroom. I got the impression that she was determined to smoke - so I told our patient care tech to let me know if he smells any smoke. He informed me that he did see her put a lighter in her pocket when she got up from the ER stretcher. I called for my clinical leader to go in & assess the situation. She wasn't in there even 2 minutes before she came out asking for the AMA form. The patient asked us again if we were planning on calling the police - very odd question. We assured her we wouldn't - although I was tempted to ask her if she had a warrant or something...but I didn't. It was apparent that her desire to smoke was stronger than her desire to be healthy. We get patients like her - who get mad when we inform them that they cannot smoke while they are in the hospital. We had one the night before smoking in her bathroom. They don't care about the dangers of smoking with oxygen nearby - they simply don't care about anyone - not even themselves. It's scary and sad all at the same time. I know addictions are difficult to overcome & I'm not asking them to quit smoking - but for the sake of yourself & others - do not smoke inside of the hospital!

I worked 5 nights last week - I have been so tired the last 2 days. I'm only scheduled for 3 nights this week...thankfully. Even after pretty much resting the last 2 nights, I still feel exhausted.

I have to take Shay to doggy daycare sometime today. My parents had been watching her, but someone complained about the rule that dogs in their park aren't supposed to be over 20 lbs. They have a lot of complainers in there - I guess it's grumpy elderly people with too much time on their hands. My parents had been enjoying it - especially my dad. He would take her for rides in his golf cart and take her out fishing at night with him. Oh well - easy come, easy go.

I'm gonna go get some more rest - it's pouring down rain right now & I'm sleepy.

Hope the rest of you are having a good weekend!

Very easy week!

This past week at work was really good - which basically means it was really easy.  My patients were stable, considerate, polite, alert & oriented - which is always a plus. 

My first patient was in with pneumonia and respiratory failure.  Only in her late 50's & already a DNR (do not resuscitate).  She needs a lung transplant, but is not a surgical candidate because the doctors don't think she'd surivive the surgery.  It's sad because it was something the doctor had to discuss with her during my shift...to make a decision should something happen while she was in the hospital.  It seems like the most pleasant people are the ones with the terrible diagnosis/outcomes. 

My second patient was admitted with vertigo rule out TIA.  Turns out it was vertigo and she just needed her Meclizine medication increased.  After that she felt fine.  However, she spent an extra 2 days in the hospital because the neurologist didn't want to discharge her until the test results were in writing on the computer. For some reason - it was really slow to get the results...which was fine with me - she was a pleasant patient to take care of. 

My third patient...hmmm...how to describe her???  Her first question to me was "How will you know if I pass out while in bed?"  Who asks stuff like that?  I did not yet realize this woman's history.  She was admitted with syncope.  It's been going on for over 4 years.  She had a big workup done at a major hospital which showed no medical basis for what she claimed to be experiencing.  What she experiences is feeling shaky, staring off into space, fainting...a variety of different things.  While in the hospital - she only experienced these situations while medical personnel were with her.  Twice in the ER, once when the admitting doctor was in the room with her, once when a nurse was with her and once when the neurologist was in.  The neurologist assessed her during one of her fainting spells - he lifted her arm up over her face & let it go.  If she were truly unconscious - the arm would have fallen on her face.  Instead it went over her head & barely touched the ground.  They were all convinced she was faking - there were no changes neurologically, physically, cardiac wise, vital signs were stable.  She did seem a bit on the dramatic side to me also.  Most of the time people who are admitted to the hospital - they can't wait to go home.  Even if they are feeling miserable, they just want to be at home as soon as possible.  Not this one - she insisted on staying in the hospital.  She was still there when I left, but I think the plan of care was to refer her to a psychologist. 

My fourth patient was strange.  He was a nice enough guy, but 95% of the time that I was in the room - he had the sheet & blanket over his head.  Not just on top of his head...but covering his entire head & face.  He even watched tv like this!  One time I walked by & he was sitting up on the side of the bed with the usual sheet & blanket covering his head.  It was bizarre.  He was in for a variety of things - congestive heart failure, anascara and right upper quadrant pain.  He did have gallstones, but he wasn't a surgical candidate because he recently had a heart attack and he had this huge wound on his foot that wasn't healing.  No surgeon wanted to touch someone with that type of history.  The wound is from uncontrolled diabetes = poor circulation.  What's weird is that he didn't even come to the hospital for treatment of that wound.  He was just covering it up at home - as if it would heal on it's own.  It was gigantic! 

My fifth patient showed up around 4:30 am.  I felt bad for her.  She was in her early 30's & her mother died last week at our hospital.  The patient was grieving which lead to chest pain.  She looked so sad.  It made me think of how I'd feel if I lost my mom & then I quickly put that thought out of my mind.  I know it would be nearly impossible to go thru that...even though we have to.  This patient didn't have any chest pain during my time with her.  I think she just needs to find some positive ways to release this stress of losing someone so close.

On top of it being an easy week -there were nursing students there for two of the nights also.  That made it even easier!  The instructor was someone that graduated with me - I have no idea how she became a clinical instructor so quickly.

I have another long week ahead.  I feel like all I do is work lately...grrrr.  I took Shay to my parents house for them to watch her this next week.  Here's her latest pics!

 

 

Interesting

When the Lord made Nurses He was into his sixth day of overtime.

An angel appeared and said, "You're doing a lot of fiddling around on this one."

And the Lord said, "Have you read the specs on this order?

A nurse has to be able to help an injured person, breathe life into a dying person,

and give comfort to a family that has lost their only child and not wrinkle their uniform.

They have to be able to lift 3 times their own weight,

work 12 to 16 hours straight without missing a detail,

console a grieving mother as they are doing CPR on a baby

they know will never breathe again.

They have to be in top mental condition at all times,

running on too-little sleep, black coffee and half-eaten meals.

And they have to have six pairs of hands.

The angel shook her head slowly and said, "Six pairs of hands...no way!"

"It's not the hands that are causing me problems," said the Lord,

"It's the two pairs of eyes a nurse has to have."

"That's on the standard model?" asked the angel. 

The Lord nodded. "One pair that does quick glances while making

note of any physical changes, And another pair of eyes that can look

reassuringly at a bleeding patient and say,

"You'll be all right ma'am" when they know it isn't so."

"Lord," said the angel, touching his sleeve, "rest and work on this tomorrow."

"I can't," said the Lord, "I already have a model

that can talk to a 250 pound grieving family member whose child has been

hit by a drunk driver...who, by the way, is laying in the next room uninjured,

and feed a family of five on a nurse's paycheck."

The angel circled the model of the nurse very slowly,

"Can it think?" she asked.

"You bet," said the Lord. "It can tell you the symptoms of 100 illnesses;

recite drug calculations in it's sleep; intubate, defibrillate, medicate,

and continue CPR nonstop until help arrives...and still it keep it's sense of humor.

This nurse also has phenomenal personal control. They can deal with a

multi-victim trauma, coax a frightened elderly person to unlock their

door,comfort a murder victim's family, and then read in the daily paper

how nurses are insensitive and uncaring and are only doing a job."

Finally, the angel bent over and ran her finger across the cheek of the nurse.

"There's a leak," she pronounced.

"I told you that you were trying to put too much into this model."

"That's not a leak," said the Lord, "It's a tear."

"What's the tear for?" asked the angel.

"It's for bottled-up emotions, for patients they've tried in vain to save,

for commitment to the hope that they will make a difference

in a person's chance to survive, for life."

"You're a genius," said the angel.

The Lord looked somber. "I didn't put it there," He said.

Author Unknown

Someone else's worries

This has been a busy week.  I started Sunday night & by Thursday morning - my feet were aching.  We have had something like 3 or 4 Baker Acts = no patient care techs to assist the nurses.  That is my pet peeve with this hospital.  They don't seem to care that we are short-staffed or overburdened.  I don't think they realize how much difference a good patient care tech can have on a unit. 

Sunday & Monday were busy, busy nights for all the nurses.  We were all exhausted by 7 a.m.  How I managed to work 4 nights in a row with that patient load - I don't know. 

Two patients stood out for me this week.  One was a woman in her 90's that came in with chest pain.  Normally I love chest pain patients because they are the easiest to diagnose/treat.  However, when they are elderly - the chances are high that they also have some degree of dementia.  Mine had that along with paranoia.  The thing is though...she was telling us stories that seemed so believable...at first.  It is strange how the mind works though - I mean she couldn't remember where she was or why she was there, but she knew her friend was stealing stuff from her house & dropped her off at the hospital, but told her it was a hotel.  The more she expanded on her thoughts, the easier it was to see how delusional she was.  Monday night when I came in - she was refusing to wear her heart monitor.  I would go in the room, put it back on her & explain the importance of it - only to see within 30 min, it was off again.  She would also get out of bed & stagger all over the place.  She was a fall waiting to happen.  So I tried to put a Posey vest on her - just to keep her in bed.  That didn't work as she fought me when I tried to put it on her & she started yelling & screaming.  This is really nice when it happens with another patient & their family in the room. 

My clinical leader came in & tried to calm the woman down.  She then turned to me & said "Get the wrist restraints."  So we put her back in bed & applied the restraints - which only made her worse.  She wouldn't stop yelling & screaming.  Again, this is always so pleasant when there are other people in the room.  @@

I ended up calling the doctor & getting an order for Haldol.  She slept pretty much the rest of the night.  I did end up moving the other patient into a nice, quiet room.  When I came in the next evening, she had been discharged....yay!!!

My other patient was one that had a stroke.  The left side of her body was affected - she could barely move her arm & leg on the left side.  Her attitude started out very sweet the first night.  By the second night - she was in denial.  The doctors were telling her & her son that she would have to go to a rehab/nursing home in order to regain any use of her left side - they couldn't send her home like that because she didn't have anyone to take care of her.  She was adamant about not going to rehab.  She wanted to go home & that was that.  I tried to explain to her the reasons a rehab was necessary, but she didn't care.  She had also gone from being sweet to being very grumpy & irritable. She even called her son to tell him I was mean!  ME??????  Mean???????????  No way!!!!!!!!!

I tried to put myself in her state of mind - the best that I could anyways.  I had a lot of patience with her because I realize that this has to be quite stressful & worrisome.  Her thought process was still in tact 100% - so she knew exactly what was going on with herself.

The next night when I came in, she was still a little grumpy - but more accepting.  She knew there was no other choice than a rehab facility.  As the night went on, she was beginning to express herself more & more...not in a good way either.  Around 1 am, she called for me & I could tell something was wrong emotionally.  She was on the verge of tears so I asked her what was wrong.  She opened up about her fears - that she was worried once she went to rehab, she'd never leave - that she'd never make it home - that she'd die there, she was worried about her sons, she was worried because a friend of hers had a stroke & died within a week.  She expressed her fear of dying. 

It was really touching & it really made me take a step back & try to understand her worries.  It also put my life in perspective & gave me the reminder that none of my worries compare to hers right now.  Her life is changing & there isn't a thing she can do about it at this point.  I do a good job at drawing the line & not getting emotionally involved with a patient or their family.  I need to have that line in order to survive in this line of work.  I don't want to take patients worries home with me - it will wear me down & burn me out.  I have been thinking about her a lot though.  How could I not?

I work Sat & Sun nights - have Monday off - then work Tues, Wed & Thurs nights.  Busy, busy, busy - but I have to be in order to pay off these dental bills.  I had a root canal last week that was like $900 and I see the dentist again this Monday for a couple of fillings that cracked.  It seems neverending!

I took Shay to the dog park today for the first time.  I took her at noon time & there wasn't a single person there...lol.  So we went back around 5 pm & stayed until 7.  It was crowded - I was surprised.  She was a little on the shy side.  She preferred to hide under the picnic table where the big dogs couldn't reach her...then she'd run out to get their attention & run back to her hiding spot.  She got braver as time went on.  Now she's exhausted & already asleep.  She's doing well though.  She'll be at doggy daycare this weekend.  I hate leaving her there overnight - knowing she's all alone, but it beats coming home to a house full of dog accidents.  My parents have been watching her while I work, but I figure they need a break.  They treat her like a child - my mom keeps her by her side all day and my dad takes her for rides on his golf cart.  She's spoiled...that's for sure!

Have a good weekend everyone!

Baker Act

Baker Act is a term used here in Florida for a person who is a danger to themself &/or others.  Being labeled a Baker Act automatically allows the state to take you into custody against your will & be under psychiatric evaluation for up to 72 hours.  We get Baker Acts at our hospital who usually have attempted suicide & need medical clearance before being transferred to a psych facility.  A requirement our hospital has with Baker Acts is that they require someone to sit at their bedside 24/7 so they don't harm themselves while they are in our care.  Our "sitters" are our patient care techs.  So it means if we have a Baker Act, then the patient care tech will sit all night instead of assisting the nurses. 

I used to wonder why did we have to have a person observing someone under a Baker Act - why couldn't we simply restrain them to the bed via wrist restraints & a Posey vest.  I guess the liability is too much for our hospital to chance that the person won't harm themself.  It wasn't until last week that I saw firsthand the importance of a sitter. 

We had a patient that came in - he was young - in his 40's.  He took something like 90 Valiums and I think drank some alcohol or took Benadryl along with it - he wasn't my patient, so I didn't know the exact details.  He was pretty out of it the night he came in, but the next night was a different story.  I was sitting near the room when I heard his sitter ask him what happened the night before.  They teach us in nursing school that there is nothing wrong with asking a person if they are feeling suicidal or what their feelings were for the reason they attempted suicide.  Personally....I don't want to know.  I'm not a psych nurse & I'm not going to be able to solve those type of problems in 12 hours anyways.  I think it's a dangerous line that can be crossed to encourage a suicidal person to express their feelings when you are not fully trained on what the next step is.  Anyways, he started telling the sitter that he was having problems with his girlfriend - they were breaking up or she was kicking him out - something like that. 

It wasn't long before he was crying.  Again, not a good thing because what do you do with those feelings that are being stirred up?  I tell his nurse that she needs to call his doctor & get something prescribed - rather quickly.  She hesitates - says he came in as a drug overdose & the doctor probably won't prescribe anything.  Ummm, yes he will.  So she doesn't call.  I go back down by the room & now the patient is telling the sitter to give him the phone - that he wants to call his girlfriend & tell her good-bye...that he would be killing himself tonight.  I again tell his nurse "you have got to get him something to reduce this anxiety or he is going to hurt himself & possibly us if we attempt to stop him from hurting himself."  I wasn't worried about him - because if it came down to it - if he was hurting himself, I wouldn't physically step in.  Sure I'd call a code gray (a call for manpower) - but no way would I put myself in danger to save this guy's life.  I was worried though that he could possibly hurt the person who was the sitter - then I'd have to step in to stop him from harming her.  That's a different story. 

The sitter comes out to tell me that she needs to talk to his nurse & asked if I could watch him while she went to talk to the nurse.  So I go in the room & try to make small talk.  He tells me that he was planning on killing himself tonight & that out of respect for the sitter - he wouldn't do it tonight because he didn't want her to have to live the rest of her life remembering him doing something like that.  Whew!  Glad to see he has somewhat of a conscience.  Eventually the nurse did get him some anti-psychotic medications & he slept the rest of the night. 

I don't even remember what my patients were like last week except Thursday was really, really busy.  From the start of shift until the end - there was no time for any breaks.  It was nothing that was an emergency - but it was non-stop work. 

 

Beauty Fades, Dumb is Forever

For those of you who know me well...you know that I am quite close to my niece.  I've practically been like a second mom to her & my nephew from the time they were toddlers because my brother & sister-in-law were separating & fighting.  I was the one that stepped in & made sure that those little kids didn't have to be in that environment.  While my ex-sis-in-law made a feeble attempt to be a mother to them, she was more focused on partying & picking up men for about 5 years.  I remember her telling my mom shortly after having the kids "When is it going to be time for me to have fun?"  Ummmm.....how about you think about that before you decide to have children.  Anyways - to make a long story short - they divorced & she hooked up with the guy my brother found her cheating with & she had a baby with him.  They are living together, but no marriage & my niece cannot stand this guy cause he is always yelling at her & my nephew.  It frustrates me that out of the 9304802394903214901 men out there, she'd have to pick the one that has a grudge against my brother because my brother beat him up when he discovered his wife was cheating.  Anyways...all of a sudden now, my ex-sis-in-law has decided to be a parent - which is great - she should be making those children a priority.  However, at the same time, she has decided that my brother & my side of the family cannot see them anymore.  Yes, my brother has a court order to see them, but he has gotten himself messed up with a DUI & a probation violation - so he will be spending a little time in jail.  So he can't take her to court to enforce the visitation until he gets his stuff all straightened out.  Who knows how long that will be.  I'm frustrated because it's been about 3 weeks since I've seen the kids & even though my ex-sis-in-law says I can spend time with them - when the time comes, she won't answer the phone or make good on her promises.  I'm not looking for any answers here, I'm just venting.  I know this subject matter definitely doesn't belong in a blog about nursing, but I have to release this frustration.  I know the real reason behind blocking me from seeing the kids is because she is resentful/jealous of the bond I have with them.  If it came down to it, both of those kids would rather be with me than her &she knows this too.  Her loser bf just adds to the drama instead of trying to find ways to resolve it.  I feel for the kids because this is all they know in their world - a revolving world of chaos & instability except when they are with me.  I know they'll be alright, but I worry.  They are 10 & 8 - getting to those crucial years of where they can be tempted down the wrong path.  I guess all I can do is be there if/when they need me.  Ahhhh, so frustrating.  Like Judge Judy says...beauty fades, but dumb is forever - my ex-sis-in-law is a shining example of that quote. 

My week at work started out good - I was actually glad to be at work on Sunday night because it gave me time to focus on something other than the family drama.  Two of my patients I had had in the past & they were really nice gentlemen.  My group was practically ready for bed by 9 pm.  I was having to wake them up to take medications!  I had the same group on Monday night, but the night didn't go as smooth.  The two patients I had in the past both were having symptoms I couldn't do anything about.

One woke up all shaky & even though he was breathing ok, he didn't feel like he was.  I checked his blood sugar because his doctor had been ordering for him to get 20 units of regular insulin twice a day REGARDLESS of what his blood sugar was as well as 35 units of Humulin (longer lasting) twice a day AND to also cover with sliding scale protocol.  It just did not sound correct to me.  I don't even give that much insulin to someone with an extremely high blood sugar much less someone that is around 150 or 200.  I tried talking to the doctor about it & he looked at me like I was the crazy one.  So I checked his blood sugar figuring he was probably crashing from these screwed up insulin dosages...he had gone from 250 to 106 in a couple of hours.  I thought maybe it was too fast of a drop for him, so I got him some orange juice and graham crackers.  The shaking stopped & eventually he was feeling ok. 

My other patient was in with congestive heart failure although he had been complaining more about feeling dizzy.  He woke up at 2 am with the complaint:  "I just don't feel right."  He couldn't describe it beyond that.  Myself & two other nurses were asking him a 100 questions to try to draw some symptoms out of him, but everything was ok other than "I just don't feel right."  I can't call a doctor & say that..especially at 2 am.  We stood there looking at him - unsure of what else to do.  His vital signs were fine, his vision & speech were fine, he was answering questions appropriately...what do you do?  He had no pain, no discomfort, not nothing except not feeling right.  I advised him to lay down & see if it went away.  He ended up going back to sleep & that was that.

After that, my first patient woke up again shaking & not breathing right.  His blood sugar was about 121 - so I didn't think that was the problem.  He also added nausea to his list of complaints.  Ok, I can call a doctor for that - that is something easily treatable.  So I get the order & give him the medication - he is doing better....laying down now...only to get back up an hour later & have the same symptoms all over again.  He originally came in for chest pain, but he wasn't having any of that.  He's actually been coming to our hospital for the last 4 or 5 months with different symptoms & they haven't been able to figure out what was causing him to feel ill.  I told him next time try a different hospital.  I mean why would you keep coming back to a hospital that you are frustrated with because they didn't have any answers?  His doctor usually rounds first thing in the morning - but of course on the morning I needed him there to witness the patient's symptoms - he was nowhere to be found.  He didn't come into the hospital until 5:30 pm.  Figures!  For some reason he wrote an order to transfer him to another hospital to do a pacemaker evaluation.  I don't think the patient needs a pacemaker as much as he needs his medications readjusted.  Oh well, I'm not the doctor.  I was glad to see he would hopefully get some different answers at the other hospital.

Tuesday night was my third night in a row - usually that is the easy night as by then I usually know my patients after having them for a couple of days.  This week it was reversed.  I got a new admission at 8:30 pm.  A 47 yr old with chest pain - I love people with chest pain because they are pretty much easy to treat & for some reason I remember that protocol the best out of anything else.  And when they are young like that - it is usually more related to stress than an actual cardiac problem.  My patient arrives to the floor & the ER nurse says to me "He just said for the first time today that he has been having extreme chest pain all day & night - but didn't want to bother us."  Why do they wait until they are on the floor to speak up about pain?  And wouldn't you know it - no pain meds had been addressed in the ER - I don't know why - he was being admitted with chest PAIN.  So I call the doctor & get some morphine & nitroglycerin sublingual.  I give him 2 mg of morphine IV & nothing changes.  I give him 2 more mg - no relief.  I go with the nitro this time - no relief & now his blood pressure is just over 100.  The patient had a CT scan of the chest to rule out aortic dissection.  I was worried maybe something really was wrong so I called the cardiologist who had already seen him in the ER.  He said there was no way this patient had an aortic dissection.  I said "Ok, what do we do for his unrelieved chest pain?"  His answer: transfer to ICU and start a nitro drip.  Grrrr...all that work just to send him to ICU. 

Later that night I also got another admission with chest pain - he seemed a bit dramatic the first 1/2 hour he was on the floor, but luckily he had a good ER nurse who rather than bring him to the floor as he complained about chest pain right before being transferred to my floor - the nurse pulled the ER doctor in to assess him one more time & got him not only pain medication, but also anti-anxienty medication AND gave it to him before bringing him to the floor.  Just about any other nurse would have dumped him & left me to call the doctor & get the medication & delay treatment by about a 1/2 hour.  So the meds kicked in as I was asking the 984013490130941 admission questions.  He went to sleep after that & the rest of my night went smoothly. 

It looks like we aren't overstaffed at night anymore - easy come, easy go...lol.  Three of the night nurses opted to go into the ICU training program and another one quit - so hopefully I'll be able to pick up a lot of overtime in the upcoming months.  I really want to pay off my car by the end of the year & put some in savings.  That's the goal.

My puppy Shay is continuing to grow...she's nearly 40 lbs now.  Somehow I don't think she's done growing - so much for the vets saying she'd be petite & about 40 lbs max.  I had her in the car today & she was barking at a motorcycle rider.  She definitely will be a great protector.  Here's another pic of her!

 

 

Volunteering & Denial

I started off my week with an ACLS re-certification class.  So much has changed in 2 years!  It's a good thing I barely remembered anything I learned when I took the class 2 years ago, because it's changed a lot.  It's much simpler, the algorhythms are easier to follow, less medications to use...just way easier than the last time I took it.  I'm glad I decided to renew it, it was a breeze.

I volunteered to work Tuesday night.  I don't know why I did, I just did.  Of course as Tuesday came around, I was regretting it - but I thought to just grin & bear it - I could use the money anyways.  As a result - we were overstaffed, which is always a good thing.  However, we only had a patient care tech until 11.  Ugh!  I'm tired of them assuming that just because we have 4 patients instead of 5, suddenly it should be primary care nursing - ESPECIALLY when the patients we have...the majority are total cares which is time consuming.  It feels more like a nursing home than a hospital lately. 

My first patient was an 89 yr old man that had passed out at home, fell & hurt his head and leg.  He had a big laceration on his head that they closed with 9 sutures.  Amazingly that wasn't causing him any pain - rather his leg hurt from the fall even though there was no fracture.  He was a very pleasant man.  When I went into his room, I noticed he was watching the tv show Big Brother - the finale.  I asked him if he liked this show & he said he did although he did not care for the guy that eventually ended up winning - those of you who watch Big Brother will understand that completely.  I laughed to myself because that show has been frustrating me for the past couple of months with all they allow that creepy contestant to get away with.  It just amused me that this man who is nearly 90 yrs old watches the same show I do & he knew everything that was going on in the show.  It was cute.  Other than having some leg pain, he was stable & easy to care for. 

My second patient is one that finally came out of denial.  She's in her early 50's & was diagnosed a couple of years ago with cancer.  She chose to do nothing about it - other than pray.  Not a good decision. It has caught up with her & she doesn't have much longer to live.  She was admitted last week when I was there, so I was suprised she was still at the hospital.  Well, as it turns out - Tuesday night is the night the oncologist decided to tell her there are no more options - her liver has had it.  There is nothing more that can be done.  I had no idea the doctor was planning on telling her this - it sure would have been nice if he would have given me a heads up, you know?  I went in to assess her & found that she had like 5 or 6 women in there all praying around her.  I gave them some privacy & told her I'd be back later.  It was then that I looked at her chart after the doctor was done with it & saw that he ordered for a Hospice Consult.  There was nothing in his notes...well nothing legible in his notes...no one could read his handwriting. 

Without directly asking the patient what they discussed, I was able to get the conversation out of her.  I just had to make it seem like I knew what was going on - which is not always so easy to do.  She appreciated how gentle I was with her & that I allowed her to have time with her close friends without any real interruptions.  It was common sense for me to do what I could to allow her to come to terms with such devastating news & I was very grateful she had a close support system.  There is nothing worse than a doctor giving news like that to a patient sitting alone in a room & then left by themself to think about it.  So heartbreaking.  I called my clinical leader & told her I don't know what the admissions look like in the ER, but I do not want anyone put in that room because I felt she needs to have her friends close to her tonight.  There was no way I was about to kick any of them out...semi-private room or not.  Luckily it worked out to my favor...we only had room for one more admission & even though she could have gone into this room...my clinical leader opted to put her in a different room.  I like when things work out like that & that a clinical leader is able to stop & think about the needs of a patient rather than the needs of the hospital first.

My third patient - another sad case & another one in denial.  He came in with congestive heart failure - he's in his mid-40's.  Wayyyyyyyy too young to have all the problems he has.  He is nearly 400 lbs...which isn't what I'm criticizing.  Most of us have some kind of weight problem that we all think about & try to improve.  What was his problem was that his weight was causing the health problems he was having, yet he didn't want to do anything to change it.  From the time I assessed him until this morning...all he talked about was food...junk food.  I didn't get it.  Most people who are in the hospital & the doctor discusses with them the need to lose weight...they usually are agreeable & do what they can while they are in the hospital to be compliant.  I'm sure most go home & fall back into their normal eating habits at home.  Not this one...all he did was talk about all the food he's going to eat when he leaves the hospital.  On top of having congestive heart failure, he had what can only be best described as sores all over his legs....deep sores, many, many, many deep sores.  Sorry to gross some of you out...but these sores were oozing blood & pus.  Gross! 

Actually, the reason he came into the hospital is because while all of these sores were developing on his legs...he was in pain & would take lots & lots of Advil.  Not a smart idea...too much Advil or any over the counter pain med can cause ulcers &/or bleeding.  He had bleeding ulcers that were starting to eat thru his stomach lining.  Once that happens....dying is a possibility.  So they fixed his ulcers & they covered his legs with many, many dressings and unaboots, and abd pads & then put ace wrap around it.  Because before they did this...all that blood & pus was weeping onto the pads & sheets on the bed (ewww!).  I thought...hmmm, looks like they wrapped his legs really good - I doubt anything will seep thru. 

Ummmm...wrong answer!  Within hours it was seeping thru all of the bandages.  On top of that, his stomach was so large that underneath it where the crease overlaps the pelvis...it was soooooooo red & raw and his thighs had rashes.  I've never seen anything like the sores on his legs or the rawness on his abdomen.  And all he could talk about was food.  Go figure!

My fourth patient...well, he was different.  He was found to have a mass in his neck at another hospital.  For some odd reason, they transferred him to our hospital.  I have no idea why...no one transfers to our hospital for help (sorry, it's true)...we send patients to bigger hospitals for better treatment.  I couldn't understand why a bigger hospital was sending us a patient with a neck mass. 

Anyways, this patient felt the need to smoke a cigarette...in his bed.  Yes, in his bed.  Another nurse was able to intervene because I was in with another patient.  She took his cigarettes & put them under water & thru them away.  I tried to explain to him that you cannot smoke IN a hospital & on our floor - you cannot go outside to smoke either.  It's just not allowed.  Luckily he was compliant the rest of the night - not that he had much choice since he no longer had any cigarettes...but he didn't put up a fuss about it either.

It wasn't a bad night for me, but many times I asked myself "Why did I volunteer for this?"  I am glad I did though.  More money = less bills.  I'm off now until Sunday night...then it's back to the 3 nights a week for awhile.  I purposely signed up for more shifts than I usually do because we seem to be overstaffed at night & it's not so easy to pick up shifts.  I'm sure it will even out by December/January when we start getting really busy.  I want the overtime.

My puppy Shay is doing well.  She recovered 100% from being spayed.  She almost got hit by a car on Monday night though.  She was in my backyard & my brother came over & was coming in thru the gate where she was...she ran out & he thought she'd run right to him since she was so excited to see him.  Instead, she went running straight for the busy road I live on.  I was in the backyard & heard him screaming her name & I knew something was really wrong.  So I started yelling "cookie" & "Who's hungry?" because as soon as she hears those words - she is right at your side.  My brother said she was like 2 feet from the street & when I said those words...she turned around & came running right back.  Whew!  I looked at her the rest of the night while silently thanking god that she didn't get taken from me.  I'm really attached to her now.  She's not the same as Jagger - no dog ever will be, but she is unique in her own way & she's turning into a pretty good protector.  I still need to get her into some puppy training classes.  I'm even thinking of sending her to boot camp for dogs...lol. 

I hope everyone is having a great week!

Finally Recognized

It was supposed to be an easy week: 2 nights of work & 1 night of Basic Life Support Class.  I went in on Monday evening & found out I was the Unit Secretary.  No problem...I don't mind putting orders in & Monday was Labor Day so most of the doctors had already been in before I even got there.  So I thought it would be a slow, but uneventful night. 

They had 3 codes during the dayshift - I know 2 of the patients died, not sure about the 3rd.  We haven't had many codes at night lately - well, except the one I accidentally set off from sharpening my pencil!  The wire from the pencil sharpener tripped the code blue button thing we have at the nurses station.  Luckily I was able to cancel it before anyone really showed up - especially the ER doctor.  It's the second time I've accidentally done that, but really...it's not my fault.  We should have a better button on the wall than the one that barely stays up & will set off with the tiniest of movement.

I was told around 11 I would be pulled to the North side to be a nurse & take admissions because the emergency room was packed.  They weren't kidding - I got 5 admissions in 6 hours.  Whew!!!!!!  Luckily, I had another nurse there to help put all the orders in and a really good patient care tech to make sure the patients were comfortable, vital signs taken & heart monitors on.  It's the little things that really do matter the most. 

I got a little annoyed with the ER when they brought up the second and third admissions within 10 minutes of one another.  I understand they were busy & pressured, but at the same time, I have to be able to assess my patients properly.  Especially these two - one was in with a TIA vs CVA (stroke) and he was acting all loopy & disoriented.  I really thought he was going to end up falling & breaking a bone.  Luckily the worst thing he did was drop his urinal & urine went all over the floor...ick. 

My other patient - as soon as he got to the floor & the ER nurse left, he starts violently vomiting.  Luckily, the patient care tech had asked me for the garbage can right before this happened & this patient was alert & oriented enough to get it all in the trash can.  Whew....disaster averted.  We're talking like 1000 cc's of vomit.  The good thing about that is he felt perfectly fine after getting that out of his system.  His wife, on the other hand, I thought was going to fall at any moment.  I went to get her from the waiting room & she was staggering down the hall.  I don't know if she needed a cane, a walker or was simply exhausted - it was about 3 am. 

I thought maybe I'd luck out & that would be the end of the admissions...but they started back up around 5:15 am.  Two in a row.  They were stable - so all was good.  I took it all in stride.  What else could I do?  It's my job.  I did joke to my clinical leader that none of these patients better be discharged by Tuesday night because I did not want anymore admissions.

Sure enough, one did go home & I had to get one admission on Tuesday evening - but that was fine.  I got a card from my manager - she took the time to write about the situation and how wonderful my attitude was.  I also got a little symbol thing that they give out when you do something above & beyond what is required.  It's just a small thing, but like I said earlier - it's the little things that mean a lot.

Wednesday night was CPR class.  It was pretty simple - a few things have changed as far as the amount of compressions you do.  A nice refresher class.  She also reminded us of how important it is for us as healthcare workers to help out when out in public if we see a situation going on.  I'm not always the best at that because I don't want the liability or the expectations.  When I was on my trip - on the train, they called out for any medical personnel to come help with a situation.  My dad urged me to go, but I didn't - using the excuse "I'm on vacation."  I just don't like walking into situations like those without any backup that I trust - as opposed to being at the hospital where there are plenty of people to help out if I am unsure of the situation.  I'll work on getting better at that.

My puppy Shay is growing so quickly - I want her to go back to being that little puppy I got 2 months ago.  Hard to believe it's been 2 months.  She was just a tiny thing....8 lbs & so small.  Now she's nearly 25 lbs & has changed a lot.  The black in her fur is practically gone - except around her face & eyes.  She is definitely german shepherd & I don't know what else - I'm thinking yellow lab, but who knows.  She did well with getting spayed, although she does have a bump under the incision.  I'm reading on the internet that it isn't uncommon, but she goes to the vet on Monday to get her stitches out, so we'll see what he says.  It was hard to keep her calm for 7 days - she was running around the day after surgery.  She seems to be ok...no pain, no discomfort, she doesn't even mess with the stitches. 

She has sooooo much energy.  I finally took her on a 20 min walk to drain some of it so that she'd take a nap.  Well, we both ended up taking a nap...sooooo much for trying to get things done while she's sleeping.  Once she gets the ok from the vet, we're gonna start doing longer walks & she'll finally get to see what a dog park is all about.  She seems to be really good around other animals - hopefully she won't attack anyone!  She's turning into a good guard dog.  Here's her latest pics.  She's officially 17 weeks old now.

 

Amoxicillin

Shay & I are both on Amoxicillin...lol.  She's on it to prevent any infection after getting spayed.  I took her in yesterday & she seems to have done well.  She was a bit groggy last night, but today she is back to her normal self.  She doesn't even seem to be in any pain today - amazing!

I'm on the antibiotic because of the toothache that began last week.  I saw my dentist on Thursday & he started a root canal...fun fun.  $705 later, I have to go back in October so he can finish it.  He's a very busy dentist, but I've been going there for 17 yrs & he is very personable.  So I'm not switching dentists until I absolutely have to.  Besides, I need some time to save up to pay that $705...ugh.  At least the pain is gone.

I worked Sun, Mon & Tues nights.  The one patient that stood out for me is one that came in with a migraine headache, was admitted with chest pain (who knows why - she never had chest pain) and ended up having surgery to remove her gallbladder.  It's usually a relatively simply surgery. I had it done back in 1996 & recovered fine.  Then again, I didn't have the surgeon she had.  He's pretty new & isn't very good yet.  It was also discovered that she had blood clots - one in her upper arm, one in her chest and one in her leg.  No one knew why she was clotting like that - so they started her on Heparin to thin her blood & prevent anymore clots.  Anyways, she had the surgery on Saturday, I was her nurse Sunday night.  I had been told she was anxious & there was Xanax ordered for her.  I gave her some with her nighttime meds.  Around 11:30, the tech went in to take her blood pressure & noticed blood on her gown.  I immediately lifted her gown to see where she was bleeding & it was a tiny but steady trickle from one of her incisions.  He had put a durabond type adhesive rather than stitches & I don't know if she scratched it or what...but it was bleeding & it wasn't stopping even with pressure.  I decided to put some 2x2's over it & tape - hoping the pressure would stop the bleeding.  It didn't.  So I replaced that dressing, put more 2x2's & covered it with surgical tape.  You could still see that it was bleeding.  At the same time, the patient was freaking out & yelling "I'm bleeding!!!!!!  Oh my god!!!!!"  I tried to get her to look at where she was bleeding from because it was just a tiny little spot, but she wouldn't look.  Then she got even more hysterical & was asking what if she was bleeding internally.  Her blood pressure was fine & I tried to reassure her that she was ok. 

I eventually called the surgeon, who of course wasn't on call.  I got one of his partners who told me to apply a pressure dressing and continue the Heparin.  It was exactly what I had been doing, but I needed to make sure one of the doctors on her case was aware of the situation.  I ended up taking an abd pad instead of 2x2's...it can absorb more - thus last longer as a dressing & taped it down with surgical tape.  Later when the surgeon came in & took the tape off - she had stopped bleeding.  Yay!

However, now she had other problems.  She wasn't urinating.  The dayshift helped assist her to the bedside commode & I guess when she stood up, she began vomiting.  Then she became diaphretic and very unstable.  They ended up moving her to ICU where they discovered she was bleeding internally!  Aaaccckkk & here I was reassuring her she was fine the day before.  It was just a small internal bleed...I guess the surgeon nicked something & with the Heparin going - it stopped the area from clotting off.  I don't know why she was having trouble urinating though.  The Heparin was discontinued in order to stop the internal bleeding. I don't know what they are going to do with the blood clotting problem.  She was also receiving blood transfusions as her H&H kept dropping.  The poor lady - recovery is not supposed to be this difficult. 

It's scary seeing some of these surgical patients that come in for something that is supposed to be simple & routine and they end up in ICU.  I hope she is ok.

I only work 2 days this week and I have CPR class on Wednesday night.  I'm so tired today & not really sure why.  Maybe I'm just a night owl - cause I always seem to be tired during the morning hours. 

Have a good weekend everyone!

 

Ahhh...the agony!

It all started with a minor pain that was alleviated with Advil...until Friday early morning.  The pain was a toothache that was progressively getting worse.  So at 5:30 am I called my dentist office & got his answering machine.  No emergency contact number...just a machine.  I tell myself that's ok...they usually call back in a timely manner even though I know they are closed on Fridays. 

Come 9 am, the pain is much worse - I'm on the verge of tears.  I have no antibiotics or pain relievers - what kind of nurse am I???  Lol.  I keep calling my dentist & keep getting the dumb machine.  By 10:30, I couldn't take it anymore - I called another dentist.  I didn't want to because I really don't like dentists - I hate the office, I hate the sounds & I really just don't like dentists.  Except my own - I've been going to his office for 17 years now (wow, time flies) & he's like a dad to me.  So kind & gentle-hearted. 

But I had to find some relief...so I go to the new dentist office & have to wait an hour.  I told myself that's ok, soon this pain will be over.  They take x-rays & the dentist comes over & says "You need a root canal, it's the weekend, so how does Tuesday sound?"  He was a creep!  I said I would prefer my own dentist to do the procedure.  The creep replies back with attitude..."It's a free country" & walks off.  At least I did get a prescription for antibiotics and a pain reliever...although Lortabs are like one step up from Advil - enough to take the edge off, but they don't get rid of pain.  He never said another word to me.  Jerk! 

I got the prescription filled & went home to find that my dentist office called 3 times & since they weren't able to reach me...they called in prescriptions for antibiotics & pain relief at the grocery store nearest to my house.  Oh thank you!  My dentist always provides Tylenol with codeine - that takes the pain away as well as provides one with sleep.  So I went to get that filled also - figure it's better to have this stuff on hand & at the grocerystore I went to (Publix)...antibiotics are free...good deal!

I came home & took the medication & tried to get some sleep.  I was shivering, sweating, nauseous all day, but eventually I felt better.  Today is a much better day as the antibiotics are kicking in & the pain is going away.  Whew! 

The bad news...a root canal.  Ugh, I swear my dentist gets all my overtime money this year.  So much for rebuilding my savings account.  I'll just have to work even more...sigh. 

I hope everyone else is having a better weekend than I am!