Tuesday, January 30, 2007

Going for it!

Yep...that's right...I'm going for it. I submitted my application to begin going to school for my Bachelor's of Science in Nursing. I already have a Bachelor's Degree in Business....so I only need 40 credit hours more to achieve a BSN & it's all online. I'm excited now, but I'm sure I'll be dreading it later when I have reading & studying to do. Oh well.....I'm focused & this is what I want right now. The summer semester begins at the end of April.

Thanks to everyone that gave me the encouragement to go back for more!!!

Saturday, January 27, 2007

Do I or Don't I?

My work week is over - at least for a couple of days.  I go back on Sunday night & will probably work the entire week if everything goes well.  This week wasn't too bad...physically it was pretty simple, but emotionally...not so simple. 

I continued to have both patients who had been diagnosed with terminal cancer.  The lady with the spinal cancer - it came down to whether she wanted to go to a skilled nursing facility & try an experimental chemo type drug or go home with Hospice care & no medical treatment other than pain relief.  She obviously would have more time with medical treatment as without, but she has 3 dogs at home that love her unconditionally & she felt that she would be abandoning them if she wasn't there.  Her family was discussing putting the dogs to sleep, which I thought was totally wrong...not just for the dogs, but for the emotional toll it was taking on my patient just thinking of that happening.  She kept saying how she just needed someone to let her dogs out once during the day while her husband was at work.  I advised her to call her vet's office, that they may be able to refer her to someone that does that type of stuff because I know I've heard of dog walkers & dog sitters.  I'm not really sure what her decision was - I forgot to ask the day nurse that discharged her.  I'm pretty sure she chose the skilled nursing facility with the hopes of going home in a week or two.  She thanked me for understanding in regards to her dogs.  I totally understood because I do think dogs are more than just pets - they are part of the family.  My dog is nearly 14 yrs old & I am having a tough time making the decision to put him down...even though it seems like he's getting worse week by week. 

My other patient - the one with the brain tumors.  They were still arranging to do a lung biopsy & a cystoscopy to see if he had lung &/or bladder cancer.  He has been so cheerful all week long.  Emotionally he got to me more than my other patient.  I don't really know why.  Maybe because of his attitude or how kind he was...I don't know.  No matter when I woke him up (for vital signs or to take medications), he was always so happy.  He has a big family and a lot of support, for that I'm glad.

My other patients were easy to care for.  I had one in with COPD exacerbation.  The doctors were ready to send him home & he said "Nope, I'm not ready."  Shocking - most patients want to leave as soon as they get admitted.  He was weak on his feet & didn't want to go home like that because he'd just end up back at the hospital in a week or two if he couldn't ambulate very well.  I ended up moving him to the med-surg floor because there was no need for cardiac monitoring anymore.

I had another gentleman that came in with chest pain.  He has chronic renal failure & gets dialysis 3 times a week.  Whenever they start dialysis, his blood pressure skyrockets & he develops chest pain.  So they are thinking his tessio cath in his chest that they use for dialysis was infected.  He had an AV graft in his right arm, but it wasn't working properly.  I am told by the day nurse on Wednesday during report that the surgeon was in & told her that we needed cardiac clearance to proceed with a revision of the AV graft.  She tells me the cardiologist will be rounding late, but be sure to get cardiac clearance.  As the night goes on, I don't see the cardiologist...so at about 10:45, I call his answering service.  I get a call back from the on call doctor that night who wasn't the doctor consulted for this patient.  I inform him of what the surgeon is requesting & just wanted to let him know that no one from their office has been in to see the patient.  I wasn't expecting him to rush over to the hospital at that time to do what I needed - I just wanted to make him aware so something could be done in the morning.  I would get in trouble if I simply ignored the surgeon's request & dumped it on the day nurse.  Needless to say, the doctor on the phone was not very receptive to my information & gave me a long lecture about how he doesn't care what this patient needs, that it's not his patient, that he doesn't care what surgery does & that he doesn't appreciate being called regarding this matter.  Grrr...not nice at all.  I have found that there is no talking sense into someone acting like that, so I let him ramble on & ended the conversation with "ok."  Oh how I would have liked to write out the order word for word as to what he said, but I knew that wouldn't really fly...can you see it...."I don't care what this patient needs, it's not my patient, I don't care what surgery does & that I don't appreciate being called regarding this matter."  I just narrowed it down & wrote the order to call the consulted cardiologist directly the next morning at 8 am at his office, not the answering service.

I did receive a call from the consulted cardiologist at 7:15 that morning, so at least the jerk informed the cardiologist that I had called & needed cardiac clearance from him.  After all that was said & done, the surgeon came in around 10 am & said "I don't need cardiac clearance, I'm doing this surgery anyways."  Ahhhhh...to be lectured for nothing...so not fair.  My patient had the procedure done & came back to me around 9 pm Thursday night.  He was in some pain, but otherwise doing well.  The cardiologist never did get to see him because by the time he came around, the patient was already in surgery.  Oh well, I'm not going to worry about it.

I had another patient that was downgraded from ICU with congestive heart failure.  He is also a dialysis patient...but a non-compliant dialysis patient.  He skips his appointments for dialysis & ends up in the hospital with CHF because he's not getting the fluid (urine) out of his body.  He's an older man & I somehow doubt that this will be the last time he's non-compliant. 

My final patient for the week was a middle-aged guy in with chest pain rule out MI (heart attack).  I've said it before & I'll say it again...those are my favorite type of patients.  It's pretty routine what to do with them, what medications to give them, what tests will be ordered & I'd say about 90% are negative for heart attacks.  He was scheduled for a stress test & had no chest pain after being admitted to the hospital.

I think the next time I start looking for a job at a different hospital, it will be in some type of cardiac type unit.  I am comfortable taking care of those type of patients.  These other ones with respiratory issues or GI issues or even surgery...I'm always uneasy because they seem so unstable to me.  Not sure if I'm making sense - I just remember the cardiac information I've been taught a lot better than other stuff. 

I'm still debating about whether to go back for a Bachelor's Degree in Nursing.  I know it's a good thing to have, but I'm not sure I want to get back into school mode.  The main advantage of having one is the idea of being able to work in a Veteran's Hospital.  I don't think they accept nurses with anything less than a Bachelor's degree.  They have the best pay & benefits - especially their retirement plan & they are building one here in Orlando that is supposed to be state of the art in the next 3 to 5 years.  I'll have to think about it a little more & investigate whether my hospital will reimburse me for it...I believe they do...which would make the decision easier.  Why not get it if it won't cost me very much?  I'd be dumb not to, right?  I've already been accepted to a local school & the courses are all online. I wouldn't even have to do any clinicals since I'm already an RN.  Do I or Don't I???  Any advice would be appreciated.  ;)

I enjoyed this week...the people I work with are fun to be around & my patients were enjoyable also.  It's one of those weeks where I can say I enjoy what I do for a living.  Hopefully next week I'll still feel the same way...lol.  Have a great weekend everyone!!!

Tuesday, January 23, 2007

Dancing Doctors & stuff

I've only worked 2 nights this week so far & I'm already feeling overwhelmed. I started out Sunday night feeling like I was in a fog. I felt so behind in my charting, yet can't really figure out why. The time just flew by.

When I got to work, one of my patients that I was assigned to had orders to be immediately transferred to ICU because technically she was an ICU patient. What was she doing on PCU? They didn't have enough ICU nurses during the day, so they sent her to us. Doesn't make sense...she should have stayed in the ER until there was an ICU nurse available. She was in the midst of having a heart attack (Troponin level on the second set was 20, normal is less than 0.4) & come to find out, she nearly coded yesterday in the ICU. I'm thanking my lucky stars that I didn't have her as a patient. Since I hadn't taken report yet, I had the day nurse give report directly to the ICU nurse & I assisted in moving her over there.

So now I was down to three patients. My first one was an older woman in with a TIA...transient ischemic attack....often referred to as a mini-stroke. She had no deficits, was feeling fine, but they were keeping her because her INR level was 1.4. Normal is between 2 & 3. She was pretty simple to care for.

My next patient was a woman in her mid-40's with a diagnosis of "frequent falls." I didn't realize that was a medical diagnosis, but anyways...she was falling down more than usual. She wasn't dizzy nor did she feel weak, but she'd still fall without any control over it. She has a history of breast cancer & the neuro doctor was concerned that the cancer may have returned. So he ordered a stat MRI of her spine & sure enough...the cancer has moved to her spine & the tumors growing are causing spinal cord compression. We immediately consulted the oncology doctor that does radiation. I spoke with him on the phone that night & he told me to inform the patient he would be coming in to see her between 6 & 7 am the next morning. I told him that she doesn't know the results of the test & he said he would break the news to her in the morning. I hate, hate, hate having terrible information that the patient doesn't know about their condition. I do my part that's expected of me & not divulge anything - that's the doctor's responsibility, but that doesn't make it any easier. I saw him in there the following morning talking to her & I went in after he left the room & she was crying...which I totally expected. She then says to me "Did you know about this all along? Did you know the entire night?" Ughhhhhhhh, I don't want to lie, but I also don't think she'd logically understand that nurses cannot give patients that type of devastating information - it's the doctors that handle that. I told her I didn't know all the details & she accepted that. She continued to cry. I didn't know what to really say to her. Cancer scares me, no one knows whether they will beat it or not & with it having already spread to the spine, chances are it's in other places too. They were running other tests, the results will probably be back today.

My third patient is one that has been at the hospital for over 3 weeks now. It started out with low electrolytes & nausea/vomiting. Now...I'm not sure what all is going on with her, but she looks miserable. She's in her early 40's but is developmentally delayed...has the mind of a 6 yr old. She was scheduled for a laparascopic lysis of adhesions from a prior surgery. When I assessed her, I saw that she has IV fluids running at 150 cc/hr as well as TPN & lipids.....so she was getting nearly 100 cc/hr combining those two....so roughly 250 cc/hr if you combine her IV fluids with the TPN & lipids. She had so much edema, she looked like she could pop. It was everywhere. She was third spacing big time. I couldn't understand why they were giving her so much fluid when it seemed like with the edema, it was too much for her body to handle. She was stable thankfully.

I got my fourth patient sometime during the night. A gentleman that came in because he felt like he was having a stroke. He didn't have any deficits other than feeling like his legs were weak or his speech was slurred....neither was really happening. I saw him walking around the room, his legs seemed very strong and his speech sounded very clear to me. I continued to observe him every 2 hours with neuro checks. I'm sure he was annoyed with me by the end of the shift. Nothing like waking someone up every 2 hours to ask the same questions & do the same assessment over & over.

That was my Sunday night...nothing major, just busy work. Monday night I got the same patients back. One was down for a CT scan, the other was in surgery. So I quickly assessed my remaining 2 patients & charted on them. I got my 3rd patient back...the one with cancer of the spine. The doctor that morning wanted to start radiation on her immediately...so fast that she was already having it started by 7:30 am. I went in to assess her Monday night & she was continuing to cry, followed by moments of something totally different. They have a consult ordered with the psych doctor for a history of bipolar disorder. She slept pretty much the entire night. I was thinking the radiation wore her out possibly. I was battling with her blood sugar though.

When she came back from CT scan, she wanted food. I had been told her accucheck before going for the test had been 470. So I told her I wanted to check it before I gave her anything to eat. It was 527. So I put a call out to the doctor...who of course wasn't on call & I got one of his partners....one that is not much fun to talk to. He started rattling off orders for insulin & I told him that she is on sliding scale protocol & that I already gave her 15 units of Regular insulin sub-q. I also informed him that she was on Decadron (causes your blood sugar to skyrocket). So he tells me to hold the Decadron & then says "I don't know this patient, I don't know what you want from me." Ummm....some orders on how to treat this outrageously high blood sugar. So he tells me to hold the Decadron & clarify in the morning what the doctors want to do with it & to recheck her blood sugar in 2 hours. Ok, no problem, that's all I needed to hear. So I recheck in 2 hours, it's 472. That's a better number, but still high for my comfort. So I call the on call doctor again. I'm sure he was thrilled to hear from me. He ordered 5 units Regular insulin IV & recheck in 2 hours. So I do...now it's 465. Another call to his answering service - seems now he is requesting to be called directly at home - skip the answering service paging him. So I do just that & he says "Heyyy, it's coming down." From 472 to 465 & he's happy? So he orders the IV insulin again & recheck in 2 hours. This time it was 285. I can live with that...I'm not happy, but it beats the 400 to 500 range.

While I was dealing with that, my surgical patient returned to the floor...in a great deal of pain & plenty of confusion about the orders for me. Nice combination! I was told by PACU that she lost blood during the operation & that she was given 2 units of red blood cells in PACU & that I was to give her a third unit. They leave & I assess my patient only to see blood coming through her gown...lovely. I knew they had switched the surgery from laparascopic to having to open her up. So she had an incision on her abdomen..stapled together...without any dressing. There was a small amount of blood coming out. Of course now I'm worried that she has some internal bleeding going on. I give her a little bit of pain medication...just a little bit because her blood pressure was 92/53. Didn't want the pain medication to drop her further. I look over the doctor's orders & see no order for blood. Hmmm, that's not good. So I call the surgeon to clarify whether she needs blood or not & he tells me he never agreed with that order, that she didn't lose any blood during surgery & he thought the lab results were wrong. Hmmm..that wouldn't be the first time a surgeon claimed something different went on in the OR than what everyone else is saying. So he tells me to recheck the Hemoglobin & Hematocrit & gives parameters as far as whether she needs another unit of blood. Then silly me throws at him that her blood sugar is only 71 & she is NPO (nothing to eat or drink). He replies "Isn't she on D5 1/2 normal saline?" Oops...yep, just got it started after she returned from PACU. I rechecked it & she was up to 92, which is good.

A little while later, my tech is telling me that her blood pressure is now 73/62. Are you sure? Rechecked it in both arms. So I do a manual BP....sure enough, she's 70/60...NOT GOOD. And her heart rate is in the mid 140's...NOT GOOD. I call the surgeon again to report my latest findings & he's ordering a 1500 cc bolus. Ummm, you do know she has pitting edema & is third spacing, don't you? He told me he knows, but she obviously needs fluids to drive up that BP. This is where I am confused & would love for someone to explain to me....wouldn't more fluids just cause more edema? And why is she third spacing if she is dry? Why aren't they giving her anything to get rid of that edema?

So as he's giving orders on how to treat the patient, I throw in there "Would you like her to remain on PCU or transfer to ICU?" He opted for a transfer to ICU. I don't think he would have done that had I not spoke up, but she was just too much to handle for me. I kept an eye on her vitals while she was in ICU...they were a little better, but not much. She definitely belongs in ICU right now. I have no problem admitting I'm not ready for someone that is in the condition she is. And as it turns out, the surgeon was right - she didn't need any more blood. Her hemoglobin was 13.3. The earlier one stating 7.7 was obviously wrong & he was right. I was impressed because usually we see where doctors mess up - it was nice to see where this one had it right all along.

My gentleman with the stroke...turns out he also has cancer that metastized...to his brain. Ugh, not good news. His mood was good though - I think he was just hiding the stress from me. I wish I had the right words to say when someone receives news like that...but there probably are no right words.

I'm going back for more tonight. Hopefully my night won't be so chaotic. :)

Oh, almost forgot...the title of this blog entry. Monday morning around 6 am, one of the doctors was inearly & not sitting too far away from me. I had my mp3 player playing some dance music. Next thing I know, he's all curious about it...because my phone is my mp3 player also. He starts singing...not very good, but it was cracking me up. He's asking me questions, then goes back to charting & comes back & asks "Do you have my song?" I asked what song is that & he replied "Sexy back." Yep, of course I have that song, so I turn it on & he asks me to turn it up & he starts singing & dancing around the nurses station. I was cracking up. Some of these docs can be amusing at times.

Thursday, January 18, 2007

2 Year Anniversary

Wow...yesterday was my 2 yr anniversary of being a nurse.  For some reason I thought it was today, but nope, it was yesterday.  Thanks to this journal, I was able to look back & see.  :)

To answer the question left in my comments...I work in PCU aka Progressive Care Unit.  It could be considered a step-down unit from ICU, but it's more for the type of patient that is considered in "guarded" condition.  If they become critical, then we transfer to ICU as well we get a lot of ICU transfers.  We do handle a lot of drips on our floor - Cardizem, Heparin, Dopamine, Dobutamine - although we don't titrate.  The doctor leaves parameters &/or I use my nursing judgement.  Common sense tells me that if the doctor doesn't use parameters on a Cardizem drip & the heart rate drops below 60, then it's time to turn that drip off.  The doctor eventually gets informed, but I'm not waiting for his return call in order to make that judgement. 

And yes....it seems like the incontinent patients are the ones with the orders for Kayexalate or my other favorite...GoLytely - which the name has to be a joke because that's the last thing a person does that drinks that...goes lightly...HA!  :)

Time to go celebrate my anniversary.  Woo hoo!!!


Wednesday, January 17, 2007

Awww...poor whale

Another humpback whale washed ashore in Daytona because it was dying.  It's beginning to be a common occurence...so sad.  They don't know why they are dying. 

I'm watching the news...looks like Texas is getting snow.  I didn't know they got snow.  The weather is so wacky.  It's 37 degrees in Atlanta, yet warm in Orlando...weird!!!  I'm not complaining.  I prefer the warmth - just not too warm.  60-70's is perfect.  It'll be 78 tomorrow...nice!

I worked Sat, Sun & Mon.  I already told you about my busy Sunday night...Monday I had the same patients plus I volunteered to take a direct admit right at the change of shift.  I'm nice like that...lol.  Of course I volunteered before finding out the diagnosis...I may have thought twice on that one, but it turned out somewhat ok.  It was an older woman being admitted because her potassium level was 5.8.  Normal range is 3.5 to 5.0.  The usual treatment for a high potassium level is a medication called Kayexelate.  It's not a favorite word of mine because it is designed to cause the patient to have many, many bowel movements - in order to get the potassium out of the body.  Luckily this patient was continent & able to get to the bedside commode as needed.  She was also admitted for weight loss.  She has lost 37 lbs in the last year without trying.  Why doesn't that happen to me??  I can't even lose that much when I do try...lol.  She came from a group home & personally, I don't think they are feeding her as much as they should.  This patient was on a lot of psych meds & I was told she doesn't sleep at night & has a lot of hallucinations.  Lovely.  She also told me I was a nice old woman...lol.  Gotta love my patients!

The good thing is...she did sleep.  Well, until I had her drink the Kayexalate - which she drank down as if it was chocolate milk.  She loved it.  She was able to sleep for a few hours, but from about 1 am on, she was awake.  She did have some hallucinations.  Kept telling me there were snakes in the room & some man was bothering her.  She kept me busy, but it wasn't bad & I was thankful it wasn't critical stuff like the night before. 

My other patients...they pretty much slept the entire night without any problems.  Heart rates were ok as well as blood pressures.  Except for my patient with the small bowel obstruction.  When I got there, her heart rate was in the high 130's, low 140's.  The cardiologist showed up a short time later.  He's new to the hospital, but I really like him.  He explains everything to us (the nurses).  It's like he does his thinking out loud.  He's open to questions.  So unlike most of the doctors who just want to get in & out of there...which I don't blame them.  They work a lot of hours as well as being woken up all night long with phone calls. 

Anyways, he gives me an order for Digoxin IV.  I administer it & her heart rate went from 142 to 139 & stayed there.  Not quite the results I was hoping for.  About a 1/2 hour later it was at 135.  So I called the cardiologist & told him.  He replied "Oh, that's fine.  It takes some time to work."  Hmmm, ok.  It took about another hour, but eventually it came back down into normal range & stayed there the rest of the night. 

I'm off the rest of the week...yay!  Back to work Sunday night.  Have a good week everyone!!!!


Monday, January 15, 2007

Jinxed myself - darn it!

Ahhh, it's my own fault.  I had to brag about having such a good night Saturday night, didn't I?  Last night was the complete opposite.  I barely sat down the first 6 hours of the shift!  And even after that I was busy, busy, busy. 

I wound up with the same 4 patients I had the night before plus 1 new one.  She was my busy patient.  She had been transferred from med-surg earlier in the day because of high blood pressure.  When she was hooked up to the monitor, it showed she was in a-fib...usually she is sinus rhythm.  On top of that, her heart rate had been in the 180's before I got there.  And even more on top of that (haha), she had been admitted with a diagnosis of small bowel obstruction & was vomiting continuously this very unpleasant green/brown liquid.

So I received report that a Cardizem drip needed to be started.  Her heart rate at that point was in the 130's-140's as the day nurse had pushed two doses of Digoxin to try to slow down the rate.  The surgeon showed up next & ordered an NG tube and some antibiotics.  So I knew I'd need another IV site as you can't run anything with Cardizem.  Sounds simple enough, right?  Wronggggg! 

My first priority was getting that heart rate under control.  The doctor had ordered the Cardizem to run at 20 mg/hr.  That's a high dose!  So I got that up & running, luckily she was tolerating it well & her heart rate slowly came down.  Next on the list was getting that NG tube in her as she was vomiting a lot.  We're talking 1400 cc's just since the beginning of shift. 

Before starting that, I wanted to make sure my other patients were doing ok as I had report that one of them was acting bizarre during the day....sleeping with her eyes wide open (how do people do that?), acting inappropriately, disoriented.  I went to check on her & sure enough, she was sleeping with her eyes open...either that or she just stares into space with no response.  At least she was stable!  I checked on my other patients & then got back to the one getting sick.  She was alert & oriented, but fighting that NG tube being placed.  I talked her through it & before you know it, she practically filled up a canister with output....1200 cc's instantly from the NG tube.  So we put up a new canister & another 400 came out...wow.  By the morning, she had a total of 2300 cc's from the NG tube.  Add in the 1400 emesis at night & another 1700 emesis during the day....she had a lot of stuff not getting thru that blockage.  Next on the list....another IV so she could get her fluids & pain medication.  The first one blew, but luckily the second one worked out ok.  She was finally settled down & comfortable.  She's the sweetest lady.  Unfortunately she has bladder cancer & they can't do surgery...so she claims she's a "walking timebomb."  How sad.  I was so happy to see her feeling better.  She continued to tolerate the Cardizem drip until about 3 am...her heart rate had dropped to 45 for a few seconds, then maintained in the 60's.  So I placed a call to the cardiologist to get the rate lowered.  We dropped it to 10 mg/hr, but by shift change, she was back up to 129.  Perhaps 15 mg/hr would do the trick.  I left that to the day nurse to discuss with the doctor.

Around 3:10 am, my patient that was not acting appropriately....her heart rate went from the 50's to 130 instantly.  I went to check on her & she was sound asleep = not a good sign.  So I continued to watch the monitor & her heart rate would go down to 70 & then climb back up as high as 150 & repeat that cycle over & over.  I woke her up & took her blood pressure...it was stable.  She started to maintain the 130's-140's...so I placed a call to the doctor.  Guess what he ordered...Cardizem!  So I bolus her with 10 mg, then start the drip at 5 mg/hr.  Not more than 40 min later, her heart rate dropped to the 30's!!!  Uh oh.....so I shut off the Cardizem dripp & monitored.  She maintained in the 60's.  I called the doctor to inform him of the change.

At the same time that was going on, her roommate in the next bed...her blood pressure went up in the 190's systolically...whilesleeping.  Grrr!  Luckily she had a standing order for Vasotec if her BP went higher than 180.  I gave that, rechecked about 45 min later & she was back in the 150's systolically - which tends to be her norm.  Yay!

I also saw our nurse manager this morning.  She says to me "I hear you are the moneypit of compliments lately."  Huh???  She said she has heard nothing but good stuff about me & how the patients comment on how well I take care of them.  It was nice hearing that.  I also noticed on the board some compliment cards from former patients & one had my name on it.  It feels good to know that someone appreciates the hard work I do.  :)

That was my night....just non-stop stuff.  The good thing about it is that the night flew by.  I'm heading to bed & will be back at work tonight - hopefully it will be a better night! 

Sunday, January 14, 2007

Losing patience for my patients

I finally got back to a Sunday, Mon, Tues work schedule as opposed to having to work weekends.  Yay!  I just prefer to get my work done at the beginning of the week - not the end.  I had been hoping to work a lot of nights in a row, but by my third night, I was ready for a break.  My patients were all stable, just very needy & it was driving me crazy.  They were constantly calling me in for little things...food, drinks, medication, IV, bathroom, etc.  Small stuff, but I felt like I never got the chance to sit down & the frustration was growing.  So I opted to take Wed. night off. 

I went out to dinner with one of my best friends.  It was nice & refreshing.  So much so, that I called in & volunteered to work Thursday night.  That was a pretty good night.  I had 4 patients...all for the most part stable.  Although I had one that had dementia & would get out of bed for no reason.  I opted to put on the bed alarm so at least I'd know when she was up & wandering around the room.  There was no talking sense into her.  I think her daughter brought her to the ER just so she could have 24 hrs of peace & quiet at home...seriously. 

I also had a patient I had a few months ago.  I had bonded with his wife & I enjoyed taking care of him.  He was in last time for hip surgery.  This time his blood pressure was out of control.  It was in the 200's, then after the meds, he was down to the 70's systolically.  He started out at 70/44 on my shift, but he stabilized & we had a good night. 

I took Friday night off & for some odd reason, decided to volunteer to work Saturday night...so I called the charge nurse at 1 am & asked her to add me to the schedule.  I was glad I did...it had to be the easiest night I've had in nursing...maybe ever! 

My first patient is in with a GI bleed, although the GI doctor says there is no bleed.  Her hemoglobin dropped nearly 2 pts overnight and her hematocrit dropped 10.  So something is going on. 

My second patient was admitted with congestive heart failure & A-fib with RVR.  Not much was really going on with her.  She was stable the entire night, didn't ask for much at all. 

My third patient came in with Accelerated Hypertension.  Her blood pressure had been in the 200's systolically.  They are trying different combinations of medications to figure out what works, but so far either her BP is too low or her BP is ok, but her heart rate is too low.  There's no happy medium...yet.

My fourth patient was a new admit.  She had fallen at home & broke her leg.  She has advanced Alzheimer's & was pretty much non-verbal.  The consulting doctors would be in today to decide what to do with her. 

That's it...such an easy night.  I am scheduled for tonight & tomorrow night...so off to bed I go!!!  :)


Thursday, January 4, 2007

Couldn't sleep

Today is the 1 yr anniversary of my one & only code blue on a patient that I was caring for - she died.  She was only 40 yrs old.  I still read the guest book that the funeral home has online for her friends & family.  I don't know why I do it, I just do it.  The whole experience has definitely touched me, although it's never led me to cry.  I don't know why I don't cry about it, I don't know why I still think about that night, I don't know why I still read what her friends & family write to her - I just do it & probably will continue to do so for the rest of my life. 

I wasn't able to sleep last night.  In fact, I didn't go to bed until after 6 am.  I guess this will be something that always stays with me. 


Monday, January 1, 2007

Happy New Year 2007

Happy New Year everyone!!!  Can you believe it's 2007?  Ahhh...just about 20 yrs since I graduated from high school.  Unbelievable.  Time really does fly by as one gets older. 

Not too much really going on - enjoying some time off before starting my quest to work hard for the next few months.  I really want to pay off my SUV.  I owe just under $11,000...so the goal is in sight.  After that is accomplished - it's time to start planning a vacation!!!

Hope everyone is doing well & had a safe, but fun New Year's celebration.  Hopefully next time I write, I'll be able to talk more about nursing.  Happy New Year!