Ahhhh

Ahhh, I had an entire week off of work. It was nice, I needed it. I got a lot of rest...both mentally & physically. I also managed to clean out my entire closet, for which, I am proud of...lol. It's so neat & organized right now that I don't even want to walk into it.

I also finalized my travel plans. Everything is all set...3 months from today I will be relaxing in Hawaii...ahhhh. This will be the longest vacation I've had since childhood...24 days. The plan is 3 days in Hawaii, then a 10-day cruise around the Hawaiian islands, up to Vancouver, Canada, over to Seattle, down to Portland & ending up in Long Beach, WA. I cannot wait. I'm sure the time will go by slowly until May 24th, although I have to say...February flew right by. My birthday is in about 10 days...another year goes by quickly...ahhhh.

Time to catch a nap before work tonight. Hope everyone has a great week!

Another Long Week

This past week was another long week at work.  I worked 60+ hours and towards the end, my body felt every part of it. 

Sunday night must have been a pretty good night because I remember nothing about it.  Monday night I played volleyball.  It was ok, not as good as usual because we don't have our usual team.  We combined with another team & our styles are so very different.  My team likes to do the bump-set-spike routine while the other team likes to wildly hit it right back over every chance they get.  Needless to say, we lost our first match. 

Tues, Wed & Thurs nights weren't too bad.  Nothing much really stands out as far as patients go.  One thing that continues is that our hospital is filled to capacity with patients.  So much so that we have patients holding in the ER waiting for beds to open up on the floors.  I like getting patients that are holding...because the admission assessment & data is completed.  All that's left is the actual physical assessment, which is nice when it's after midnight & the patient just wants to get to sleep. 

Friday night was a rough one.  My floor only had 3 nurses which meant 5 patients each and no tech.  Luckily I was with 2 other nurses who are really helpful...that makes a big difference when you know you can count on others to help when you need it or to even take the initiative when a patient needs something.  The other half of our unit had only 2 nurses & 6 patients each.  At least they had a tech, but still, our limit is supposed to be 5 patients max...especially when many of the patients we currently have probably belong in ICU, only there is no room for them.  They are completely full. 

I made a deal with the other 2 nurses...I'll take vital signs at 8 pm & they would do them later (midnight & 4 am).  After I got done doing vital signs, I had a patient that was very anxious...crying out...but couldn't tell me what was making her so anxious.  I gave her a Xanax & hoped that would calm her down.  Afterwards, her pulmonologist came by & asked me how she was doing.  I told her she seemed extremely anxious.  He told me she had about a liter of fluid in her left lung & he was probably going to do a thoracentesis (drain the fluid) the next day.  She was complaining of pain all over, so I gave her 2 mg of Morphine IV...after that she was more comfortable. 

My second patient was doing well.  She was rather calm as opposed to the previous nights in which she had been crying because she needs to go to rehabilitation before she can go home.  She just wants to go home to Tennessee.  We talked about it the last few nights & I tried to tell her that the rehab will make her stronger & isn't that a better idea than going right home & ending up in the hospital again.  She was at peace with the decision which was nice to see. 

My third patient was pretty easy to care for.  She probably should have been discharged that night only the cardiologist hadn't given the ok yet.  She had a stress test during the day.  Luckily she was ok with staying the night. 

My fourth patient I had all week.  She was a woman in her 80's that lives alone at home. How she is able to get around, I don't know, but it was apparent that she was unable to care for herself properly at home.  When I got report from the ER earlier in the week, I was told she had a little bit of redness on her buttock area.  Well, my idea of a little bit of redness is far different than that ER nurse.  This patient had stage 3 decubitis on her buttocks/coccyx and her lower right leg.  So much so that there was a consult for wound care.  She was totally alert & oriented, only she also existed in her own little world.  She claimed her boyfriend was Dean Martin and thought she was staying in a hotel (as opposed to a hospital).  The psych doctor was consulted & deemed her incompetent which means she'll be sent to a nursing home or skilled nursing facility when she's discharged.  All she wants is to go home.  I'm not sure she realized she wouldn't be going home again....that got to me when I had a little bit of free time to think about it. 

My fifth patient was the one that kept me on my toes.  She was admitted earlier in the week to ICU with respiratory failure...only we had no ICU beds available, so they brought her to us & quickly downgraded her.  She also had diabetes & her left foot was gangrenous...not enough circulation.  I checked her blood sugar only to find out it was 36.  She was arousable though not totally with it.  I rechecked it & got a 31.  I gave her some orange juice that had a few sugar packets added to it.  I wasn't getting the result I wanted, she was still out of it so I got some D50 & went the IV route.  Within minutes she was alert & asking what was going on.  I rechecked her blood sugar & it was 260...a little high, but I'll take that over a 31.  Ok, crisis over, so I thought.  It's about 11:30 pm now & I sit down to finally start some charting. Nope!  Her heart rate is maintaining a rate between 38 & 42 even while awake.  Luckily her blood pressure was stable.  I watch the monitor for a little while & there is no change.  I was worried that when she fell asleep, it would drop even more as that's what heart rates tend to do while at rest.  I talk it over with my charge nurse/clinical leader & she advises me to call the doctor, but make him aware that we don't have any ICU beds available.  Great!  I call the admitting doctor & he tells me to call the cardiologist....did I mention there is no cardiologist on her case?  I inform him of this, so he advises me to consult one & get his input.  There's nothing like calling a doctor at midnight who has no idea who the patient is because he's never seen her before & ask him what to do for her.  They just love that...lol.  So I say a little prayer & hope that his partner is on call because the partner is a lot nicer to deal with.  Luckily the partner was on call & called me right back...not only called right back, but thanked me for calling him????  He advised to hold the morning blood pressure medications & to have an external pacemaker at bedside (we already had that set up before the call).  That was it.  So I nervously watched the monitor all night & her heart rate stayed between 38 & 42 the entire night. 

I was glad when that shift was over, not to mention I was tired.  I went to my parents house Saturday morning, got about 2 hours of sleep & then celebrated my nephew's birthday.  The weekend has flown by...I still feel like I'm catching up on sleep.  I haven't decided what nights I'm working this week...I'll figure it out later.

My vacation of a lifetime plans are going well.  The airfare is all taken care of as well as the cruise.  Just need to pick out the hotels.  I'll be applying for my passport sometime this week.  I'm leaving on May 24th...I cannot wait.

I took my niece to see Bridge to Terabithia today.  I'm not sure what I thought of it....I did not like the ending.  I won't give it away, but I totally did not understand why they twisted it the way they did. 

Nascar started this past week...yay!  Tony Stewart was doing so well, then ended up at the back of the race...worked his way to the front only to end up in a crash & out of the race.  That's too bad...he would have won that race had that not happened.  A little while later Dale Jr. crashed out also, so my interest was pretty much gone.  I'm glad the season has started, it's my favorite sport lately.

Oh...another thing...just wanted to say to a friend of mine...CONGRATULATIONS NURSE CINDY....she graduated from nursing school last week & had her pinning ceremony. 

Have a good week everyone!

 

So, so tired

It's been a long, tiring week. I worked Monday thru Thursday night. It had been a somewhat decent week until last night - mostly because we were without a patient care tech. Of course that happens on a night when I could really use the extra help as I had two very needy patients and another in critical condition...luckily my fourth patient slept practically the entire shift & needed nothing other than medications.

My needy patients...one had a cardiac cath that day & was brought back to the floor at shift change. Why do they do that? It's the worst time to bring patients to the floor. She had orders for complete bedrest until the next morning. This was my first night caring for her, but I was familiar with her as I had taken care of the patient in the other bed in the same room the last 3 nights & this one would complain about how come I wasn't her nurse also. I had to explain it each time. I could tell she had anxiety issues, but luckily they didn't come out on last night's shift. She loved her call light though.

My other needy patient was a man in with CHF. I was told he was very easy to care for...which as in most cases, it ends up being the opposite. I had antibiotic IV medications to give him & of course his IV wouldn't work. When it came time to put in a new IV, he refused. Refused to have an IV, refused any medications via IV. I tried to explain to him the advantages of IV medications as opposed to meds you take by mouth. He didn't care, he didn't like needles. It still surprises me how many adults are afraid of needles. Anyways, I called his doctor & got the medications changed to pills. Which then later complained that they made his stomach hurt. Ummm, didn't I tell you the advantages of IV vs. by mouth?

He had a dressing change for a foot amputation that was scheduled for 10 pm. Since I had no patient care tech & was running around trying to keep everything in order, I didn't get to do the dressing change until 11:45 pm. I documented exactly why it was done late - that we seemed to be short-staffed and without a patient care tech. Which was a semi-lie because they sent nurses home & called a few off....we always use a nurse as a PCT if we don't have enough PCT's. So there was no excuse other than to save on $$$$. I probably shouldn't have charted it exactly that way, but let's say hypothetically one day I'm called in & asked why it was done so late...I wouldn't be able to remember other than my charting notes. It's pretty self-explanatory. This guy was on the call light most of the night. That can be time consuming in itself.

The patient that had me worried was an older woman in with respiratory failure, GI bleed and anemia. She received orders in the ER at 7 pm for 3 units of fresh frozen plasma now. She got to the floor around 11:30 pm and not one unit had been hung yet. So much for emphasizing the word "now." When she got to the floor, she was pale, her lips were bluish-purple, her lungs were wet...her breathing sounded like one of those coffee makers that percolates. She was a DNR, but that doesn't make it any easier for me. One of the ICU nurses walked by & stopped & then asked me if the patient was dead. Huh??? Don't say that! She looked that awful. She belonged in ICU, not PCU...but somehow she was mine for the night. I hung the first unit of FFP...I didn't run it as fast as I could have because I was afraid of fluid overload. I had no order for Lasix (diuretic) inbetween the units...so I ran the FFP between 100-150 ml/hr. An additional order was if her hemoglobin drops below 8.5, transfuse 2 units of red blood cells. Sure enough, the lab results were back...she went from 8.9 to 8.1 in just a few hours. Ok, hmmm, do I continue giving the 3 units of FFP or interchange the RBC units inbetween the FFP units? I discuss it with my clinical leader & we decide that since it seems she does have an active internal bleed somewhere, it would be better to give all the FFP first so when we do give the blood, the FFP will hopefully slow down the bleed in order to benefit from the blood transfusion. On top of all that going on, she had some liquid stool that had that icky C-diff smell & she was unable to let me know when she had to go. The one night I could have used a patient care tech was a night like this...go figure.

I managed to keep her alive through the night & was so glad to see the day shift nurse take over her care. I had a patient earlier in the week that came into the ER...a patient with a DNR from a nursing home. She not only coded in the ER, but went into asystole...long period of asystole (flat line). I guess since the nursing home didn't send over the DNR paperwork, the ER had to code her. She came back from the dead, the family consented to a pacemaker & she was back to normal. Weird how things turn out.

I'm very tired...heading to bed. Tomorrow I make the plane reservations for my vacation in Hawaii. I am going first-class. Hey, if it's supposed to be a trip of a lifetime, I'm making sure it's done the right way. I got some vacation time approved at work...so I could be away for 5 weeks if I wanted. I'm still deciding on whether to go to Portland & Seattle after Vancouver. I'll figure it out tomorrow, I'm too tired to think about it right now.

Have a good weekend everyone!

Neighbors Helping Neighbors

That is the theme that is taking place after the killer tornadoes Friday morning...."neighbors helping neighbors." It is so refreshing to see how many good people there are in this world. One area that was hit really hard was The Villages. It's mainly a retirement community...a very nice retirement community...the Disney World of retirement communities. They have something called An Ambassador Club in which people make their homes available to others in need. It has really come in handy after the devastation. In fact, they have more homes available than people in need. That's pretty nice.

There are of course a lot of sad stories being reported also. In one instance, a mother, her daughter & granddaughter all died. A father trying to protect his 7-yr old son...they both passed away. So far a total of 20 people died. I thought for sure it would be higher, I don't know how some of these people survived. Their homes are literally gone & yet, they are not only alive, but uninjured. God really does work in mysterious ways. Then you have those that are posing as a helpful, kind citizens only to find out they are crooks & stealing what they can. How can anyone do that? Seriously, how sick is your mind that you can steal from someone that just went through this horrible ordeal? They also showed some young men that were hovering around the home where the mother, daughter & granddaughter passed away...because they wanted to steal stuff. Their replies..."well they're gone, they won't need it." Ugh, sickening. I don't even want to try to understand that thought process. I can only hope that one day they get what's coming to them.

I commend newly appointed Gov. Crist for doing an excellent job. He just took over the role of Gov. but I think if anyone had doubts about him before, they don't anymore. He has been totally hands on & getting people what they need as well as FEMA & all that they are doing.

One thing that I don't agree with is people that say it's the govt's fault this happened or it's the govt's fault that we didn't have a better warning system in place. I suppose if I was where they are right now...I'd be questioning why & looking to blame someone also. Since I'm an outsider to their pain, I have a different viewpoint. It was a natural disaster. The weather forecasters had been warning us since 1 pm that afternoon that there were tornado watches & warnings. It's not uncommon to have a tornado watch...most of the time nothing happens. Sorta like hurricanes. They want tornado alarms/sirens some such device installed, but I don't think it's a good idea. I think there would be a lot of false alarms & before you know it, no one would pay any attention to the alarm. For $25 you can get a weather radio that will signal..but the thing is, it would have been going off all evening because those tornado watches remained in effect all night long. The weather forecasters were on tv all night long. I guess that should have been a real clue now that I look back - since when to weather forecasters stay on the air all night long for a tornado watch? But what are you going to do, stay up the entire night "just in case." No. Besides, even with the warning - would it have made much of a difference? I am of the belief that when it's your time to go to heaven, then it's your time - there's no escaping it.

They say it was 3 tornadoes that spanned over 70 miles from beginning to end. It started near the west coast & made it all the way over to the east coast & took out everything in it's path practically. Florida has never seen anything like that. Heck, I doubt most of the US has ever seen tornadoes going for that long of a distance. I am surprised that no one has any video footage of it. I thought it would definitely surface. They say the winds were estimated at 150 to 165 mph. No wonder those homes & businesses were torn apart instantly.

Tonight my Chicago Bears lost the Superbowl to the Indianapolis Colts. Oh well, at least they made it that far. Maybe next year will be a better year. It was an entertaining game, that's all I can ask for.

Time to get back to work tomorrow night. I'm hoping to put in a lot of shifts, but as usual, I'll take it day by day. Have a good week everyone!

Tornadoes

Early this morning central Florida had many, many tornadoes touch down & wipe out homes, neighborhoods, businesses, etc.

Luckily I'm fine as well as my family & friends...but there is so much devastation. I was awake the entire night as my plan to stay awake until 10 pm last night didn't happen. Instead I fell asleep from 3 pm to 10 pm. So I was awake all night & I knew the weather was odd...it was very windy...like what you see during hurricanes. Never did I think it was going to end up like this. I would be surprised if the death toll isn't in the hundreds. Please say a prayer for these people that are having to deal with the reality of a tornado. It is a very sad day in central Florida.

Change of Plans

Noooo, it's not what you're thinking!  I'm still planning to pursue a Bachelor's Degree in Nursing.  My change in plans is to push back my goal of paying off my car by June & shooting for December.  Why you ask?  Because I am planning to go on a much needed vacation to....

 

 

HAWAII...woo hooo!!!!!!  The plan right now is to fly to Hawaii on a Thursday...stay in a hotel for 3 nights & then take a 10 day cruise around the different islands & end up in Canada.  From there I can either fly home or continue the trip to see Seattle & Portland...these are all places I've never been to before. How can I pass it up?  It will be expensive, but I have until May 24th to save up some money...that's why I'm putting off paying off my car.  I want this vacation paid for before I step on that plane. 

Of course my plan to work hard starts next week...I only worked 1 night this week & that was enough.  It was a very easy night - I felt as though my patients had been drugged or something because they all slept practically from the time I got there & were still sleeping when I left.  Other than medications & something to drink, they never called for me.  I was considering working tonight or this weekend, but my sleep schedule is so messed up.  Yesterday morning after work, I got about 4 hrs of sleep...then got up & went to watch my oldest nephew play baseball.  He's in college now & it's a lot different than high school.  I actually liked the high school games better.  It was so cold out that we couldn't stay for the entire game.  Next time I'll bring a blanket! 

Last night I saw the movie "Catch and Release."  I was worried cause the critics had been slamming it...but I've learned that 9 times out of 10, the critics are wrong.  I usually like whatever they don't & can't stand what they do like.  It's a total chick flick...pretty good movie.  I tried to get some sleep last night, but only slept for about an hour & have been awake ever since.  I feel like a zombie right now...I know I'm lacking sleep, but I don't want to take a nap now & be up all night again...so I'll force myself to stay up & maybe just go to sleep around 10 tonight...I have to see Grey's Anatomy. 

They are enforcing that working weekends rule at work again so I went ahead & signed up for every other weekend.  I need to work a lot anyways & I don't mind having days off during the week. 

There's not much to really say about my patients this week as they slept 95% of the time I cared for them...except my new admit who was very dramatic.  She came in with chest pain and also diagnoses of anxiety, dizziness & bipolar.  I was told she had already signed an AMA (leaving against medical advice) in the ER, but they managed to talk her into being admitted....not a good sign.  She was very different than the usual patient...not quite sure how to describe it, but I was getting the impression that she was drug seeking.  I could be wrong, but she was insisting on something stronger than the Lortab that was prescribed EVEN THOUGH she wasn't complaining of any pain.  She said she felt dizzy.  Well, I'm not going to add a stronger pain med to that symptom.  She came up to the floor around 11 pm & by 4:30 am she was complaining that she was still feeling the same way as when she came in & why wasn't I doing anything.  I wanted to say I'm a nurse, not a miracle worker.  I found that the less time I spent talking to her, the better.  That doesn't sound that nice, but in this case, I think she was thriving on any attention she was getting.  She started complaining of a bad headache...while having the tv right in front of her face with the volume up & she refused to turn it off.  I know for me when I have headaches...a dark, quiet room works wonders.  I did give her a Lortab for the headache & left her to continue watching her tv shows.

I'm still waiting for the official admittance from the collegefor my Bachelor's degree.  All we are waiting on are my official transcripts from the other 3 colleges I attended.  I'm beginning to think I'm a professional student.  3 colleges = 3 degrees.  I am good at finishing what I start...lol.  I think my hospital will only pay $1500 a year, which is basically nothing as the classes are anywhere from $750-1500 each.  My hospital also wants a commitment that I'll continue to work there after I get my degree & I am not sure I want to commit to that...so I will probably just end up paying for it all myself...yet another incentive to work more.  Time will tell.