Monday, February 19, 2007

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  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!



tendernoggle said...

That is so sad about the eldrly ady having to go to the nursing home ...but hten again she will be watched...I hope she did not have any pets at home...
love ya,

am4039 said...

omg sounds like you  had a busy week. To bad for that 80 year old woman.  She doesn't know what's going on. May will be here soon enough so you can enjoy your vacation.

ceejaec1 said...

Thanks for the congrats, Jen!!  I finally got to sign up for NCLEX.  I take it March 20th.  Now, you get some rest and dream about that vacation!  It will be here before you know it, and you've earned it my friend!!!  Oh yea, and in case you didn't know.....YOU ROCK!!!


molly146012 said...

wow! you had another busy will be ready for that vacation! :)
enjoyed your post.  Molly

l7cupid said...

Hey Jen!

It was nice to come home to a new journal entry.  You had such a busy week!  I'm so excited about your upcoming vacation.  You have certainly earned the trip of a lifetime!  Have a good week and get some well needed rest.  I agree with Cindy.  YOU ROCK!!


steveb2221 said...

Hi Jen ( and everyone else)... sounds very familiar with the packed house... we have had patients , holding in our ER for 3 and 4 days at times. Makes it very difficult for the ER, as our incoming load doesn't get any lighter. I hope you have the butt kicking-est vacation ever... Cindy... CONGRATS, I dont envy you... not so much for the test, but the 2 days of misery waiting to see how you did afterwards!!! Good Luck!!!