Friday, April 27, 2007

Non-compliant Patient

I cannot stand when I have a non-compliant patient.  The one I had this week was a very obese male (around 400 lbs) that came in with chest pain & dizziness.  What's the first thing he wanted to do upon arriving on the floor....go outside & smoke.  Ummm, you not realize that smoking is unhealthy ESPECIALLY when you are having chest pain?  Our unit does not allow patients to leave the floor, much less go outside & smoke.  He complied with me the first night I had him thanks to my clinical leader helping out...although he tried to sneak out but I followed him & he gave up trying.  Last night, however, was a different story.  He declared he was going outside.  I informed my clinical leader (a different one than I had the night before) & I grabbed a form for him to AMA (against medical advice) form & I was fully prepared to not allow him to come back to the floor.  I told him "our rules" about leaving the floor = that we will not take on that liability & if he leaves, the only way he'll be re-entering the hospital is thru the ER where he'd have to start the admission process all over again.  However, my clinical leader did not back me up.  She basically took a "who cares" attitude & did not even speak to him one time.  So he left the floor, I informed the doctor...but without any backup from my clinical leader, there wasn't much I could do.  He came back & was being very annoying.  The type that wouldn't stop talking about nonsense...then he proceeds to go into our refreshment room where patients aren't allowed.  I said "Sir, you aren't allowed in here."  He walks out & proceeds to call me a f'n bitch.  Nice, huh?  At that point, I refused to have anything more to do with him.  I had an orientee who I had assigned to him & she put up with his b.s. the rest of the night.  At one point the patient care tech came out of his room & told me he had been smoking in there.  I, once again, informed my clinical leader...who did absolutely nothing.  I thought to myself "screw it, if she doesn't care, then why do I care?"  And I documented all that went on that evening & added in about the clinical leader's attitude & lack of involvement regarding this patient.  This is the type of patient that I have absolutely no patience or compassion for.  If I ever run into him at the hospital again, I will refuse to take care of him.  Life is too short to have to put up with someone like that.

My other patients were the ones I had over the it made it easy to get report.  I also was orienting a new nurse to our hospital.  She's not new out of school, she's been a nurse for 4 yrs...she's just new to our hospital.  It's nice having an orientee. 

I'm off now until Monday night.  I went to a baseball game tonight & I'm gonna go to another one Friday night.  It looks like my nephew is going to get an offer to play professional baseball...most likely with the Atlanta Braves.  We'll know by June.  Wish him luck!

I hope everyone has a safe & wonderful weekend!

Monday, April 23, 2007

New Doctor for Me

I got up early today...7 am. I'm sure I'll regret it tonight as I am working all night & didn't take a nap. Ahhh, such is the life of a night nurse. The reason I got up early was to see my doctor for a physical exam and to get some lab work done as well as I needed him to sign some documents for my bachelor's degree (immunizations & physical). I also had him sign a document that I need for travel nursing. This was the first time I ever went to see this doctor as my usual doctor isn't on the insurance plan that my hospital offers. That's ok, because after seeing how she treats the hospital staff and phone calls, I really don't want her as a doctor any longer. She's just awful...yelling, hanging up, talking down to them...not to mention I had one of her patient's on Friday night. The lady had an extremely high blood sugar...559. All we did was treat it with 10 units of Regular insulin & no rechecks. Not to mention the patient was in with respiratory problems and seemed to be getting worse rather than better during her hospital stay, but my doctor wouldn't consult for a pulmonologist for the patient. I asked not to have that patient on Saturday night because I did not feel safe taking care of her without any support from the doctor. Anyways, the way I picked my new doctor was on how polite he is to the hospital staff, how he treats his patients and not to mention...he used to be the chief of staff. I was impressed with how he was in the office. He spent a good 1/2 hour just talking to me about different things. He is encouraging me to go on to get a Master's Degree & become a nurse practitioner. I cannot see myself doing that. Mostly because I don't want the extra stress & I don't feel...hmm, what's the word...mature enough? I couldn't see myself in that type of role. Who knows, maybe in the future. Right now I'll just work on getting the Bachelor's Degree and travel nursing.

I worked last Friday & Saturday nights. It was my last weekend of working Fridays & Saturdays as the hospital now needs people to work on Sundays. I prefer working Sunday nights as opposed to Friday nights. I do have to have a life, ya know? :)

There's not really much to say about my one really stood out as anything different than the usual. I had a great time Saturday night with the people I worked with. We were laughing so hard we nearly cried. The kind of laughing where you just can't stop. I like moments like those. I almost got to see Kenny Chesney in concert last night...9th row floor tickets! I passed it up because I didn't want to be tired for my doctor's appt this morning. Oh well...maybe next time.

I hope everyone had a wonderful weekend!!!

Thursday, April 19, 2007

Off-topic: Virginia Tech

I'm sure by now anyone reading this has heard what happened Monday morning at Virginia Tech.  There are no words that can fully describe the evil that took place.  We are all left wondering "why???"  Now the killer's videos have turned up at NBC & after watching them, I still find myself asking "why???"  I don't think it's anything anyone is ever going to be able to answer logically.  It reminds me that although we may not always understand how or why something terrible happens, but that we need to reach acceptance in order to heal & move forward. 

My thoughts & prayers go out to those affected by this tragedy.

Thursday, April 12, 2007

It's Never What You Expect

I had an easy week this week...I chose to work only one night since I worked so much the last 2 weeks.  I really didn't want to go to work as I had woken up at 8 am yesterday & never was able to take a nap prior to going to work at 6 pm.  I felt tired...mentally & physically. 

I got to work and we started out with 4 nurses, but that quickly changed as another floor demanded they needed another we were down to 3 nurses with 15 patients.  That means we each got 5 patients.  On top of that, our patient care tech would be leaving at 11 pm and we also had no secretary.  It's so not fair to expect us to do not only our job, but also 2 other jobs as well as care for 5 patients each.

Three of the patients I had from last week were still there.  I volunteered to take them back since I was somewhat familiar with them.  One of them was an older lady that came in with shingles and cellulitis.  She was originally admitted on the med-surg floor, but she fell down there & broke her femur plus her heart rate was in the 170' she had been moved to PCU and remained there.  The family seemed to always be there & helped out a lot.

The second patient had come in with chest pain a couple of weeks ago.  It turns out he had cardiac tamponade - that is where liquid accumulates around the heart and it decreases the heart's ability to pump blood adequately.  The liquid around this man's heart was pus (ewwwww).  It is a major medical emergency and the cardiologist and surgeon were called in the middle of the night to treat this condition.  He kept the ICU staff busy that entire night when he first came in.  So by the time he got to me, he was much better as far as his cardiac status.  However, it was also found that he has cysts on his liver.  They put in a JP drain to remove some of the fluid buildup accumulating in his liver.  He was downgraded to med-surg and I transferred him around 9 pm.

My third patient is a frequent flyer...COPD and CHF.  He is non-compliant with diet & fluid restrictions so he is at the hospital a lot.  When I had him as a patient over the weekend...somehow his heart monitor was found in the toilet (gross).  I don't know what he did, nor did he...but amazingly it still 

My fourth patient was in with unstable angina.  She already had her stress test done yesterday and was simply awaiting the results.  She probably got discharged today.

My fifth patient was my problem patient.  He was an older man that was shown to be having a heart attack when he arrived at the hospital on Tuesday.  They admitted him to ICU, treated him with heparin and he was transferred to PCU.  He was confused and hard of hearing...not a good mix.  His family was a little overbearing, but I tried to be patient with them.  I try to remember that this is their loved one and they are very concerned with his health.  At the same time though, families also need to realize that their family member is usually not the nurse's only patient.  I can't spend all my time with one patient, it's just not possible.  They wanted to talk with me at shift change...when I hadn't even gotten report on him yet.  A little while later the son wanted me to come into the room and watch him interact with his father.  That's fine, I don't mind doing that.  It helps to talk to the family...especially when the patient is confused and can't really talk to you themselves.  The family left shortly after that.  The patient remained confused...would talk randomly out loud even with no one in the room with him.  When I was in there with him, it was like he was looking behind me or off to the side - as if someone or something else was there carrying on a conversation with him.  It was actually a little eery...made me think of that movie City of Angels & wondering if there were angels in the room with him....preparing him for what's to come.  You never know! 

I got a new admit around midnight.  A man in his 80's with A-fib with RVR and CHF.  RVR basically means rapid heart rate, but luckily it was under control by the time he got to me. 

It was about 2 am and I was behind on my charting.  I had been so busy - which is good because it makes the time go by quickly.  Around 3 am, my confused patient's heart rate first dropped to 47 (from 85) and then instantly went up to 159 and didn't come back down.  Ugh...I don't like when this happens at 3 in the morning.  I couldn't even tell if he was in pain, he was unable to hear or tell me.  I waited a few minutes hoping his heart rate would come back down on it's own...but that didn't happen.  I had to call the cardiologist twice to get a call back.  The patient was started on Cardizem and within a 1/2 hour, he was back to a nice rhythm and rate. 

After that I had to hurry up with my charting, take vital signs, weigh my patients, do I&O's, pass was non-stop. 

I came home & fell asleep by about 8 am.  They wanted me to come back in tonight, but I needed one night all to myself.  It's been so busy lately and I miss having some alone time.  I'm one of those people that doesn't need people around all the time.  I like it nice & quiet with nothing to do but relax.  That's my night tonight.  I watched the season finale of Friday Night Lights....that is such a good show.  It better be renewed.

My trip plans have changed just a little...for the better.  I'm still going to Hawaii, still going to Vancouver, still going to Seattle....but Portland and Long Beach are out.  Instead I'll be heading from Seattle to Lake Geneva, Wisconsin for a few days and then over to Chicago for a few days.  I've been wanting to go to Chicago for this shall be fun.  6 more weeks to go!

Have a good weekend everyone!

Friday, April 6, 2007

In a Fog

I love the song I'm listening to right now...The Dance by Garth Brooks.  Wednesday marks a month since I had to say good-bye to Jagger.  It doesn't seem like he's been gone that long.  I still miss him so much.  I have learned to cope, but his absence does not go unnoticed.  I know in the future I will get another dog...after my trip sometime. 

I felt like I was in a fog at work this week.  I can't figure out why.  I don't have too much on my mind, I got plenty of sleep, I wasn't overwhelmed with patients.  I just don't feel like myself right now.  Sunday night at work was a relatively easy night except for having to talk to a doctor that was acting like a jerk on the phone.  I'm sure I've mentioned him the past...the cardiologist that gave me a hard time when I called because we needed cardiac clearance on a patient that needed surgery.  He likes to lecture & after going on & on, he said "I don't care what the surgeon wants or what he does...tell him I said that."  The reason I was calling him on Sunday night is because I had an elevated Troponin result on someone that had come in with chest pain.  So I called the cardiologist - even made it a stat call.  He calls back & pretty much yells at me "What is going on that required you to label this a stat call?"  I explain to him that the patient had an elevated Troponin when he was admitted just an hour ago & now it's even higher on the second set of labs."  He says that is not a "stat" call & then proceeds to lecture me about Troponin levels & that just because they are elevated, it doesn't mean the patient is in any danger.  So after he went on & on, he says he has no orders to give me right now since the patient is asymptomatic.  Ok, doesn't sound right to me, but he is the cardiologist after all.  I inform my clinical leader of the situation so she is aware & even she thinks it's odd that he's not giving any orders.  I go about my night when about a 1/2 hour later, it's the same doctor calling me again.  Ugh is my first thought.  Surprisingly he is calling to apologize!  GASP!  He told me he had a long day & he is sorry for taking it out on me, that he didn't mean to come across so rude.  Wow!  Shocking!  The rest of my night went well after that.

Monday night I went into work & my name wasn't on the schedule.  For a split second I thought about walking right back out the door & going home...but since I was already at work, I may as well stay if I can.  I go to speak with the charge nurse & she tells me I can be a unit secretary in the ICU if I wanted.  Fine...I don't mind putting orders in the computer.  I think I was there for about 2 or 3 hours & only had like 3 orders to put in.  I knew it was going to be a long night...but I wasn't complaining.  I was looking forward to a night that was calm.  I prefer to be in PCU because that is the staff I work with.  I knew the ICU nurses, but they aren't as easy to chat with as the people I'm used to working with. 

By 10:30, my night had totally changed.  I was asked if I minded going to the med-surg floor & taking PCU patients because PCU was filled & the ER was overflowing.  I said "Ok, no problem."  It was myself & another nurse and we admitted 8 patients in a row...back to back...with no breaks.  It sounds awful, but it wasn't bad.  It definitely made the night fly by. 

My first patient was a woman in her 60's that in the middle of the day...started having trouble remembering things & having strange speech, balance, etc.  They diagnosed her with a TIA.  It's not a stroke, but it does present with stroke symptoms that don't last very long.  The thing is...her symptoms are lasting, although they are not exactly strokelike symptoms.  It was more like amnesia or short-term memory loss.  I'll explain more about her later.

The next patient I got came in with chest pain.  As you all know...those are my favorite kind of patients!  Everything is so routine & easy to understand...except in this case.  My patient was originally from India & only spoke Hindi.  Hmmm...that could be a problem if he was experiencing chest pain because we didn't have anybody at the hospital that wasable to understand anything he said.  Well, except, he was able to tell me he needed water with no ice...???  I wonder if he understood more than he was letting on.  Anyways...the good thing about a patient that cannot communicate with the nurse - it makes the data assessment very  Luckily he had no episodes of chest pain that night. 

My third patient was another one that came in with chest pain...he was very easy to understand.  My only problem with his condition is that he had a positive D-dimer in the ER & they never followed up with a V/Q scan or a CT of the chest to rule out a pulmonary embolism.  When I questioned the nurse about it, first she lied & said the doctor didn't want to do anything about it - that he would address it the next day.  That didn't sound right to me so I told her I would have to call the doctor tonight (it was 2:30 am) & get it clarified & he'd be upset if I called him on something that was orginally ordered earlier.  She confessed that it was never mentioned to the doctor & that she would handle it.  I didn't care that it wasn't mentioned....just tell me that up front instead of lying.  I know they were busy in the ER...I totally understood it & would have made the call to the doctor when the patient got to the floor.  The ER nurse brings the patient & the orders and all that's written is "follow PE protocol."  Ummm...what?  Does he want a CT of the chest or a V/Q scan...that's the protocol.  So I ended up having to call the doctor anyways & mentioned to him that the patient's creatinine level was just a tad bit high & CT wouldn't touch him with that lab result.  All we had left was a V/Q scan.  I explained it to the patient & his wife...they were fine with it & the test was done.  He had no more episodes of chest pain.

My last patient was actually a med-surg patient.  I was told she was non-verbal & non-responsive.  She ended up not being brought to the floor until 6:30 I made sure she was comfortable in the bed, started her IV & fluids and told the oncoming nurse that the orders were being put in now & that none of the assessments were done. 

Tuesday night I went in & found that now they had me as a PCT (patient care tech) on one of the PCU floors.  That's my least favorite job...especially when the floor is completely full.  Still though, I was happy not having to be a "nurse" that night.  It's always nice to mix it up a little.  My role as a PCT lasted about 2 minutes.  They sent a med-surg nurse to take my place & I was told to just hang out while they made sure all the PCU nurses had shown up.  So I chilled for about a 1/2 hour when I was asked if I minded going back to the med-surg floor & taking patients again.  I really didn't was a nice change.  I ended up with 2 of my original patients back.

I had the patient with the short-term memory loss again.  She was worse that night than the night before.  She couldn't remember how old she was, or that her husband was disabled & hadn't worked in 2 years or who her granddaughter even was.  She couldn't remember where she worked - even though the night before she told me in detail where she worked & what she did.  I don't know if medications played a role in her forgetfulness or what...but it was strange.  All of her tests were coming back negative & they couldn't figure out what it was that was causing this.  Scary stuff!  My clinical leader told me that her mother-in-law layed down for a nap one day & woke up unable to remember 1/3 of her life.  Strange!

I had my non-English speaking patient back.  He had gone for a stress test & developed chest pain while on the treadmill.  So they changed it to an adensoine stress test & he ended up having an allergic reaction to the medications used for that test.  I was trying to explain to him the medication I was giving him (Benadryl)...but I don't think he understood.  That's got to be scary...being in a hospital (or anywhere) & unable to communicate properly. 

My third patient was admitted the night before with COPD.  I don't even know why he is there...his labs were all very normal, no breathing difficulties, no fluid retention, he wasn't even on any oxygen.  Ididn't complain...give me all of the stable alert & oriented patients you got. 

My fourth patient was a med-surg patient.  Not the same one from the night before.  This was a new admit that had kyphoplasty done in the OR & I was getting her after the procedure was done.  She was easy to care for, but I did find myself checking on her quite a bit because she wasn't a PCU patient (so she had no heart monitor on).  I don't know if I could be a med-surg nurse now..I'm so use to knowing that my patient is doing ok by watching a monitor or at the very least...that they had a pulse.

That night was so easy that the time ticked by so slowly.  It was nice down there though.  It gave me a little taste of what travel nursing could be like because I didn't know the majority of the staff & they do things totally different down there than on PCU.  I have started doing a lot of research on travel nursing.  I just want to be sure to pick a good company & make sure the contract is written up the way I want it.  Part of me wonders if it would be wiser to go to one of the big hospitals in Orlando & try to get hired into an ICU training program to learn more critical skills before I venture off into the unknown. 

I'll think a lot about it during my trip.  It's only 7 weeks away! 

I paid for my first class towards my BSN.  It was $855 and that doesn't even include the books.  Ugh!  That's a lot of money for one class.  Oh well, a Bachelor's Degree in Nursing will be worth it in the long run. 

I worked a lot in the past 2 make up for the time I took off.  I have been off the last 2 nights, but I go back tomorrow for Fri & Sat.  I hope this fog that I feel I'm in goes away & that I'm able to think clearly again. 

Have a good weekend everyone & Happy Easter!