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!

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