Beauty Fades, Dumb is Forever

For those of you who know me well...you know that I am quite close to my niece.  I've practically been like a second mom to her & my nephew from the time they were toddlers because my brother & sister-in-law were separating & fighting.  I was the one that stepped in & made sure that those little kids didn't have to be in that environment.  While my ex-sis-in-law made a feeble attempt to be a mother to them, she was more focused on partying & picking up men for about 5 years.  I remember her telling my mom shortly after having the kids "When is it going to be time for me to have fun?"  Ummmm.....how about you think about that before you decide to have children.  Anyways - to make a long story short - they divorced & she hooked up with the guy my brother found her cheating with & she had a baby with him.  They are living together, but no marriage & my niece cannot stand this guy cause he is always yelling at her & my nephew.  It frustrates me that out of the 9304802394903214901 men out there, she'd have to pick the one that has a grudge against my brother because my brother beat him up when he discovered his wife was cheating.  Anyways...all of a sudden now, my ex-sis-in-law has decided to be a parent - which is great - she should be making those children a priority.  However, at the same time, she has decided that my brother & my side of the family cannot see them anymore.  Yes, my brother has a court order to see them, but he has gotten himself messed up with a DUI & a probation violation - so he will be spending a little time in jail.  So he can't take her to court to enforce the visitation until he gets his stuff all straightened out.  Who knows how long that will be.  I'm frustrated because it's been about 3 weeks since I've seen the kids & even though my ex-sis-in-law says I can spend time with them - when the time comes, she won't answer the phone or make good on her promises.  I'm not looking for any answers here, I'm just venting.  I know this subject matter definitely doesn't belong in a blog about nursing, but I have to release this frustration.  I know the real reason behind blocking me from seeing the kids is because she is resentful/jealous of the bond I have with them.  If it came down to it, both of those kids would rather be with me than her &she knows this too.  Her loser bf just adds to the drama instead of trying to find ways to resolve it.  I feel for the kids because this is all they know in their world - a revolving world of chaos & instability except when they are with me.  I know they'll be alright, but I worry.  They are 10 & 8 - getting to those crucial years of where they can be tempted down the wrong path.  I guess all I can do is be there if/when they need me.  Ahhhh, so frustrating.  Like Judge Judy says...beauty fades, but dumb is forever - my ex-sis-in-law is a shining example of that quote. 

My week at work started out good - I was actually glad to be at work on Sunday night because it gave me time to focus on something other than the family drama.  Two of my patients I had had in the past & they were really nice gentlemen.  My group was practically ready for bed by 9 pm.  I was having to wake them up to take medications!  I had the same group on Monday night, but the night didn't go as smooth.  The two patients I had in the past both were having symptoms I couldn't do anything about.

One woke up all shaky & even though he was breathing ok, he didn't feel like he was.  I checked his blood sugar because his doctor had been ordering for him to get 20 units of regular insulin twice a day REGARDLESS of what his blood sugar was as well as 35 units of Humulin (longer lasting) twice a day AND to also cover with sliding scale protocol.  It just did not sound correct to me.  I don't even give that much insulin to someone with an extremely high blood sugar much less someone that is around 150 or 200.  I tried talking to the doctor about it & he looked at me like I was the crazy one.  So I checked his blood sugar figuring he was probably crashing from these screwed up insulin dosages...he had gone from 250 to 106 in a couple of hours.  I thought maybe it was too fast of a drop for him, so I got him some orange juice and graham crackers.  The shaking stopped & eventually he was feeling ok. 

My other patient was in with congestive heart failure although he had been complaining more about feeling dizzy.  He woke up at 2 am with the complaint:  "I just don't feel right."  He couldn't describe it beyond that.  Myself & two other nurses were asking him a 100 questions to try to draw some symptoms out of him, but everything was ok other than "I just don't feel right."  I can't call a doctor & say that..especially at 2 am.  We stood there looking at him - unsure of what else to do.  His vital signs were fine, his vision & speech were fine, he was answering questions appropriately...what do you do?  He had no pain, no discomfort, not nothing except not feeling right.  I advised him to lay down & see if it went away.  He ended up going back to sleep & that was that.

After that, my first patient woke up again shaking & not breathing right.  His blood sugar was about 121 - so I didn't think that was the problem.  He also added nausea to his list of complaints.  Ok, I can call a doctor for that - that is something easily treatable.  So I get the order & give him the medication - he is doing better....laying down now...only to get back up an hour later & have the same symptoms all over again.  He originally came in for chest pain, but he wasn't having any of that.  He's actually been coming to our hospital for the last 4 or 5 months with different symptoms & they haven't been able to figure out what was causing him to feel ill.  I told him next time try a different hospital.  I mean why would you keep coming back to a hospital that you are frustrated with because they didn't have any answers?  His doctor usually rounds first thing in the morning - but of course on the morning I needed him there to witness the patient's symptoms - he was nowhere to be found.  He didn't come into the hospital until 5:30 pm.  Figures!  For some reason he wrote an order to transfer him to another hospital to do a pacemaker evaluation.  I don't think the patient needs a pacemaker as much as he needs his medications readjusted.  Oh well, I'm not the doctor.  I was glad to see he would hopefully get some different answers at the other hospital.

Tuesday night was my third night in a row - usually that is the easy night as by then I usually know my patients after having them for a couple of days.  This week it was reversed.  I got a new admission at 8:30 pm.  A 47 yr old with chest pain - I love people with chest pain because they are pretty much easy to treat & for some reason I remember that protocol the best out of anything else.  And when they are young like that - it is usually more related to stress than an actual cardiac problem.  My patient arrives to the floor & the ER nurse says to me "He just said for the first time today that he has been having extreme chest pain all day & night - but didn't want to bother us."  Why do they wait until they are on the floor to speak up about pain?  And wouldn't you know it - no pain meds had been addressed in the ER - I don't know why - he was being admitted with chest PAIN.  So I call the doctor & get some morphine & nitroglycerin sublingual.  I give him 2 mg of morphine IV & nothing changes.  I give him 2 more mg - no relief.  I go with the nitro this time - no relief & now his blood pressure is just over 100.  The patient had a CT scan of the chest to rule out aortic dissection.  I was worried maybe something really was wrong so I called the cardiologist who had already seen him in the ER.  He said there was no way this patient had an aortic dissection.  I said "Ok, what do we do for his unrelieved chest pain?"  His answer: transfer to ICU and start a nitro drip.  Grrrr...all that work just to send him to ICU. 

Later that night I also got another admission with chest pain - he seemed a bit dramatic the first 1/2 hour he was on the floor, but luckily he had a good ER nurse who rather than bring him to the floor as he complained about chest pain right before being transferred to my floor - the nurse pulled the ER doctor in to assess him one more time & got him not only pain medication, but also anti-anxienty medication AND gave it to him before bringing him to the floor.  Just about any other nurse would have dumped him & left me to call the doctor & get the medication & delay treatment by about a 1/2 hour.  So the meds kicked in as I was asking the 984013490130941 admission questions.  He went to sleep after that & the rest of my night went smoothly. 

It looks like we aren't overstaffed at night anymore - easy come, easy go...lol.  Three of the night nurses opted to go into the ICU training program and another one quit - so hopefully I'll be able to pick up a lot of overtime in the upcoming months.  I really want to pay off my car by the end of the year & put some in savings.  That's the goal.

My puppy Shay is continuing to grow...she's nearly 40 lbs now.  Somehow I don't think she's done growing - so much for the vets saying she'd be petite & about 40 lbs max.  I had her in the car today & she was barking at a motorcycle rider.  She definitely will be a great protector.  Here's another pic of her!

 

 

Volunteering & Denial

I started off my week with an ACLS re-certification class.  So much has changed in 2 years!  It's a good thing I barely remembered anything I learned when I took the class 2 years ago, because it's changed a lot.  It's much simpler, the algorhythms are easier to follow, less medications to use...just way easier than the last time I took it.  I'm glad I decided to renew it, it was a breeze.

I volunteered to work Tuesday night.  I don't know why I did, I just did.  Of course as Tuesday came around, I was regretting it - but I thought to just grin & bear it - I could use the money anyways.  As a result - we were overstaffed, which is always a good thing.  However, we only had a patient care tech until 11.  Ugh!  I'm tired of them assuming that just because we have 4 patients instead of 5, suddenly it should be primary care nursing - ESPECIALLY when the patients we have...the majority are total cares which is time consuming.  It feels more like a nursing home than a hospital lately. 

My first patient was an 89 yr old man that had passed out at home, fell & hurt his head and leg.  He had a big laceration on his head that they closed with 9 sutures.  Amazingly that wasn't causing him any pain - rather his leg hurt from the fall even though there was no fracture.  He was a very pleasant man.  When I went into his room, I noticed he was watching the tv show Big Brother - the finale.  I asked him if he liked this show & he said he did although he did not care for the guy that eventually ended up winning - those of you who watch Big Brother will understand that completely.  I laughed to myself because that show has been frustrating me for the past couple of months with all they allow that creepy contestant to get away with.  It just amused me that this man who is nearly 90 yrs old watches the same show I do & he knew everything that was going on in the show.  It was cute.  Other than having some leg pain, he was stable & easy to care for. 

My second patient is one that finally came out of denial.  She's in her early 50's & was diagnosed a couple of years ago with cancer.  She chose to do nothing about it - other than pray.  Not a good decision. It has caught up with her & she doesn't have much longer to live.  She was admitted last week when I was there, so I was suprised she was still at the hospital.  Well, as it turns out - Tuesday night is the night the oncologist decided to tell her there are no more options - her liver has had it.  There is nothing more that can be done.  I had no idea the doctor was planning on telling her this - it sure would have been nice if he would have given me a heads up, you know?  I went in to assess her & found that she had like 5 or 6 women in there all praying around her.  I gave them some privacy & told her I'd be back later.  It was then that I looked at her chart after the doctor was done with it & saw that he ordered for a Hospice Consult.  There was nothing in his notes...well nothing legible in his notes...no one could read his handwriting. 

Without directly asking the patient what they discussed, I was able to get the conversation out of her.  I just had to make it seem like I knew what was going on - which is not always so easy to do.  She appreciated how gentle I was with her & that I allowed her to have time with her close friends without any real interruptions.  It was common sense for me to do what I could to allow her to come to terms with such devastating news & I was very grateful she had a close support system.  There is nothing worse than a doctor giving news like that to a patient sitting alone in a room & then left by themself to think about it.  So heartbreaking.  I called my clinical leader & told her I don't know what the admissions look like in the ER, but I do not want anyone put in that room because I felt she needs to have her friends close to her tonight.  There was no way I was about to kick any of them out...semi-private room or not.  Luckily it worked out to my favor...we only had room for one more admission & even though she could have gone into this room...my clinical leader opted to put her in a different room.  I like when things work out like that & that a clinical leader is able to stop & think about the needs of a patient rather than the needs of the hospital first.

My third patient - another sad case & another one in denial.  He came in with congestive heart failure - he's in his mid-40's.  Wayyyyyyyy too young to have all the problems he has.  He is nearly 400 lbs...which isn't what I'm criticizing.  Most of us have some kind of weight problem that we all think about & try to improve.  What was his problem was that his weight was causing the health problems he was having, yet he didn't want to do anything to change it.  From the time I assessed him until this morning...all he talked about was food...junk food.  I didn't get it.  Most people who are in the hospital & the doctor discusses with them the need to lose weight...they usually are agreeable & do what they can while they are in the hospital to be compliant.  I'm sure most go home & fall back into their normal eating habits at home.  Not this one...all he did was talk about all the food he's going to eat when he leaves the hospital.  On top of having congestive heart failure, he had what can only be best described as sores all over his legs....deep sores, many, many, many deep sores.  Sorry to gross some of you out...but these sores were oozing blood & pus.  Gross! 

Actually, the reason he came into the hospital is because while all of these sores were developing on his legs...he was in pain & would take lots & lots of Advil.  Not a smart idea...too much Advil or any over the counter pain med can cause ulcers &/or bleeding.  He had bleeding ulcers that were starting to eat thru his stomach lining.  Once that happens....dying is a possibility.  So they fixed his ulcers & they covered his legs with many, many dressings and unaboots, and abd pads & then put ace wrap around it.  Because before they did this...all that blood & pus was weeping onto the pads & sheets on the bed (ewww!).  I thought...hmmm, looks like they wrapped his legs really good - I doubt anything will seep thru. 

Ummmm...wrong answer!  Within hours it was seeping thru all of the bandages.  On top of that, his stomach was so large that underneath it where the crease overlaps the pelvis...it was soooooooo red & raw and his thighs had rashes.  I've never seen anything like the sores on his legs or the rawness on his abdomen.  And all he could talk about was food.  Go figure!

My fourth patient...well, he was different.  He was found to have a mass in his neck at another hospital.  For some odd reason, they transferred him to our hospital.  I have no idea why...no one transfers to our hospital for help (sorry, it's true)...we send patients to bigger hospitals for better treatment.  I couldn't understand why a bigger hospital was sending us a patient with a neck mass. 

Anyways, this patient felt the need to smoke a cigarette...in his bed.  Yes, in his bed.  Another nurse was able to intervene because I was in with another patient.  She took his cigarettes & put them under water & thru them away.  I tried to explain to him that you cannot smoke IN a hospital & on our floor - you cannot go outside to smoke either.  It's just not allowed.  Luckily he was compliant the rest of the night - not that he had much choice since he no longer had any cigarettes...but he didn't put up a fuss about it either.

It wasn't a bad night for me, but many times I asked myself "Why did I volunteer for this?"  I am glad I did though.  More money = less bills.  I'm off now until Sunday night...then it's back to the 3 nights a week for awhile.  I purposely signed up for more shifts than I usually do because we seem to be overstaffed at night & it's not so easy to pick up shifts.  I'm sure it will even out by December/January when we start getting really busy.  I want the overtime.

My puppy Shay is doing well.  She recovered 100% from being spayed.  She almost got hit by a car on Monday night though.  She was in my backyard & my brother came over & was coming in thru the gate where she was...she ran out & he thought she'd run right to him since she was so excited to see him.  Instead, she went running straight for the busy road I live on.  I was in the backyard & heard him screaming her name & I knew something was really wrong.  So I started yelling "cookie" & "Who's hungry?" because as soon as she hears those words - she is right at your side.  My brother said she was like 2 feet from the street & when I said those words...she turned around & came running right back.  Whew!  I looked at her the rest of the night while silently thanking god that she didn't get taken from me.  I'm really attached to her now.  She's not the same as Jagger - no dog ever will be, but she is unique in her own way & she's turning into a pretty good protector.  I still need to get her into some puppy training classes.  I'm even thinking of sending her to boot camp for dogs...lol. 

I hope everyone is having a great week!

Finally Recognized

It was supposed to be an easy week: 2 nights of work & 1 night of Basic Life Support Class.  I went in on Monday evening & found out I was the Unit Secretary.  No problem...I don't mind putting orders in & Monday was Labor Day so most of the doctors had already been in before I even got there.  So I thought it would be a slow, but uneventful night. 

They had 3 codes during the dayshift - I know 2 of the patients died, not sure about the 3rd.  We haven't had many codes at night lately - well, except the one I accidentally set off from sharpening my pencil!  The wire from the pencil sharpener tripped the code blue button thing we have at the nurses station.  Luckily I was able to cancel it before anyone really showed up - especially the ER doctor.  It's the second time I've accidentally done that, but really...it's not my fault.  We should have a better button on the wall than the one that barely stays up & will set off with the tiniest of movement.

I was told around 11 I would be pulled to the North side to be a nurse & take admissions because the emergency room was packed.  They weren't kidding - I got 5 admissions in 6 hours.  Whew!!!!!!  Luckily, I had another nurse there to help put all the orders in and a really good patient care tech to make sure the patients were comfortable, vital signs taken & heart monitors on.  It's the little things that really do matter the most. 

I got a little annoyed with the ER when they brought up the second and third admissions within 10 minutes of one another.  I understand they were busy & pressured, but at the same time, I have to be able to assess my patients properly.  Especially these two - one was in with a TIA vs CVA (stroke) and he was acting all loopy & disoriented.  I really thought he was going to end up falling & breaking a bone.  Luckily the worst thing he did was drop his urinal & urine went all over the floor...ick. 

My other patient - as soon as he got to the floor & the ER nurse left, he starts violently vomiting.  Luckily, the patient care tech had asked me for the garbage can right before this happened & this patient was alert & oriented enough to get it all in the trash can.  Whew....disaster averted.  We're talking like 1000 cc's of vomit.  The good thing about that is he felt perfectly fine after getting that out of his system.  His wife, on the other hand, I thought was going to fall at any moment.  I went to get her from the waiting room & she was staggering down the hall.  I don't know if she needed a cane, a walker or was simply exhausted - it was about 3 am. 

I thought maybe I'd luck out & that would be the end of the admissions...but they started back up around 5:15 am.  Two in a row.  They were stable - so all was good.  I took it all in stride.  What else could I do?  It's my job.  I did joke to my clinical leader that none of these patients better be discharged by Tuesday night because I did not want anymore admissions.

Sure enough, one did go home & I had to get one admission on Tuesday evening - but that was fine.  I got a card from my manager - she took the time to write about the situation and how wonderful my attitude was.  I also got a little symbol thing that they give out when you do something above & beyond what is required.  It's just a small thing, but like I said earlier - it's the little things that mean a lot.

Wednesday night was CPR class.  It was pretty simple - a few things have changed as far as the amount of compressions you do.  A nice refresher class.  She also reminded us of how important it is for us as healthcare workers to help out when out in public if we see a situation going on.  I'm not always the best at that because I don't want the liability or the expectations.  When I was on my trip - on the train, they called out for any medical personnel to come help with a situation.  My dad urged me to go, but I didn't - using the excuse "I'm on vacation."  I just don't like walking into situations like those without any backup that I trust - as opposed to being at the hospital where there are plenty of people to help out if I am unsure of the situation.  I'll work on getting better at that.

My puppy Shay is growing so quickly - I want her to go back to being that little puppy I got 2 months ago.  Hard to believe it's been 2 months.  She was just a tiny thing....8 lbs & so small.  Now she's nearly 25 lbs & has changed a lot.  The black in her fur is practically gone - except around her face & eyes.  She is definitely german shepherd & I don't know what else - I'm thinking yellow lab, but who knows.  She did well with getting spayed, although she does have a bump under the incision.  I'm reading on the internet that it isn't uncommon, but she goes to the vet on Monday to get her stitches out, so we'll see what he says.  It was hard to keep her calm for 7 days - she was running around the day after surgery.  She seems to be ok...no pain, no discomfort, she doesn't even mess with the stitches. 

She has sooooo much energy.  I finally took her on a 20 min walk to drain some of it so that she'd take a nap.  Well, we both ended up taking a nap...sooooo much for trying to get things done while she's sleeping.  Once she gets the ok from the vet, we're gonna start doing longer walks & she'll finally get to see what a dog park is all about.  She seems to be really good around other animals - hopefully she won't attack anyone!  She's turning into a good guard dog.  Here's her latest pics.  She's officially 17 weeks old now.

 

Amoxicillin

Shay & I are both on Amoxicillin...lol.  She's on it to prevent any infection after getting spayed.  I took her in yesterday & she seems to have done well.  She was a bit groggy last night, but today she is back to her normal self.  She doesn't even seem to be in any pain today - amazing!

I'm on the antibiotic because of the toothache that began last week.  I saw my dentist on Thursday & he started a root canal...fun fun.  $705 later, I have to go back in October so he can finish it.  He's a very busy dentist, but I've been going there for 17 yrs & he is very personable.  So I'm not switching dentists until I absolutely have to.  Besides, I need some time to save up to pay that $705...ugh.  At least the pain is gone.

I worked Sun, Mon & Tues nights.  The one patient that stood out for me is one that came in with a migraine headache, was admitted with chest pain (who knows why - she never had chest pain) and ended up having surgery to remove her gallbladder.  It's usually a relatively simply surgery. I had it done back in 1996 & recovered fine.  Then again, I didn't have the surgeon she had.  He's pretty new & isn't very good yet.  It was also discovered that she had blood clots - one in her upper arm, one in her chest and one in her leg.  No one knew why she was clotting like that - so they started her on Heparin to thin her blood & prevent anymore clots.  Anyways, she had the surgery on Saturday, I was her nurse Sunday night.  I had been told she was anxious & there was Xanax ordered for her.  I gave her some with her nighttime meds.  Around 11:30, the tech went in to take her blood pressure & noticed blood on her gown.  I immediately lifted her gown to see where she was bleeding & it was a tiny but steady trickle from one of her incisions.  He had put a durabond type adhesive rather than stitches & I don't know if she scratched it or what...but it was bleeding & it wasn't stopping even with pressure.  I decided to put some 2x2's over it & tape - hoping the pressure would stop the bleeding.  It didn't.  So I replaced that dressing, put more 2x2's & covered it with surgical tape.  You could still see that it was bleeding.  At the same time, the patient was freaking out & yelling "I'm bleeding!!!!!!  Oh my god!!!!!"  I tried to get her to look at where she was bleeding from because it was just a tiny little spot, but she wouldn't look.  Then she got even more hysterical & was asking what if she was bleeding internally.  Her blood pressure was fine & I tried to reassure her that she was ok. 

I eventually called the surgeon, who of course wasn't on call.  I got one of his partners who told me to apply a pressure dressing and continue the Heparin.  It was exactly what I had been doing, but I needed to make sure one of the doctors on her case was aware of the situation.  I ended up taking an abd pad instead of 2x2's...it can absorb more - thus last longer as a dressing & taped it down with surgical tape.  Later when the surgeon came in & took the tape off - she had stopped bleeding.  Yay!

However, now she had other problems.  She wasn't urinating.  The dayshift helped assist her to the bedside commode & I guess when she stood up, she began vomiting.  Then she became diaphretic and very unstable.  They ended up moving her to ICU where they discovered she was bleeding internally!  Aaaccckkk & here I was reassuring her she was fine the day before.  It was just a small internal bleed...I guess the surgeon nicked something & with the Heparin going - it stopped the area from clotting off.  I don't know why she was having trouble urinating though.  The Heparin was discontinued in order to stop the internal bleeding. I don't know what they are going to do with the blood clotting problem.  She was also receiving blood transfusions as her H&H kept dropping.  The poor lady - recovery is not supposed to be this difficult. 

It's scary seeing some of these surgical patients that come in for something that is supposed to be simple & routine and they end up in ICU.  I hope she is ok.

I only work 2 days this week and I have CPR class on Wednesday night.  I'm so tired today & not really sure why.  Maybe I'm just a night owl - cause I always seem to be tired during the morning hours. 

Have a good weekend everyone!