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!