Monday, October 29, 2007

Quick Update on Power of Addiction

Just a quick update on the patient I described in the earlier post.  Last night I was the Patient Care Tech - yes, us nurses can do practically  As I was taking the first set of vital signs - I noticed that a patient seemed very familiar to me.  Turns out it was the one that signed out AMA early Friday morning!

She returned back to the hospital Friday early evening complaining of nausea and dizziness.  I didn't mention who I was.  I'm glad she came back - obviously she has something medically related going on.  Hopefully they'll be able to fix it.  She did have a nicotine patch on - so no worries about her needing to go smoke. 

I just got done with a nursing skills assessment type fair - I'm tired & I have to be back at work tonight.  Hope everyone is having a happy Monday.  It's raining here by me - perfect sleeping weather.  Sweet dreams! 


Sunday, October 28, 2007

Power of Addiction

Let me start by saying that I am so glad I have never tried smoking in my life. Not necessarily because of how unhealthy it is, but more because of the power it has over someone that smokes. The reason I'm thinking about this is because early Friday morning I got an admission from the ER - it was about 2:30 am. She was admitted with high blood pressure and an abnormal EKG. When she arrived at the hospital, her blood pressure was something like 230 over 114 - that is extremely high - especially for someone that claims they already take blood pressure medications. I didn't have a chance to see what they had given her while she was in the ER, but whatever it was - it was working as the last blood pressure they had on her was something like 134 over 80. However, when she got to the room and layed down in bed, I could tell she was visibly upset. I asked what was wrong & she started crying & telling me she was stressed out and didn't care that her blood pressure was high - that she just wanted to go home. She was in her early 50's & this is way out of the norm for someone that is admitted so early in the morning. Usually they simply want to go to sleep. She told me she had a stroke before & she didn't care. I informed her that no one would keep her here against her will - that she was free to leave if that's what she really wanted. She replied saying "I just want to have a cigarette." I informed her that would not be possible - there is no smoking anywhere inside the hospital and that she cannot leave the floor - if she does, she will not be allowed back to her room - she would have to go thru the ER again & start the process all over. She was crying even more now - saying she can't afford a hospital bill, that she has no insurance - then she asked me a strange question..."if I leave the hospital, will you call the police?" Huh? No, why would we do that. I told her there was a paper she could sign (AMA - against medical advice) & she would be free to leave. She didn't say yes or no, simply stated that she had to go to the bathroom. I got the impression that she was determined to smoke - so I told our patient care tech to let me know if he smells any smoke. He informed me that he did see her put a lighter in her pocket when she got up from the ER stretcher. I called for my clinical leader to go in & assess the situation. She wasn't in there even 2 minutes before she came out asking for the AMA form. The patient asked us again if we were planning on calling the police - very odd question. We assured her we wouldn't - although I was tempted to ask her if she had a warrant or something...but I didn't. It was apparent that her desire to smoke was stronger than her desire to be healthy. We get patients like her - who get mad when we inform them that they cannot smoke while they are in the hospital. We had one the night before smoking in her bathroom. They don't care about the dangers of smoking with oxygen nearby - they simply don't care about anyone - not even themselves. It's scary and sad all at the same time. I know addictions are difficult to overcome & I'm not asking them to quit smoking - but for the sake of yourself & others - do not smoke inside of the hospital!

I worked 5 nights last week - I have been so tired the last 2 days. I'm only scheduled for 3 nights this week...thankfully. Even after pretty much resting the last 2 nights, I still feel exhausted.

I have to take Shay to doggy daycare sometime today. My parents had been watching her, but someone complained about the rule that dogs in their park aren't supposed to be over 20 lbs. They have a lot of complainers in there - I guess it's grumpy elderly people with too much time on their hands. My parents had been enjoying it - especially my dad. He would take her for rides in his golf cart and take her out fishing at night with him. Oh well - easy come, easy go.

I'm gonna go get some more rest - it's pouring down rain right now & I'm sleepy.

Hope the rest of you are having a good weekend!

Saturday, October 20, 2007

Very easy week!

This past week at work was really good - which basically means it was really easy.  My patients were stable, considerate, polite, alert & oriented - which is always a plus. 

My first patient was in with pneumonia and respiratory failure.  Only in her late 50's & already a DNR (do not resuscitate).  She needs a lung transplant, but is not a surgical candidate because the doctors don't think she'd surivive the surgery.  It's sad because it was something the doctor had to discuss with her during my make a decision should something happen while she was in the hospital.  It seems like the most pleasant people are the ones with the terrible diagnosis/outcomes. 

My second patient was admitted with vertigo rule out TIA.  Turns out it was vertigo and she just needed her Meclizine medication increased.  After that she felt fine.  However, she spent an extra 2 days in the hospital because the neurologist didn't want to discharge her until the test results were in writing on the computer. For some reason - it was really slow to get the results...which was fine with me - she was a pleasant patient to take care of. 

My third to describe her???  Her first question to me was "How will you know if I pass out while in bed?"  Who asks stuff like that?  I did not yet realize this woman's history.  She was admitted with syncope.  It's been going on for over 4 years.  She had a big workup done at a major hospital which showed no medical basis for what she claimed to be experiencing.  What she experiences is feeling shaky, staring off into space, fainting...a variety of different things.  While in the hospital - she only experienced these situations while medical personnel were with her.  Twice in the ER, once when the admitting doctor was in the room with her, once when a nurse was with her and once when the neurologist was in.  The neurologist assessed her during one of her fainting spells - he lifted her arm up over her face & let it go.  If she were truly unconscious - the arm would have fallen on her face.  Instead it went over her head & barely touched the ground.  They were all convinced she was faking - there were no changes neurologically, physically, cardiac wise, vital signs were stable.  She did seem a bit on the dramatic side to me also.  Most of the time people who are admitted to the hospital - they can't wait to go home.  Even if they are feeling miserable, they just want to be at home as soon as possible.  Not this one - she insisted on staying in the hospital.  She was still there when I left, but I think the plan of care was to refer her to a psychologist. 

My fourth patient was strange.  He was a nice enough guy, but 95% of the time that I was in the room - he had the sheet & blanket over his head.  Not just on top of his head...but covering his entire head & face.  He even watched tv like this!  One time I walked by & he was sitting up on the side of the bed with the usual sheet & blanket covering his head.  It was bizarre.  He was in for a variety of things - congestive heart failure, anascara and right upper quadrant pain.  He did have gallstones, but he wasn't a surgical candidate because he recently had a heart attack and he had this huge wound on his foot that wasn't healing.  No surgeon wanted to touch someone with that type of history.  The wound is from uncontrolled diabetes = poor circulation.  What's weird is that he didn't even come to the hospital for treatment of that wound.  He was just covering it up at home - as if it would heal on it's own.  It was gigantic! 

My fifth patient showed up around 4:30 am.  I felt bad for her.  She was in her early 30's & her mother died last week at our hospital.  The patient was grieving which lead to chest pain.  She looked so sad.  It made me think of how I'd feel if I lost my mom & then I quickly put that thought out of my mind.  I know it would be nearly impossible to go thru that...even though we have to.  This patient didn't have any chest pain during my time with her.  I think she just needs to find some positive ways to release this stress of losing someone so close.

On top of it being an easy week -there were nursing students there for two of the nights also.  That made it even easier!  The instructor was someone that graduated with me - I have no idea how she became a clinical instructor so quickly.

I have another long week ahead.  I feel like all I do is work lately...grrrr.  I took Shay to my parents house for them to watch her this next week.  Here's her latest pics!



Wednesday, October 17, 2007


When the Lord made Nurses He was into his sixth day of overtime.

An angel appeared and said, "You're doing a lot of fiddling around on this one."

And the Lord said, "Have you read the specs on this order?

A nurse has to be able to help an injured person, breathe life into a dying person,

and give comfort to a family that has lost their only child and not wrinkle their uniform.

They have to be able to lift 3 times their own weight,

work 12 to 16 hours straight without missing a detail,

console a grieving mother as they are doing CPR on a baby

they know will never breathe again.

They have to be in top mental condition at all times,

running on too-little sleep, black coffee and half-eaten meals.

And they have to have six pairs of hands.

The angel shook her head slowly and said, "Six pairs of way!"

"It's not the hands that are causing me problems," said the Lord,

"It's the two pairs of eyes a nurse has to have."

"That's on the standard model?" asked the angel. 

The Lord nodded. "One pair that does quick glances while making

note of any physical changes, And another pair of eyes that can look

reassuringly at a bleeding patient and say,

"You'll be all right ma'am" when they know it isn't so."

"Lord," said the angel, touching his sleeve, "rest and work on this tomorrow."

"I can't," said the Lord, "I already have a model

that can talk to a 250 pound grieving family member whose child has been

hit by a drunk driver...who, by the way, is laying in the next room uninjured,

and feed a family of five on a nurse's paycheck."

The angel circled the model of the nurse very slowly,

"Can it think?" she asked.

"You bet," said the Lord. "It can tell you the symptoms of 100 illnesses;

recite drug calculations in it's sleep; intubate, defibrillate, medicate,

and continue CPR nonstop until help arrives...and still it keep it's sense of humor.

This nurse also has phenomenal personal control. They can deal with a

multi-victim trauma, coax a frightened elderly person to unlock their

door,comfort a murder victim's family, and then read in the daily paper

how nurses are insensitive and uncaring and are only doing a job."

Finally, the angel bent over and ran her finger across the cheek of the nurse.

"There's a leak," she pronounced.

"I told you that you were trying to put too much into this model."

"That's not a leak," said the Lord, "It's a tear."

"What's the tear for?" asked the angel.

"It's for bottled-up emotions, for patients they've tried in vain to save,

for commitment to the hope that they will make a difference

in a person's chance to survive, for life."

"You're a genius," said the angel.

The Lord looked somber. "I didn't put it there," He said.

Author Unknown

Friday, October 12, 2007

Someone else's worries

This has been a busy week.  I started Sunday night & by Thursday morning - my feet were aching.  We have had something like 3 or 4 Baker Acts = no patient care techs to assist the nurses.  That is my pet peeve with this hospital.  They don't seem to care that we are short-staffed or overburdened.  I don't think they realize how much difference a good patient care tech can have on a unit. 

Sunday & Monday were busy, busy nights for all the nurses.  We were all exhausted by 7 a.m.  How I managed to work 4 nights in a row with that patient load - I don't know. 

Two patients stood out for me this week.  One was a woman in her 90's that came in with chest pain.  Normally I love chest pain patients because they are the easiest to diagnose/treat.  However, when they are elderly - the chances are high that they also have some degree of dementia.  Mine had that along with paranoia.  The thing is though...she was telling us stories that seemed so first.  It is strange how the mind works though - I mean she couldn't remember where she was or why she was there, but she knew her friend was stealing stuff from her house & dropped her off at the hospital, but told her it was a hotel.  The more she expanded on her thoughts, the easier it was to see how delusional she was.  Monday night when I came in - she was refusing to wear her heart monitor.  I would go in the room, put it back on her & explain the importance of it - only to see within 30 min, it was off again.  She would also get out of bed & stagger all over the place.  She was a fall waiting to happen.  So I tried to put a Posey vest on her - just to keep her in bed.  That didn't work as she fought me when I tried to put it on her & she started yelling & screaming.  This is really nice when it happens with another patient & their family in the room. 

My clinical leader came in & tried to calm the woman down.  She then turned to me & said "Get the wrist restraints."  So we put her back in bed & applied the restraints - which only made her worse.  She wouldn't stop yelling & screaming.  Again, this is always so pleasant when there are other people in the room.  @@

I ended up calling the doctor & getting an order for Haldol.  She slept pretty much the rest of the night.  I did end up moving the other patient into a nice, quiet room.  When I came in the next evening, she had been discharged....yay!!!

My other patient was one that had a stroke.  The left side of her body was affected - she could barely move her arm & leg on the left side.  Her attitude started out very sweet the first night.  By the second night - she was in denial.  The doctors were telling her & her son that she would have to go to a rehab/nursing home in order to regain any use of her left side - they couldn't send her home like that because she didn't have anyone to take care of her.  She was adamant about not going to rehab.  She wanted to go home & that was that.  I tried to explain to her the reasons a rehab was necessary, but she didn't care.  She had also gone from being sweet to being very grumpy & irritable. She even called her son to tell him I was mean!  ME??????  Mean???????????  No way!!!!!!!!!

I tried to put myself in her state of mind - the best that I could anyways.  I had a lot of patience with her because I realize that this has to be quite stressful & worrisome.  Her thought process was still in tact 100% - so she knew exactly what was going on with herself.

The next night when I came in, she was still a little grumpy - but more accepting.  She knew there was no other choice than a rehab facility.  As the night went on, she was beginning to express herself more & more...not in a good way either.  Around 1 am, she called for me & I could tell something was wrong emotionally.  She was on the verge of tears so I asked her what was wrong.  She opened up about her fears - that she was worried once she went to rehab, she'd never leave - that she'd never make it home - that she'd die there, she was worried about her sons, she was worried because a friend of hers had a stroke & died within a week.  She expressed her fear of dying. 

It was really touching & it really made me take a step back & try to understand her worries.  It also put my life in perspective & gave me the reminder that none of my worries compare to hers right now.  Her life is changing & there isn't a thing she can do about it at this point.  I do a good job at drawing the line & not getting emotionally involved with a patient or their family.  I need to have that line in order to survive in this line of work.  I don't want to take patients worries home with me - it will wear me down & burn me out.  I have been thinking about her a lot though.  How could I not?

I work Sat & Sun nights - have Monday off - then work Tues, Wed & Thurs nights.  Busy, busy, busy - but I have to be in order to pay off these dental bills.  I had a root canal last week that was like $900 and I see the dentist again this Monday for a couple of fillings that cracked.  It seems neverending!

I took Shay to the dog park today for the first time.  I took her at noon time & there wasn't a single person  So we went back around 5 pm & stayed until 7.  It was crowded - I was surprised.  She was a little on the shy side.  She preferred to hide under the picnic table where the big dogs couldn't reach her...then she'd run out to get their attention & run back to her hiding spot.  She got braver as time went on.  Now she's exhausted & already asleep.  She's doing well though.  She'll be at doggy daycare this weekend.  I hate leaving her there overnight - knowing she's all alone, but it beats coming home to a house full of dog accidents.  My parents have been watching her while I work, but I figure they need a break.  They treat her like a child - my mom keeps her by her side all day and my dad takes her for rides on his golf cart.  She's spoiled...that's for sure!

Have a good weekend everyone!

Baker Act

Baker Act is a term used here in Florida for a person who is a danger to themself &/or others.  Being labeled a Baker Act automatically allows the state to take you into custody against your will & be under psychiatric evaluation for up to 72 hours.  We get Baker Acts at our hospital who usually have attempted suicide & need medical clearance before being transferred to a psych facility.  A requirement our hospital has with Baker Acts is that they require someone to sit at their bedside 24/7 so they don't harm themselves while they are in our care.  Our "sitters" are our patient care techs.  So it means if we have a Baker Act, then the patient care tech will sit all night instead of assisting the nurses. 

I used to wonder why did we have to have a person observing someone under a Baker Act - why couldn't we simply restrain them to the bed via wrist restraints & a Posey vest.  I guess the liability is too much for our hospital to chance that the person won't harm themself.  It wasn't until last week that I saw firsthand the importance of a sitter. 

We had a patient that came in - he was young - in his 40's.  He took something like 90 Valiums and I think drank some alcohol or took Benadryl along with it - he wasn't my patient, so I didn't know the exact details.  He was pretty out of it the night he came in, but the next night was a different story.  I was sitting near the room when I heard his sitter ask him what happened the night before.  They teach us in nursing school that there is nothing wrong with asking a person if they are feeling suicidal or what their feelings were for the reason they attempted suicide.  Personally....I don't want to know.  I'm not a psych nurse & I'm not going to be able to solve those type of problems in 12 hours anyways.  I think it's a dangerous line that can be crossed to encourage a suicidal person to express their feelings when you are not fully trained on what the next step is.  Anyways, he started telling the sitter that he was having problems with his girlfriend - they were breaking up or she was kicking him out - something like that. 

It wasn't long before he was crying.  Again, not a good thing because what do you do with those feelings that are being stirred up?  I tell his nurse that she needs to call his doctor & get something prescribed - rather quickly.  She hesitates - says he came in as a drug overdose & the doctor probably won't prescribe anything.  Ummm, yes he will.  So she doesn't call.  I go back down by the room & now the patient is telling the sitter to give him the phone - that he wants to call his girlfriend & tell her good-bye...that he would be killing himself tonight.  I again tell his nurse "you have got to get him something to reduce this anxiety or he is going to hurt himself & possibly us if we attempt to stop him from hurting himself."  I wasn't worried about him - because if it came down to it - if he was hurting himself, I wouldn't physically step in.  Sure I'd call a code gray (a call for manpower) - but no way would I put myself in danger to save this guy's life.  I was worried though that he could possibly hurt the person who was the sitter - then I'd have to step in to stop him from harming her.  That's a different story. 

The sitter comes out to tell me that she needs to talk to his nurse & asked if I could watch him while she went to talk to the nurse.  So I go in the room & try to make small talk.  He tells me that he was planning on killing himself tonight & that out of respect for the sitter - he wouldn't do it tonight because he didn't want her to have to live the rest of her life remembering him doing something like that.  Whew!  Glad to see he has somewhat of a conscience.  Eventually the nurse did get him some anti-psychotic medications & he slept the rest of the night. 

I don't even remember what my patients were like last week except Thursday was really, really busy.  From the start of shift until the end - there was no time for any breaks.  It was nothing that was an emergency - but it was non-stop work.