Thursday, December 13, 2007

Mixed up schedule

I've mixed up my schedule this month from my usual Sun, Mon, Tues nights. This week I worked Sun & Mon and this weekend I'll work Sat, Sun, Mon night. It's nice to have a little variety and the patient acuity level has been high - so anything more than a couple of days can be really tiresome.

Both Sunday and Monday nights were very busy. Our hospital is completely full to the point that they are holding patients in the ER because there are no beds available. And as usual, at my friend's hospital - they are empty and calling nurses off. It seems seasonal like that - when my hospital is busy, hers is a ghosttown and vice versa. Just weird!

I started off with 3 patients Sunday night. One was very stable - she had come in with chest pain and congestive heart failure. She had a heart attack while in ICU and was recovering. There wasn't much to do for her besides assessment, medications and make sure her needs were met.

My second patient was an older man admitted with pneumonia. He had a history of dementia and alzheimer's. Patients with that history tend to confuse day with night and sleep all day while up all night. He was no different except that he would continuously yell for things - like his wife. It didn't matter how many times I went in and reoriented him to place and time, five minutes later he was yelling for his wife. Nothing can be done for that and unfortunately he kept most of the patients up all night with his continuous yelling. Finally around 4 am he decided it was his bedtime and he layed down and went to sleep. I was told that was his routine.

My third patient was very sick, but I'm not even sure she realized how sick she was. She had a tumor in her stomach removed and was on post-op day 5. The surgeon had written orders for her to walk four times a day - no exceptions, but of course the nurse before me put her off claiming she was "too busy" to walk with her. We're always too busy - when isn't a nurse busy? She asked me to walk with her at 8 pm and even though it wasn't an ideal time for me, I made sure she knew I was committed to helping her get better. She had an NG tube and a couple of IV medications running. She was weak on her feet - which is to be expected after surgery. She did well ambulating and I could tell just by not giving her an excuse or putting her off to walk later - that she was beginning to trust me.

The reason she was on our floor as opposed to the med-surg floor is because that day she had spiked a temp over 102 and they were worried she was getting septic. A few hours later she asked me if the nurse tomorrow would be as willing to walk with her as I was. I told her I would definitely make it a point with whatever nurse was coming on - that it was important to make sure she ambulates. I then asked her if she wanted to walk again and there we were at midnight walking the halls. Getting up and walking after surgery is one of the best things you can do for your body. It may hurt like hell - but the benefits outweigh the cons. Too much bedrest can do more harm than good.

I got a fourth patient right before midnight. I was a little worried as he was admitted with nausea/vomiting/diarrhea and altered mental status. I was picturing a confused person that was throwing up & going to the bathroom at the same time. He was nothing like that. He was totally alert and oriented - never had any nausea or vomiting and had one episode of diarrhea while in the ER. After the initial assessment & 3920348023 questions we ask on admission, he was content with getting some sleep for the night.

So two easy patients and two a little more intense. Not a bad combination, but it was time consuming which made the night go by quickly. I contemplated whether to refuse to take the dementia patient back again on Monday night. Mostly because it affects me when I can't make someone feel better. I decided to leave my name up by his on the board & just deal with it when I came back that night.

I went home - slept the entire day & went back. Turns out the elderly yelling man had been discharged. Yay! I still had the other three patients plus one that was admitted with a possible stroke. This poor lady - what a rough night she had. It started out when they drew blood for a D-dimer's a test that checks to see if someone has a pulmonary embolism. The test isn't 100% accurate meaning just because you test positive with a D-dimer, it doesn't mean you definitely have a PE. It means that the next step is to do a CT of the chest to rule out PE. I sent her down around 10 pm for the CT only to get a phone call that when they went to inject the contrast - they blew the IV and now her arm was swollen and they were unable to do the test so they were bringing her back. Her arm was sooo swollen. I call the doctor and inform him of what happened. He orders for a Lovenox injection (blood thinner) and a VQ scan - which is another test to check for a pulmonary embolism. It's not quite as accurate as a CT, but it's doable. So I have to call nuclear medicine in because they aren't there 24 hrs a day. They come in - not happy at all with me - as if any of this is my fault. It takes them about an hour to do the test. I finally get my patient back around 2 am. The test results still couldn't tell me if she had a PE or not. It said "intermediate probability." I spoke to the doctor & he ordered antibiotics - I guess he thought it was more of a chance of pneumonia than a PE.

I got a fifth patient in the middle of all this - a woman with a GI bleed. She had been admitted during the day in the ER and while they were holding her there - she luckily had a good nurse that made sure she got 2 units of packed red blood cells. Usually the ER will get the order at say 2 pm and we'll get the patient around midnight without any of the blood transfused. I was impressed that she had gotten both units. After the initial assessment, she went to bed for the night.

It was an easier night, but still busy. My surgical patient had to have 2 units of blood transfused. She had spiked a 101.8 temp for me, but luckily the Tylenol brought it back down rather quickly. I hope she's ok. I don't like to see surgicalpatients with abnormal temps.

So I've been off since Tuesday - time flies by. I'm doing my Christmas shopping in the morning & planning to get it all done tomorrow - from start to finish. Christmas for me is about the little ones - my younger niece & nephew and they are pretty easy to buy for. I'll meet up with them tomorrow afternoon after they get out of school and I think I'm going to take them to the Scholastic Books Warehouse sale. Everything is 50% or more on sale and it's a huge warehouse. They've never been there and lately they have really been into reading - so I may as well take them so they can pick out exactly what they like.

I went out Tuesday night to this Italian restaurant and wouldn't you know it - a lady two tables down starts choking. It was impressive to see the waiter jump right in with the adbominal thrust (aka Heimlich manuever) and save her. I also saw the movie "Awake" after dinner. It was ok, but really far-fetched. Anyone in the medical field & even those not in the medical field could see how inaccurate it was...but that's the movies for you.

Hope everyone has a great weekend! Stay warm up north! Stay cool down south - I love the 80 degree temps, but I would like to see some cold weather since it is the middle of December! Careful what I wish for - I know!!! :)

1 comment:

tendernoggle said...

Good to hear that you are doing good...I love reading your journal...Thanks for puting some of it in laymans terms so I can understand...:-)
I still have some shopping to do...I will be glad to see it over with!
Love ya,