Thursday, July 17, 2008

It's official!

I have a second job! I got the job at the other hospital and it turns out, another nurse from my unit also got hired there and starts orientation with me on Monday. I didn't even know she was applying nor did she know I was. Small world! Hopefully it will be a positive experience.

My patient that coded a couple of weeks ago passed away last week. He had been in hospice care and ended up passing away after his wife left to make a phone call. Some say that he was waiting until she left the room. I'm not so sure he was even aware enough to know whether she was there or not. I think it was the transfer from ICU back to PCU that did him in. It seems like when we have patients that are very close to passing - that when you move them around - such as giving a bed bath or transferring to another bed - that's enough to push them over the edge.

I had a patient this week that had been made hospice and was supposed to be transferred the next day to the hospice care center if he "survives" the night. Not exactly the words I like to see written about my patients. I informed my patient care tech that we would not be bathing or moving this patient at all - because I know the moment we start doing that stuff - bad things can happen. He was developing a fever...he had been for awhile, but now that the antibiotics had been seems the infection was causing his temperature to rise. We had an order for Tylenol, but it didn't make sense to me to even have that order....because Tylenol wasn't going to stop the infection which was the reason his temperature was rising. I tried to cool him down with cold washcloths - it helped a little bit, but we all knew it was just a matter of time.

One word of advice to those that may become hospitalized in the future....when the doctor is visiting you, that is the perfect time to ask questions and make requests. Don't wait until 10 pm or even 2 am to start making requests...because chances are the doctor is not very receptive at that time or he's not even the doctor on call.

I had 5 patients the other night all making requests thru the night that required doctor's orders. That's fine...I'm used to it, I'll make the call & try to meet your needs. I don't mind waking up sleeping doctors if the reason warrants that. But every one of the patients had told me "Oh, I didn't want to bother him while he was here." What? Bother him? He's there to see how you are doing and what you need. If he is talking to you - that is the time to ask questions and make he can write orders.

For example: I had a patient in with chest pain. They put nitropaste on him and the major side effect of that is a bad headache. So Tylenol was given at 9 am and the nitropaste was removed. The Tylenol didn't help, but the admitting (primary) doctor was in at 2 pm - even gave the patient his business card. Now it's 8 pm and the patient is very upset that he still has this headache. Ok...did you tell the doctor you had a headache? No, I didn't want to bother him with that. How is that going to bother the doctor? Plus the cardiologist was also in to visit and he didn't want to tell that doctor either. So I call the primary and of course his partner is on call who knows absolutely nothing about this patient. I tell the partner that this patient is complaining of a headache. The partner is concerned now that it might be more than a headache and should we order a CT or MRI of the brain. Ummm, I don't think so, but of course I don't want to be the one to decide that. He's running through all sorts of theories of what it might opposed to a nitroglycerin induced headache. He finally decides we'll try Lortab and see if that takes care of it...which it did. But then I had to wait another 45 minutes for pharmacy to process the order and before you know's about 10 pm before I can give this patient anything to help. I'm just saying it would have been easier if he had told the doctor standing in front of him at 2 pm that he has a headache unrelieved with Tylenol so we could resolve it then instead of 8 hours later.

Oh and another thing...if you want/insist on a private that while you arestill in the emergency room. The time not to do it is when they are wheeling you into a semi-private room. My new admit started crying while still on the ER stretcher...declaring "I can't do this! I need a private room." I've never seen anyone react quite like that. The thing is...once the room is assigned, it's rather difficult to change the assignment unless we have plenty of extra room available - which is rare. So either insist on a private room and wait in the ER until one is available or suck it up and deal with being in a semi-private room. Don't get me wrong, I am a strong advocate that ALL rooms should be private - however, I don't get to make the decisions. I, for one, would be the one insisting on a private room if I ever have to be hospitalized. So don't feel bad if that's what you want also. :) Just make it known sooner than later.

Sunday, July 6, 2008

My Second Code Blue

I went into work Thursday night - a night I did not orginally schedule for myself, but our scheduler rearranged my schedule that week. So I was there. I was just starting shift change report when the wife of a patient reported to me and the day nurse that she felt her husband was restless and anxious - could we get him a Xanax. Rather than insisting the day nurse get it - since it was technically still her shift as I hadn't even gotten report yet, I volunteered to get the medication so the patient did not have to wait at least 30 minutes because of shift change.

I brought the Xanax 0.25 mg PO (pill form) into the room. His wife who is also a nurse, sat him up in bed. The patient wasn't saying very much to me. The wife claimed physical therapy worked with him a lot today and he was tired. Yet anxious because he was not going to be discharged until tomorrow. So I give him the pill, he takes a few sips of water - swallows the pill - takes a few more sips of water. I ask him if he got the pill down. He agrees that he did. Within 60 seconds of that, he went unresponsive. His eyes were still open and that threw me a little, but his wife immediately starting mouth to mouth on him really threw me. It wasn't anything like what we learn in ACLS....check for breathing, check for pulse...nope, she just yelled "Something's wrong" & started mouth to mouth. I got the day nurse to come in to assess him and by that time the wife was now doing compressions. I guess she just went into panic mode. I went ahead and called a code blue because obviously there was a change in this patients condition - not that I was sure that he had stopped breathing or that his heart stopped.

The only good thing about a code at shift change is that you get twice as many people showing up - day staff and night staff. The patient's heart had never stopped beating and although he was having difficulty breathing, he never stopped breathing. They ended up intubating him and transferring him to ICU. Kinda weird considering the day nurse had spent all day getting his doctors to clear him for discharge the next day. Guess it is just not meant to be.

I don't believe he choked or aspirated the pill or water we gave him. I think the restlessness and anxiousness were more of a sign that he wasn't feeling right to begin with and that this would have happened regardless of whether I medicated him or not. There's always a doubt though. I felt a little helpless, but am grateful we have a good staff when it comes to codes.

I got a call from that other hospital. I have to call them back tomorrow. I'm pretty much positive they'll offer me the position - which I will accept. I want to see what it's like outside of my comfort zone.

I saw a couple of movies last week....Wanted and Hancock. I enjoyed Wanted = great action flick. Hancock....ehhhh, it's ok, very different.

I have to work the next 4 nights in a row. Hopefully it will be a good week.

Take care everyone!