Saturday, January 3, 2009

Happy New Year 2009!!!

It's a couple days late....but Happy New Year 2009. I hope everyone had a wonderful time celebrating yet another new year. I love the holiday traditions & the hope that a new year inspires. I haven't set any resolutions or anything like that....because I know they'll just end up broken. Well, at least the things I really should be doing...eating better, exercising, finding positive ways to release stress. It's not to say that I'm not going to work on doing all of that, but I'm not going to add the pressure of making it a resolution.

I worked the 31st and the 1st. Both nights were really busy. The patients seem to be sicker (is that a word) than ever. I don't know if it's the season or they simply delayed treatment to get thru the Christmas holiday. Out of the 5 patients I had Wednesday night, 3 of them needed assistance using the bedside commode. I don't mind doing that, but I was worried about reinjuring my back. It started to give me a little trouble last night, but it feels better than ever.

I had a patient last night that was 100 years old. She had pneumonia and was also having a heart attack - but she didn't even know it. It was mild. Of course I worried about her though when the cardiologist didn't want to do anything for it. I guess her age makes the difference, although she was more alert, oriented and active than all of my other patients. Plus she was very kind and thankful.

I did have a typical change of shift Thursday night with the day nurse trying to stick me with a discharge. She was an agency nurse, but she knows our hospital well enough that she couldn't pretend she didn't know how to do the paperwork. If it was a simple, easy discharge & the majority of the stuff is done...I don't mind taking care of it. However, there are signs which I pick up on quickly when I know the difference between what they are saying & the truth. She was in too much of a hurry to get out of there....which basically meant she hadn't done ANY of the paperwork even though the discharge orders had been written at 9:30 that morning. The only thing that should have been holding that patient up was waiting for the portable oxygen tank to be delivered.

The day nurse had at least 10 hours to go thru the prescriptions and discharge instructions. 10 hours! I look at the stack of prescriptions...we're not talking 3 or 4....there was at least 10-12 prescriptions written...which didn't include what she was already taking at home. So I ask "Have you put all of these medication changes in the computer?" She doesn't answer except to say "I made copies of all the prescriptions for you." As if she had done some huge favor. By this time it was 7:30 pm and I still had to get report on 2 other patients. She says to me "Ok, you're going to handle it right now, right?" Nope. I'm going to continue to get report on the rest of my patients. I told her she can tell the patient I will handle the discharge, but it's probably going to be at least another hour. The patient was already furious it was taking as long as it was & I don't blame her.

So I asked the clinical leader to go over the medications with the day nurse while I continue to get report on my other patients. 20 min go by & now I'm done with report. I look over & they were deeply involved in trying to figure out all of the medications. So much for a quick & easy discharge. I wasn't about to step in & help...because she should have had this stuff done. She only had 3 patients absolutely no excuse for not getting the paperwork done. I made myself scarce, visited with my patients & before I knew was 8:30 pm & they were finally done with the paperwork. I can only hope the day nurse will not slack next time someone is discharged. I know she was furious being there because I don't think they get paid extra to stay - since she is agency. Not my problem.

I got a new admit around 10:30 pm. It was a rather sad case. The patient was 60 yrs old and had been getting confused for months I was told. They had her in 4 pt restraints, gave her Ativan, her heart rate was 145 and her blood pressure was 180/63. I talked to the ER nurse about it & she thought it was because she was so agitated. When she got to the floor, it turns out her temp was 101.3. They hadn't taken a temp in the ER since 5 pm. Her blood pressure was a little better, but the heart rate was in the 140's. She had Digoxin PO ordered, but I didn't think I'd be able to get her to take it since she was so agitated. I attempted which she bit down on the straw & didn't let go. So much for that.

I called the doctor & he was half asleep. I told him her vital signs.....mostly focusing on the temperature and heart rate. He replies "Ok, so what are you calling for?" Ummm...something to lower her temp & heart rate. He was totally out of it - which is really scary if you think about it. So I suggested Tylenol for the fever & IV Digoxin until she was able to take medications by mouth which he replies "Why can't she take medications by mouth right now?" I explain to him that she's very confused, in restraints and very uncooperative. He skips right by that & says nothing. So I suggest a consult with infectious disease since that doctor just happened to be sitting at the nurses station. He asked "What is he doing there?" Ummmm...working. He asks "Why do you think she needs an ID consult?" Because she is very confused, has a temp...could she possibly be septic? She has a UTI also. So he agrees to that & is ready to hang up...I asked again about medication for her heart rate to which he didn't want to do anything about it. He figured when we got the temp down, the heart rate would follow.

The ID doctor wasn't crazy about a new consult at 11:30 pm, but he cheerfully assessed the patient and wrote orders. He restored my faith in doctors for another day. The patient managed to drift off to sleep. The tylenol suppository did bring down the temp and her heart rate while still tachy, was in the low 100's. Much better for me. She was awoken by the lab tech around 6 am and while she was a tad bit more with it, she was still thoroughly confused and yelling out. The husband wants her tested for early alzheimer's. She's so young, I hope they are able to figure out why she is behaving the way she is. Her drug screen was 100% negative.

I had another patient who was to have a hospice consult today. The doctor made me a little mad as he was doing everything in his power to avoid the family. Maybe he's just not a people person, but he asked for a family meeting to be arranged and then he didn't even show up. And this morning he rounded sooooo early that it was pretty obvious he was once again avoiding the family. The patient is in her 90's and doesn't want anymore treatment. She's barely eating, her kidneys are failing, she says she wants to die. The family finally gave in to her wishes, although as of last night we were still pumping her full of different IV fluids. I felt like all those IV fluids were going to put her into heart failure, but who am I to say?

Taking care of her was like taking care of a baby. I tried to get her to take some Tylenol for her back pain. I'd mix it in apple sauce & she'd just end up spitting it back out. This happened over & over until I finally gave up. She was cute though. I think her vocabulary consisted of 4 or 5 sentences...."I'm hungry, I'm thirsty, I'm cold, no more and I love you."

Between my 90 something year old and the 100 yr old, it got me thinking about how much those 2 have seen in changes over the years. I wish I had more time to sit & chat with my patients to see what life was like back in their day...when they were in their prime. I'm sure they have many interesting stories. All of my grandparents passed away years ago.

On a sad note, one of our older doctors passed away on Christmas Day. His family had called the hospital looking for him because he told them he'd be doing rounds. Turns out they found him at his office slumped over his desk. Apparently it was a heart attack. Sad....and on Christmas Day of all days. RIP Dr. R.

I have to go get some sleep. I work Sat night, off Sun night, work Mon & Tues night, off Wed & Thurs night, work Fri night. Ahhh, such a mess of a schedule. I wasn't supposed to work Fri night, but I'm helping another nurse out.

Have a good weekend everyone!!! Happy New Year!


Amanda said...

So sad about Dr. R. His poor family

I hate when people shift-dump. Our discharges are REALLY easy though. We just hand the Rx over to the patient, read the instructions and they sign. All we do is write a DC note in the chart. Case mgmt handles all the other stuff.

Isn't it funny how super-old pts are often more mobile than the ones in their 50s and 60s?

Pamela said...

I remember those kind of days in the hospital. I don't miss it a bit! LOL!

Jmoqueen said...

Sounds like you have quite an amazing job to do x Shame people like that agency nurse wanted to bring it down for you :( Hope your back holds out x