Monday, May 25, 2009

A Little Bit of This & A Little Bit of That

I've managed to get a little bit of free time, so I thought I'd write a little. I worked last night....crazy to say the least. Hence, the reason I am too sick to work tonight! I don't know if the patients are just more sick then when I started nursing or I'm just more relaxed then I was back then & have more time to actually think about the patients I have rather than being so task oriented.

I remember the days of when a patient stated they had chest pain, I would start to panic & have chest pain of my own. I'd run around all scrambled to get the nitro tabs & to get their blood pressure & order an EKG stat and calling the doctor. Now...I calmly stand there staring at my patient as if my eyes are a truth gauge as to whether they are a) having true chest pain, b) having chest pain but non-cardiac related chest pain or c) drug seeking. Nine times out of ten the answer is c, but we can't always assume it. I'm glad I don't freak out anymore though. patients...all 6 of them. Let me start off by saying I think having 6 patients is too many, but since hospitals and insurance companies are cheapskates...there's not much I can do to change that - other than phase into ICU nursing (soon....sooooon). My first one is in with AMS = Altered Mental Status. Half the time these AMS'ers are perfectly fine, alert & oriented x 3. This time he was not. However, I don't think this was any change from the way he normally is. Only in his early 50's, was in a car accident a few years ago & ended up with brain damage. He's been this way ever since. Why they decided he needed to be hospitalized with a heart monitor, I'll never know. And the funny thing....standing order to transfer to the psych floor when medically cleared. Medically cleared from what? He's got pre-existing brain damage. We're not going to cure that. Add on top of the brain damage...a three pack a day smoking habit which we so graciously slapped a nicotine patch on his arm hoping for a miracle., not happening. This guy was jonesing for a cigarette. I had to tell him if he even thought about lighting a cigarette in his room, it would probably cause the entire hospital to explode - so think twice. Instead he settled for chocolate pudding & some saltine crackers. He tossed the spoon aside & began eating the pudding with his fingers. Then he starts dipping the crackers in the pudding & if that wasn't enough, he was touching everything in the bed with his pudding filled fingers. You can't help but stop & stare. It wasn't like he didn't know how to use a spoon. I gave him pudding all throughout the night which he ate just fine using a spoon. For some reason...5 am meant finger painting with pudding.

My second patient was a male with a kidney stone. I know they hurt, but there is a side of me that taps into the female way of thinking & is glad God invented kidney stones for men. It gives them a small ounce of what it feels like to be a woman. I'm not talking about being equivalent to child birth, because I've never had a child & I doubt ANYTHING can compare to the pain of that. But the years & years of menstrual cramps & periods....I'm sure is far worse than one kidney stone. I did feel a little sorry for him though...he had a stent placed in his ureter & eventually they are going to laser the stone. The reason I felt sorry...just wait until it's time to take that stent out. He has no clue. Another reason not to feel bad for him & his kidney stone....he had a Dilaudid PCA. Are you kidding me? I swear....a guy comes in with a little pain, they are immediately taken in, the problem is averted within a few hours AND they get the strongest pain medication on the floor???? Come on.

There was a time I had something like 50 gallstones moving around in my gallbladder & blocking the major duct...did I get surgery & Dilaudid quickly? No, I had to wait 3 weeks for my surgeon to get an opening in his schedule & I think I got a week's worth of Percocet tablets by the time it was all over. Sigh. I don't want to hear that a kidney stone is worse than labor or gallstones...unless you've experienced all three. Anyways, you would think this patient would be the happiest one in my bunch since his procedure was basically over & he had a superstrong pain medication at his disposal. Nope, he was basically what I would refer to as gloom & doom. Zero personality & his wife was waiting on him hand & foot. He actually looked annoyed at me whenever I would walk into the room. Sorry bud, just doing my job.

My third patient was the world's loudest ever....and she had no reason to be. She wasn't yelling out in pain or had any needs...she just yelled out for the fun of it. Luckily she was given an Ativan prior to my shift starting & that pretty much kept her asleep most of the night. Every now & then I'd hear her yelling from 200 feet away....but at least she wasn't in any distress.

My fourth patient was an overdose....combination of Valium & Tylenol. You would think she'd be under a Baker Act for trying to harm herself...but no. In fact, I have yet to see a Baker Act at this hospital. (A Baker Act is a 72-hour hold on anyone that is a threat to themself &/or others). Nope, this one was going to be discharged home today with the recommendation to get help. What? Recommendation? I understand that no one will get better unless they want to get better...but she has multiple suicide attempts. I guess it falls back to health care & lack of places that can help these people. It's all about money & unfortunately those that need this type of help rarely have the money to pay for it....much less the desire. And what do they prescribe for her when she's in the hospital for a suicide attempt.....IV Dilaudid every 4 hours for back pain. What? Who are these doctors?

My fifth patient was my chest pain patient. 22 years old & already has 4 he's hooked on Roxicodone....well non-prescription Roxi. Basically means he's buying it off the street & taking however many he feels like. How he affords this habit, I don't know.....maybe he's a sperm donor (see line above about the # of kids he has at age 22). I go in to assess him & he declares he has chest pain on the right side. So I ask "What kind of chest pain?" He replies "I don't know." I reply "You're having pain, but you don't know what it feels like?" Silence. More silence. Then he says "It's not pain, it's pressure." Ok...."on a scale of 1 to 10, how bad is this pressure?" He immediately says "7". Can pressure even be measured on a scale of 1 to 10? So I say to him "I see they are giving you IV Demerol for this, is it working? Does it take away the pressure?" He answers "Not really." I can tell he's hoping I'll get him something stronger...he doesn't know me very well. I say "Ok, let's see what else I can give you." I glance at his med sheet & say "Hmmm, ok, there's Tylenol. Let's try that." He asks "What's Tylenol?" Oh come on!!!!!! I tell him it's a pain reliever that we should try since the Demerol isn't working. He mumbles "No, I'd rather stick with the Demerol."

My final patient was a new admission that arrived on the floor around 3 am. An older gentleman that was in with congestive heart failure. The ER told me he was alert & oriented x 3. So I ask him "Do you know where you are right now?" No. "Do you know what year it is?" 809. "Do you know who the President is?" What's a President? Yeah....alert & oriented all right. He looked & sounded he had this pus or something coming out of his eyes. I have no idea what it was. I tried my best to wipe it off with a washcloth, but I think the end result was now he couldn't even open his eyes. Oh well...he needed some rest anyways. He reminded me of my patient from last week. It wasn't a good feeling. He survived my shift in tact though.

I gave report & silently yelled at myself for scheduling two days in a row here. I knew this morning I would not be going back. Plus I didn't get much rest I'm not going. I have three more nights of work at my usual hospital. It's just much better when you are around people you know. Makes me hesitant about traveling in the future. I never really thought of myself as social, but when I'm somewhere for 12 hours...I need someone to talk to...someone I know.

It's about to storm out...again. I think we've gotten something like 20 inches of rain in the last week. We need it & don't tell anyone...but I like when it rains. It gets rid of the heat.

Have an awesome week!!!


Amanda Smith said...

Are you able to Baker Act as an RN? The law says "psychiatric nurse" but if you are the only one who seems concerned then I'd suggest that you order a psychiatric evaluation for your peace of mind if nothing else.

Tylenol and Valium certainly could be lethal and if she has a history of suicide attempts, it's unlikely that she won't make another attempt.

As you know, multiple suicide attempts are a criterion of borderline personality disorder—a severe mental illness that has a suicide completion rate of 8 to 10%.

Thank you for all that you do for others!

Amanda L. Smith
Florida Borderline Personality Disorder Association

Jen said...

No, I can't Baker Act....only the doctors in my hospital can. She definitely had more issues going on besides the suicidal tendencies. This happens a lot though...sometimes they'll start out a Baker Act & the psych doctor will come in & D/C it because at that moment - they are no longer a threat to themselves. Then they send them home.

I've had one patient that directly told him she wants to cut her wrists & die....he still d/c'd the Baker Act/sitter. It's ridiculous.

Thank you for your comments! I appreciate all comments (hint hint).

LivingDeadNurse said...

Wow that sounds like a long day. I have notice that anymore healthcare isn't always directed toward the welfare of our pts. Sometimes the insurance doesn't cover things it should or the paperwork seems to get in the way of taking care of your pt to the fullest extent...all you can do is work with what you have and try your best to help change healthcare to be more pt centered

Amanda said...

Wow. I can imagine that's very difficult for you to witness.

Pamela said...

You are right, it's all about the money. Sad, huh? Sounds like you had a crazy night. I would not have gone back either.

Karin, RN said...

I learned to check if my patients have insurance or not, if their diagnosis does not match exactly with doctors' treatment and plan of care. It helps me understand why, although many times I don't agree.