Monday, July 6, 2009

So Ready to be off of Orientation!

Did everyone have a wonderful 4th of July? I spent it at my brother's house/party. It left me wondering...what is it about men & fireworks? He had thousands of dollars worth of fireworks that took 90 minutes to set off....and it wasn't like one at a time. It was these huge boxes of fireworks that they were lighting 3 at a time. It was fun to watch, but it left me wondering...why are men so willing to spend tons of money on fireworks? I never see women rushing out to buy fireworks. I don't know what is spending ridiculous amounts of money on fireworks or us women that stand there watching them go off. Hmmm...maybe that's why men do it...for women's admiration. Who knows?

Anyways, it was a good time. Hard to believe the year is half over. Where did it go??? Before we know it...Thanksgiving & Christmas will be here. I wouldn't mind it cooling off a bit. I nearly passed out at the party just from standing in the sun talking. Seriously! It was that 97 degrees. I went to sit down & was feeling awful & silently telling myself "please don't pass out, please don't pass out." I went inside & put some cold water on my face, drank down a bottle of Vitamin water & hoped for the best. Luckily, the icky feeling went away quickly.

Last week at work was fine. I am so ready to be off of orientation & on my own. I want independence. It's funny how we all have different ways of doing the same job. I noticed there are some nurses that are all about the charting....they don't let a single thing slip by them when it comes to the chart or the computer. However, it seems like the thing they are least concerned with is the actual patient. It's so odd to me that they can be so fixated on the charting aspect, but suck at actual patient care. And when I mean suck....their idea of an assessment is to introduce themselves to the patient & that's it! They don't touch them, they don't listen to their lungs...they don't even ask the patient how they are doing. It's so bizarre to me.

I, on the other hand, focus more on the patient than the paperwork. The charting can wait until later...when the patient is sleeping or when my assessments are done & everyone is A-ok. For instance, my preceptor & I had a patient the other night...yes, we shared our patients because apparently she's only been a nurse since October & didn't feel comfortable letting me take care of any patients on my own. I didn't mind...whatever suits her best. So we have this patient in his late 80's who just had a lap chole (gallbladder surgery). His blood pressure at 8 pm is something like 93/48. A little low, but considering they gave him Oxycontin for pain...I would expect it to be low. The nurse says to me "His blood pressure is low because he's in pain." Ummm, I don't think so. Usually it's the reverse....BP goes up when one is in pain. He had also received 8 mg of Bumex (diuretic) during the day because he had congestive heart failure. 8 mg is a big dose. So I figured between the pain medicine & the makes sense his BP is a little on the low side.

The nurse keeps taking his blood pressure over & over until she finally gets a reading of 103/52. She's relieved now. I just stood there looking at her. She tells me his next dose of Bumex is due at 11. I said "We're not going to give it, are we?" She thought I was insane & reminded me of how high his BNP (lab test that shows one is in congestive heart failure). It was over 2,000 which is high, but his blood pressure is don't give diuretics to someone with a low BP. I felt bad for him because he was complaining of pain from the surgery, but all we could offer him was Tylenol because anything else could lower his BP.

Now it's 10:30...she's going to have lunch & I tell her I'm going to recheck his blood pressure. The first reading I get is 79/38. Uh oh. So I recheck it on the other arm. 80/41. Not good. I go into the breakroom to tell her & the advice I get....give him something to drink & put his feet up. Are you serious? This is a post-op patient. For all I know, he could be bleeding internally. About 15 min later she ventures into the room & his BP is still low. So she gets the charge nurse & they stand there discussing him & debating about whether to give the dose of Bumex. I didn't say a word, but trust me...if they had pulled that dose to give, I would have spoken up loud & clear.

She then announces she's going to call the doctor...that the patient probably needs IV fluids. So she says she's going to call the primary doctor. I inquired as to why not call the cardiologist...that is the doctor that ordered the diuretic and the blood pressure is freaking low. She says they don't call the consulting doctors...just the primary. What? Isn't that the purpose of having specialists on the case? She calls twice & gets no call back. Are you going to try to call the cardiologist now? No. She calls a rapid response instead. Weird. I would have called that the first time I got the really low BP, not an hour later, but ok. Maybe they just do things differently here.

He shows up...yes, it's a one man rapid responder. He comes to the same conclusion that I had an hour ago. That the patient needs fluids and no more Bumex. She calls the primary one more time & he finally calls back....all she gets to say is the patient's blood pressure before the doctor cuts her off, orders fluids & hangs up. See, this is why I don't like dealing with primary doctors for important stuff. They aren't the best at handling critical situations.

While she's starting the fluids, I look back over his medication record & see that the day nurse had not only given him Oxycontin, Bumex 8 mg IV...she also gave him Isosorbide (blood pressure lowering medication)...which is all fine & dandy...except his BP when she gave all this stuff was 102/49. Ugh...that's why his BP is so low now. We're just going to have to hope the fluids work & wait until his medications wear off. Thankfully he remained stable the rest of the night & was still responding appropriately to us & his 02 sat was good...even though his lips were blue. The nurse would keep telling him to wet his lips so the blueness would go away. Sigh.

I'm back tonight for 3 in a row. I have to take some competency test on Friday. You'd think they'd have you take the test before hiring someone, wouldn't you? We have 2 hours to take it...I hope it's not that long of a test. She's like "bring your calipers & a calculator." Ugh!

Have a great week!!!


Pamela said...

You are a great nurse! Sounds like you should have been orienting THEM! Good luck on the test! You'll do great!

Julie said...

We routinely give heart meds to patients with low pressure, over 90 if the patient is asymptomatic. We want to reduce the heart load. Pulled nurses flip out but are used to the low pressures on the cardiac floor. It all depends on the patients condition. I know you will be glad to get off of orientation. It's hard when your not a new grad.