Wednesday, July 27, 2011

Third Degree Heart Block

I am still thoroughly enjoying my part time schedule. I'm there just long enough to get a decent paycheck, but short enough that when a night goes bad...I'm so glad I don't have to come back.

I had 3 patients last week. One with a mystery as to why he was so weak & suddenly anemic, one alcohol withdrawal and one who has chronic anemia, but again, they have no idea why. They sounded terrible on paper. I should know by now not to assume they will be as terrible as they sound...because usually the train wrecks on paper are awesome patients, while the ones that sound too good to be true...end up being a pain in the ass. So I should know by now not to think the worst. I just pictured having to give blood to two of them while dealing with an out of control alcoholic as the third patient. Luckily, NONE of that happened.

Pt #1...mystery man. I made an extra effort to connect with him. I could tell he was frustrated being in the hospital for a couple of weeks and not getting any real answers. We could tell him everything it wasn't, but one had figured out what was causing his problems. So I really took my time to comfort him. He slept like 10 hours out of my 12 hour it wasn't bad.

Pt #2...the alcoholic. He looked a mess, but for some reason, he & I bonded. He didn't give me any trouble, I didn't give him any judgment. Whatever he needed, I got it for him...if it was ordered. One thing I wouldn't get was nausea medicine. I cannot allow myself to call an MD for nausea medicine when a patient says "I'm feeling nausous, I need medicine....oh, and can you get me a turkey sandwich, a pepsi & some ice cream too." Uhhhh, no...pick one or the other. Nausea medicine or food. Which is more important to you? He always chose food.

Pt #3...although his hemoglobin was enough to make you the 5 and 6 range, he actually never asked for a single thing and the only time he would call was if his IV machine was beeping. During his time at the hospital, they had already transfused something like 15 units of blood. His count would go up for a day & then drop back critically low. NO.IDEA.WHY.

I also got an admission around 4:30 in the morning, but one of my friends did nearly the entire admission. She rocks! The patient had an active GI bleed. Eeeekkkk...don't like those because the smell is horrible. And you never get used to it.

So my first night was good. You know what that means. My second night would have to be bad.

I come back & get my first 3 patients, but didn't have to deal with GI bleed. Well, other than continuously spraying the hall every hour because that odor was creeping its way into the nurse's station. My patients were all doing well. You know you've bonded with a patient when they say "Heyyyyyy girlfriendddddddddddd" as you enter the room. That would be pt #2.

Everything was going great until about 4 am when I'm told I'll be getting an admission. Ok, fine. I start getting report from ED and the nurse tells me the patient's blood pressure is labile. Ummmm, can you explain a little more in I'm clicking on the vital signs tab on the computer. She says "It goes up & down." I look...he came in it was 130/65, now two hours later it's 75/22. Uhhhhhhhhhhhh....................hold up. I call the nursing supervisor & she says she'll check it out. I tell the ED nurse what's going on & she says "I understand what you're saying, but you do know that blood pressure & stability are NOT related. Really? What nursing school did you go to?

The nursing supervisor checks him out, says he's fine...talking, joking, bp currently 110/60. Ok, fine, whatever. Bring him here...fully expecting I'd have to do a rapid response should his bp drop. I take my other patients vitals. Everyone is great...stable. My new patient arrives, no less than 2 min later I get a call from the monitor tech...."uhhh, your patient is sustaining a heart rate of 30." So I rush over to that room. It's pt #1. Thirty min earlier he had been normal sinus rhythm with a heart rate of 80. Now he was 30. Luckily he's talking to me & his blood pressure hasn't changed. Whew..did not want a code blue.

I tell my charge nurse what is going on....5 of us go back in his room & are staring at This is the tricky have to tell your patient why you are there, but you don't want to scare him either. I leave to call the cardiologist. Someone else reminded me to call rapid response. I call the rapid response nurse & get the reply "He sounds fine." Uhhh, you can tell all that over the phone??? So he comes up, looks at the rhythm strip & runs to the room. He tells us the patient is in 3rd degree complete heart block. Eeekkk...this can be fatal. In my 7 years as a nurse, I have never seen someone go from normal sinus rhythm right into complete heart block.

I'm still waiting for the cardiologist to call back, so we order an EKG and I call the primary to get an order for ICU. She calls me back quickly, I get the order....easy peasy. Finally the cardiologist calls back & after I read him the EKG strip. He thanks me for telling him & hangs up. WTF? I wasn't telling him the morning weather report.

Anyways, we quickly got my patient to ICU. The nurse down there asked him what was going on as a gauge to see how much he knew. His reply..."one minute I was sleeping and the next thing I knew...5 beautiful nurses were standing over me asking if I was alright." Awwwwww....sweet! I really hope he's ok.

Needless to say, I got back to my floor at 6:30 am...I checked on my admission who was now sound asleep & I passed him onto the day nurse. I had a staff meeting at 7:30, so no way would I have been able to do the admission. And he was sleeping, it could wait. Wow, what a morning. So glad I then had like 9 days off. :)

Weird thing is....within 48 hours...two more patients on my floor went into complete heart block. This never happens!!!!!!!!!!

Some good things...
*We got a cost of living raise....yesssssssssss

*I pretty much spent that raise staying at a resort for 2 days & drinking frozen drinks by the pool....yessssssssss

*I went from having no guys lately to two asking me out....yessssssssss

*I got a new dishwasher....yessssssssss

*Found out my friend that just went thru a double mastectomy for breast cancer is now cancer free....yesssssssssssss!!!!

Hope everyone is having a good week!!! :)))

1 comment:

Carlene Noggle said...

sounds like all in all you have had some good luck! Congratulations on the pay raise..I haven't had one in over ten years!