Grad class is over & out!

Yessssss!  Class is over!  The class was very helpful, but after 8 weeks of it, I think all of us were ready for it to be over.  Today we had a lecture from respiratory regarding chest tubes & also suctioning.  We also did somewhat of a mock code...so we would know what our responsibility when we have a patient that codes.  That helped although I'm sure it's still gonna be a scary experience when I encounter it. 

I only got about an hour of sleep last night because I slept too much after work during the day.  That is one reason I wanted class to be over with...so I wouldn't have to switch back & forth from nights to days in less than 24 hours. 

Volleyball was fun last night....Julie nailed me with the ball, but somehow it hit my shoulder & went over the net.  Julie fell down laughing...lol.  I love my volleyball nights.

Time for me to go enjoy my week off...yay!

Some time off

Last night at work was a pretty good night.  I'm getting used to handling 3 patients now.  I had an 80 yr old man diagnosed with TIA.  He was for the most part alert & oriented...kept complaining that he couldn't move his legs, even though he was moving them.  Someone in the ER put in his foley catheter wrong & caused some trauma in his urethra which resulted in a lot of blood which is still bleeding.  They inflated the balloon before reaching the bladder!  The strongest pain med we had for this guy was Tylenol.  I felt bad that I couldn't make him feel better, but with a TIA it's unlikely they would prescribe him anything strong anyways.  My other gentleman is a 45 yr old man that had complete occlusions in his iliac arteries - so young to have that.  He is scheduled today to have some stents put in.  He was very anxious/nervous all night about what to expect today.  I tried to comfort him as best I could considering the circumstances.  I had a new admit last night also...a 21 yr old girl that had a seizure while swimming.  Someone was there to catch her before she went underwater.  In the ER she had another seizure, but she didn't have any of the residual effects so it was tough to determine what was going on with her.  She showed up on my floor wearing a bikini.  Why they didn't have her change into a gown, I'll never understand.  Or maybe she didn't want one, who knows?  They were all stable throughout the night.  I finally felt like I had some idea of what I was doing.  I'm sure that will be short-lived.  I am off the floor until next Saturday night - it will be a nice (nearly) week off.  I have a 1/2 day of class tomorrow & then some freedom to do whatever I want for a few days.  I'm happy!!!!!!

Back to work

I need to start getting ready for work. I have slept so much in the last 48 hours...guess I really needed it. I wish I had one more night to just relax, but I gotta work. I'm sitting here wondering what kind of patients will I have tonight...will it be a difficult night or a good night? I guess that is part of the thrill - not knowing what to expect. I am hoping for a not too difficult night as I'm feeling pretty mellow at the moment. Maybe that will change as I start drinking some caffeine. Gina won't be there tonight cause she worked Friday night. I like it better when she is around, someone to talk to & joke around with.

Dale Jr. already crashed out of the race in Vegas today, so no need to continue watching. :) Oh well, that's about all that is happening right now. I need to jump in the shower & get my night going. Ciao!

A Day to Myself

It is so nice to have a day to myself. I have absolutely nothing planned, nowhere to go & no one to see.....so refreshing. I have spent my morning putting my nclex books for sale on Ebay. I don't need them anymore! Woo hooooooo! May as well make some money, right?

I was so busy at work on Thursday night. I think it's because I told my preceptor "I'll take 3 patients from now on." What a difference it is from 2 patients...especially when one was a total care patient. I couldn't help but feel bad for him. He was a 72 yr old gentleman that is in end-stage renal failure & his AV shunt was clotted & infected. He came into the hospital a few weeks ago & has declined since then. It's sad to see that happen. In his room was his walker from home. After seeing him laying in bed, very confused & lethargic, it was hard to believe that he walked himself into the hospital just weeks ago. I don't believe he has been out of the bed since he arrived because his health deteriorated so much. He had an NG tube for feedings and because he was confused, we had to restrain his hands so he wouldn't pull the NG tube out. I don't like restraining people, even when it is in their best interest. It just seems so...I don't know the right words...I just don't like seeing them restrained to a bed against their will. The nurse I got report from was just awful. It made me question if he had even spent anytime reading the chart or even in the patient's room. He told me that the gentleman came in because of an infected shunt in his RIGHT arm, so they put a new one in his LEFT arm. That wasn't true, the infected shunt was in his LEFT arm & they put a new one in his LEFT arm because his right arm was ecchymotic & weeping a yellowish type fluid - I'm not sure what was going on with that. As we read through the doctors orders, we saw an order from TWO days ago to d/c his central line (because it was clotting) & put in a peripheral line. Where in the world did this doctor think we could put in a peripheral line? Definitely not in his left arm with the new shunt there & the right arm was totally off-limits with all that yellow fluid weeping out. Did the doctor even observe this patient??? Doesn't seem like it. Anyways, the real concern was why was this order not addressed on the day the order came in? We asked the day nurse & his reply "I never saw the order." What? Do you not read the chart? So what does my preceptor tell me - call the doctor & tell him it can't be done. Ummm....I'm supposed to just outright tell the doctor that? Is he going to be ok with that? It just sounded like I was setting myself up to be yelled at or at the very least, thoroughly questioned about a patient that I had just received a poor report from the day nurse. We paged the doctor, but (thankfully) he never called back. We did attempt to put an IV in, but it just wasn't happening. Looking back now, I should have documented all of that, but it slipped my mind totally. Now I know better. Charting is my weakness right now....when it comes time to chart, suddenly I can't think of the words to say & I'm usually good at putting my thoughts into writing. I'm working on it. Something else I forgot to chart on was respiratory. This poor man was practically drowning in his own fluids...he couldn't cough it up. We suctioned him, but couldn't get it all out. So I called the doctor at five am to tell him I needed an order for respiratory to suction & provide respiratory treatments. I'll talk about the dr's call a little later, but I did get the order. Respiratory came up, did what they could, but the man still had a terrible unproductive cough. I don't think I could ever be a respiratory therapist - it looks like torture when they do suctioning, not to mention the lovely looking fluids they pull out of people's throats...ugh. On top of all that, the day nurse tells me in report....look, his potassium level is 3.3 & that was at 5 am that morning. Why in the world did he not contact the doctor during the day?? The gentleman was on the potassium protocol, but that is only good for people with kidneys that function properly. So I had to contact a different doctor to get an order to help raise his potassium level. It amazes me that the day nurse had no clue what a low potassium level can do to a person - it can kill them! It was definitely an eye opener seeing that there are some nurses out there that just don't have a clue. They probably mean well, but that isn't going to make a person's health improve. This gentleman's temp had been as high as 104 during the day. There is a doctor's order that read "If temp is >101, get a blood culture & contact me for Ancef orders." We show it to the day nurse & his reply "I didn't see that order." I wanted to ask "Are you blind??" Since the patient's temp was down to 99 when I got report, we didn't contact the doctor. I definitely passed that important message to the nurse that took over after my shift in case his temperature did rise. It was 100.4 when I left. Did the day nurse not realize that a temp of 104 is not a good thing? I swear, he was the worst that I have encountered so far.

Well, next to the doctor phone calls. I don't know what it is, but it seems like 90% of the doctors on staff are from another country...which is fine, but I can't understand anything they say - especially over the phone. They talk so fast & with their foreign accents, I can only interpret like every 3rd word out of their mouth. When a doctor gives an order, we're supposed to write it down & repeat it back to him. That sounds nice in theory, but the doctor's usually don't want to take the time to have us read it back which I don't understand because it's in their best interest that the order is correct. This is what I hear "tkadjfaoireakfsaopokra, ok?" Huh??? Maybe it's cause I'm new, but I can't imagine ever being able to understand what these doctors are saying without the need to say "Can you repeat that?" Not to mention sometimes it's the middle of the night when I call & they are half asleep & mumbling their words. Hopefully in time I won't mind calling the doctor, but right now it's not on my favorites list.

My other patients were pretty easy to care for. One lady was in for chest pains R/O MI. She didn't have a MI, her labs were normal. I don't even see why she was still there after 3 days. She was asymptomatic, labs were normal & nothing was ordered for the following day. I had a new admit around 9 pm. He had been to his doctor that day & his pulse was 35. So his doctor sent him over for a direct admit. By the time he got to my floor, his pulse was 60 & he was asymptomatic. So he was pretty much an easy 23-hour observation. He was a very nice gentleman. I like doing admits...I like asking them 1,000 questions (on the admit form) & getting to know who they are & trying to make them feel comfortable with their hospital stay. I guess it's the customer service side of me from jobs in the past. He was in the same room as a long-time friend of my family. I don't think I told that story earlier...

I was at work a week earlier & the nurse's call bell rang. I looked at the screen & immediately recognized the name. He is a gentleman that was a really good friend of my dad's in the past growing up. He's known me since I was born! So I pick up the phone to see what he needed & he went on & on about something he bought in Chicago. That is not the norm...usually people call to say they have to go to the bathroom or need pain meds, etc. So I go into his room to see if he recognized me as I probably haven't seen him in about 10 years. He didn't recognize me, he was confused & just kept going on about this story from Chicago. That was so weird to see - someone I had known for a long time to be so disoriented. Anyways, when I came into work on Thursday, he was so much more with it & he immediately knew who I was. It was nice to see that he wasn't confused although at one time during the night he had gotten up & I thought he was trying to climb into bed with my patient! That wouldn't be the first time a patient has done that...that is one reason I don't like the semi-private rooms. You never know who your roommate is or what condition they may have. At my old hospital, every single room was a private room so I got used to it. Never had to worry about someone invading someone else's space. Most hospitals are not like that though, so I will get used to the semi-private rooms.

Anyways, the night flew by. I don't know how I'm going to be able to care for 5 patients. So much paperwork!!!! I guess it takes time to learn how to be organized. Tuesday is my last day of class...yay! Freedom at last! Now it's just work, work, work & I'm looking forward to it! I have a light week next week...I work on Sunday & Saturday, have class on Tuesday & many days off inbetween. I'm looking forward to have a few days off in a row.

Suddenly I am craving a peanut butter cookie - a nice, warm cookie. Hmmm...where can I get one of those? I'm really trying to eat better because I got on the scale earlier in the week & did not like what it said. So I've been eating pretty well since Wednesday & managed to lose the extra pounds I had gained this month. Now I just need to continue eating well & add in exercise so I can get rid of the rest that I need to get rid of. Easier said than done, right?

Another year older

I turned 36 yesterday!  I spent my birthday playing volleyball & then going to Chili's for dinner & drinks.  I'm going out tonight with my best friends to dinner & to see "Be Cool."  It's nice to finally have a full day & night off.  I feel like I've been working, working, working.

I had 2 patients this weekend for both nights.  One was a very sweet older lady that adored me.  She told me many times how wonderful I was & how I was taking such good care of her.  She was in the hospital because of pneumonia & at that time they also detected that she was low in potassium.  She was really easy to care for.  When I was leaving yesterday morning she was asking when I was working again.  I told her not until Thursday & hopefully she will be home by then.  So she asked for my name & address on a piece of paper.  I wasn't sure what to do or what the hospital policy was on stuff like that.  I ended up writing it down & giving it to her.  I didn't see anything wrong with that.  I figure she just wants to send me a thank-you card.  After I did that, she asked if she could give me a hug.  So I gave her a little hug & she says "I love you."  It was sweet.  It was nice to be appreciated.  If only all patients could be like that! 

My other patient was someone that I had first encountered in the ICU when I was a student last fall.  She's a 41 yr old woman that had a heart attack & a stroke while she was sleeping.  Needless to say, she is no longer herself.  She is pretty much unresponsive.  She has a trach & can breathe on her own, but her mind is disconnected from her body - the body is just doing what it's programmed to do - make the heart & lungs work.  It is no longer getting signals from the brain.  She has a peg (feeding) tube & her hands & feet are starting to have contractures.  She has been taken home only to return to the hospital because of infections.  The day nurse said to me "The husband is in the room & he won't leave until he meets you & trusts you can take good care of her."  I was thinking "Uh oh, I've never cared for a patient in this type of condition, how am I going to get him to trust me?"  My preceptor told me to go in there on my own & do an assessment - she didn't want to go in with me & let on that I was a new nurse because he might not allow me to care for her.  So I went in & he says "Are you here to care for my angel?"  I told him yes.  He asked if there was anything I wanted him to tell me about her.  I replied "Anything that you would want me to know."  So he went over some things & about 15 min later he said he was going home - so I guess I passed his test.  I took good care of her. It's sad to see someone in that condition - especially as such a young age.  That's why people should have living wills - take the responsibility & guilt out of your family's hands.  I don't think anyone would want to live that way.  I had my parents & one of my brothers & myself fill out a living will so that the decision has already been made should we ever encounter something like that cause you just never know.  It reminded me of the Terry Schiavo situation.  15 years on a feeding tube & no real sign of brain activity.  My patient's family still believes that one day she will wake up & everything will be back to normal.  The husband was showing me pictures of her before this happened.  Just so unreal that you could go to bed & never really wake up. 

 

IT'S OFFICIAL - JEN THE RN!!!!!

Woo hoo!!!!! I did it - I passed the state nursing board exam - I'm an RN!!!!!

It still hasn't really hit me, but I am happy. Gina passed also. We found out around 11 am. I already picked up my work badge that says RN on it. It's been a long 2 1/2 years, but I finally feel like I've accomplished something very worthwhile. No more studying, no more practice nclex questions....freedom!!!!!! In fact, I'm going to start selling my nursing books & nclex study guides on Ebay - I'm tired of having them around the house.

We had grad class today - so boring. A respiratory therapist came in to talk to us about ABG's - the thing is, we already knew everything he was attempting to teach. It seems like this entire "grad class" has just been focused on information that we already know. Do they not realize that they do teach us stuff in nursing school? I wish they would teach more real world things - like how properly call a doctor: what kind of info is he/she going to want, what should we be anticipating, etc. Also, how to handle a difficult patient or family member or how to handle a patient and family who has just been told the patient has a terminal illness. Those kind of situations would be a lot more helpful than what they are currently doing.

I took Kelly to the airport a little while ago. Ivan is coming back from Germany & they are spending the next couple of days in Cocoa. She was all dressed up....dress & heels even. I'm happy for her - hope things work out. I can't believe they are engaged!

I should be out celebrating, but I am tired plus I have a busy week ahead. I work tomorrow night, have my birthday "party" Friday night, work Saturday & Sunday night, my birthday & volleyball on Monday night.....soooo I am staying in tonight & relaxing - and breathing a sigh of relief. :)

La da di, la da da - patiently awaiting

Is it Wednesday yet??? I want to know the results of my nclex exam. I've been keeping busy...playing volleyball, running errands, watching tv...patiently awaiting the results to see if I'm an official RN or not. I have grad class tomorrow & I know my classmates will be asking the results. Ohhhhhh, I hope it's good news.

My 36th birthday is on Monday. Where has the time gone??? Ok, time for me to go find something to do so it keeps my mind off this waiting game. Hopefully the next time I post on here, it will be happy news!