Mother's Day weekend

Ahh, back to a normal day schedule...feels refreshing.  I am up early because I am going over to my parents home today.  I am working tomorrow night & will not be able to spend Mother's Day with my mom - or as she likes to call it:  "Mother's Day weekend."  So I am going out there today & we plan to go shopping.  Next year I'll have to remember to plan this better & not be working on Mother's Day as it is a day where my family usually gets together.  It just totally slipped my mind back in April as I was filling out my schedule for the next 2 months.  Live & learn.

I got 3 new scrub tops yesterday.  I think I am becoming obsessed with them, but I hate wearing the same tops over & over.  What can I say, I like variety!  Even though I just got 3 new ones this week & 4 new ones like two weeks ago - I still want more.  I think I have enough now to wear for a month straight & not have to wear anything twice.  Oh well...nothing wrong with wanting variety, right?  And it beats having to buy business dress type clothing - yet another perk of nursing - nice, comfortable clothing. 

 

 

 

Yawn

I just woke up from a 3 hour nap...that is one thing I don't like about working the nightshift - it really messes up your sleep schedule when you try to get back to waking up during the day.  I worked Sat, Sun, Mon & Tues nights - with each day I gain a little more confidence.  I love being on my own!  I still ask plenty of questions & discuss many situations with my clinical leader, but it's nice to have the independence & be able to plan my evening the way I want to.  Two of those nights Gina was on my floor - makes it more fun when you have a friend close by. 

One of my patients was the same one I had the week before.  I got to know her & her daughter a little better.  By my last shift with them, the daughter was hugging me & thanking me for taking such good care of her mother.  One cute thing that I will remember about this patient is when I went in to ask her exactly how to pronounce her last name (because the day nurse had been pronouncing it very differently than the way I was).  So I say to my patient "Mrs. so-and-so, how exactly do you pronounce your last name?"  She replied "To you, it's Naomi" (her first name).  It was just so sweet & genuine.  Taking care of her was sort of like a rollercoaster ride...one night she was out of it & lethargic, could barely speak and the next night she was alert & fiesty.  It seemed to vary between the two extremes.  She is in her late 80's & it seems her daughter realized she doesn't have a lot of time left.  It was hard to watch her struggle with that reality because the thought of my parents passing away scares the heck out of me.  She called me one night & said she was having a hard time sleeping & could I please go into the room & tell her mother that she loved her.  It was touching.

I had another patient that came in with a diagnosis of Tylenol overdose.  I don't even know why she was at our hospital because where the overdose took place was over 60 miles away.  She belonged at the hospital that has a psych facility (which was closer to her than we were).  As soon as we got her stable, she was transferred over there.  She was a handful - ripped out her IV, threatened to leave the room, got all aggressive towards the staff & in the next minute - quiet & cooperative as she could possibly be.  I tried to have patience with her, but when I saw that reason wasn't always working - I'd leave the room until I could think up another strategy.  Needless to say, I wasn't disappointed when I came into work Monday night & heard she had been transferred.  I don't have a lot of patience when it comes to people that purposely want to harm themselves.  I try to be understanding, try to see the outlook from their perspective, but it's not always easy to do - especially when they are giving you a hard time when all you're trying to do is help. 

I had a couple of other patients that were in with chest pain r/o MI.  In fact, I had two of them complaining about chest pain within 30 minutes of one another.  Those are so NOT my favorite words = "I have chest pain."  I assessed the first one, find out that it's more of a really bad headache than chest pain.  The last thing I want to do is give her nitro SL since it would cause an even worse headache.  I couldn't even give her any at the moment anyways because pharmacy messed up & forgot to add it to her MAR & the day nurse missed that also.  So as it was being refaxed to the pharmacy, I continued to assess the patient.  That's when she stated she didn't feel chest pain any longer, that it was a really bad headache.  So I gave her tylenol instead & after about 45 min, she was fine.  As I was finishing up with her, the patient in the next bed started complaining about chest pain (I'm beginning to think it's contagious...lol).  I assess her, get the nitro & about ready to give it to her when she states "It's my head that hurts, not my chest anymore."  Ok, scratch the nitro, more tylenol instead.  Never underestimate the power of tylenol.  :)

I had another patient that was in with a diagnosis of syncope.  I was convinced he was a "decoy" that the hospital set up.  Let me tell the whole story.  We have JCAHO coming to our hospital either next week or the following week.  And in that time, we have had at least 3 hospital employees (that I know of) suddenly become symptomatic.  One of them was my patient.  I'm probably paranoid (Gina thinks I'm nuts), but I kept telling her he was a decoy...lol.  Mostly because all of his labs were normal, all tests were normal, etc.  So who knows - that's my story & I'm sticking to it.  They have been doing mock JCAHO stuff lately, why couldn't this be it also???

My final patient of my 4-day (night) shift was a woman with a peg tube & an open abdominal wound (she had bowel surgery in the past month or so).  Those were not her problems, again...chest pain.  She was not complaining of chest pain or if she was, I didn't know about it because she only speaks spanish (put that on my list of things to learn).  Her peg tube was not able to be used because it ended up in soft tissue rather than her stomach.  But her major problem (in my eyes) was the infected abdominal wound.  You could smell it & it was not a pretty smell.  I had orders to put it to negative suction.  It's funny - we just had an inservice from wound care on how to operate the equipment & I was seriously thinking at the time "When am I ever really going to use that device???"  Well, here I am with an order to use it.  My clinical leader & Gina helped out (or should I say, did most of the work - thanks guys!).  I also had an order for a wound culture.  We took off the gauze that was there & saw what was underneath.  I had no idea what I was looking at nor did my clinical leader.  It was a large, deep abdominal wound - I was surprised we didn't see organs or that there was no blood seeping out.  There was a lot of drainage though - awful looking smelly drainage.  We packed the wound with this sterile black sponge stuff & then applied suction.  I felt like we were doing surgery...lol.  It looked rather impressive after we were done I must say! 

After work on Wednesday morning, for some reason Gina & I decided to go to a job fair that was an hour away & it was raining out.  We were so tired.  In fact I knew Gina was tired because when we got there, she hardly even spoke & that is not like her.  Usually she's asking a zillion questions to perspective employers.  We ran into our old employer - well the human resources lady anyways - she is a strange one.  I don't think I'll ever go back to workthere if I have todeal with her.  Then we were basically pursued by another local hospital - the lady came up to us.  The time spent talking to her made the drive worth it.  The hospital sounds awesome - it's all computer charting - you have your own laptop, you are teamed with your own tech to deliver patient care rather than having one tech for 18 patients or no tech at all.  They have nurses that handle the admitting paperwork completely....the list goes on & on.  Needless to say, it sounded like heaven compared to where we are at now.  I really like the staff where I'm at, but there is no computer charting, we are lucky if we have a tech - let me rephrase...lucky if we have a tech that actually helps out rather than disappearing after vitals are done.  I'm not dissing techs in general, just some of the ones that work at the hospital I'm at.  I used to be a tech while I was a student & I did as much as I possibly could to help out the nurses.  Most of our techs give us attitude if we ask them to take a person to the lobby that has just been discharged or if we get a new admit that needs vitals, etc.  They make up excuses of why they can't do their job or they just disappear for awhile.  It's frustrating.  Anyways...this other hospital is something to look forward to in the near future.  I did have an opportunity to work there - they wanted to hire me into the post-open heart surgical floor & it intimidated me as a new grad.  I wasn't ready for that & not sure I am yet - but definitely in the future. 

On top of all that, I also got a raise at work.  Not because of my hardwork, but because the hospital is trying to be competitive with it's rates & they raised up the starting rate of new nurses & therefore I believe I will receive over a $1/hr raise.  We'll see in the upcoming weeks when I get my pay stub.

Time to go relax & watch Survivor!

First week...complete...almost.

My first week on my own without a preceptor went well.  There is one thing I really like about being a nurse & there is one thing I really don't like about being a nurse....funny how they are one & the same = never knowing what type of patients you are going to have or how your night is going to go. 

I don't know why some people call nurses control freaks - because we have absolutely no control over how the night will play out.  There always seems to be little things that happen through the night...problems.  Most of the time there are quick solutions...medications, repositioning, some type of intervention to alleviate the problems.  Tuesday night I had one patient complaining of pain in her abdomen & heart burn, another patient who seemed A&Ox3, but yet would not call for assistance when she felt the need to get out of bed (a possible TIA pt), my third patient was a man who was very upset that he wasn't able to get discharged because his PT/INR was way too high and my fourth patient who was sooooo fixated on moving his bowels. 

I focus on my first patient because pain is not something to overlook.  Her daughter was at bedside & I noticed that the patient acted much different (more needy) when her daughter was around as opposed to when she wasn't.  It's also interesting to see how as people age, the roles get reversed.  This was a daughter caring for her mother so very much like a mother would care for her own child.  Anyways, I  give her some tylenol & later morphine to take care of the pain & allow her to sleep. 

My second pt - I kept reorienting her & having her do return demonstration on how to contact the nurses station should she feel the need to get out of bed.  I really did not want to have to restrain her, but I also didn't want her falling & breaking her hip either.  My third patient...his early morning PT/INR came back at something like 95.5/8.58 - soooooo very much outside of normal limits.  I call the doctor at 5:30 am & it sounds as though he is whispering his orders.  I ask if I can call him back from a different phone as the one I'm on...you can't control the volume.  He wouldn't allow it...he kept repeating his order.  I made him say it 3 times before I repeated it back to him...Vitamin K 2 mg IV x 1.  I run to the ER to get the medication.  Vitamin K doesn't sound like it could be all that dangerous, does it?  HA!!!!!!  (Nursing students, listen up - it will be a test question...lol).  It is the antidote for Coumadin - helps with the clotting factor.  It normally isn't pushed IV, it's usually a SQ or PO med.  The nurse in the ER questions the dose...saying 2 mg doesn't sound like much.  I run it by my clinical leader who is also an ICU nurse, she says it is the proper dose given the route.  I try to look it up online before pushing it & am unable to find anywhere on medline that shows it being an IV med.  I use my common sense & push it slowly after flushing his IV with 5 cc's of saline & following it with another 5 cc's of saline.  I find I have a few extra minutes so I google Vitamin K IV & find that it is indeed a very dangerous medication.  In fact, it says only cardiac nurses may push the drug, otherwise a physician has to administer it.  Then I remember...I am a cardiac nurse...lol.  The article goes on to say that some patients can go into shock immediately after administration which surprises me because 2 mg appears to be a very small dose in a syringe (0.2 ml).  Luckily my patient tolerated it just fine.  I am curious to see how his PT/INR was after that, but I won't find out until Saturday night. 

My last patient was a new admit around 2 am.  He was on a clear liquid diet & he was wanting prune juice.  He went on to say that he drinks 5 glasses of prune juice at night and another 8 glasses in the morning with breakfast (ick).  He was so fixated on moving his bowels...unlike anything I've ever seen before.  Since he couldn't have prune juice because of his diet orders, he seemed to think that drinking warm water would stimulate his bowels <sigh>.  Why do older people get so fixated on their bowel movements???

Needless to say, I was glad when my shift was over.  I was tired, needed sleep.  No more than 60 minutes after getting home, the hospital was calling & asking if I wanted to work a 4th shift Wednesday night.  No thanks!  They called again today asking if I would work Saturday night.  After adding up what I would make for one extra night of work, I found it hard to resist...nearly $500.  So I am most definitely doing overtime! 

There is a job fair next week - time to see what else is offered in the real world.  Stay tuned!!!  :)

 

Bet you're wondering!

Hi to all those that take the time to read my journal - keep posting & writing to me.  I really enjoy it.  And I'm sure you're all just going crazy with the suspense of wondering how my first night without a preceptor went for me, aren't you?? 

Well, worry no more - it went great!  Probably because I only had 3 patients.  :)  I must say, at the beginning of the shift, I was a little anxious because my first patient's heart rate was between 160 & 170.  Wayyy too high for my liking.  The day nurse had called the cardiologist & he ordered Lopressor PO...ugh!  So she gave the dose at change of shift & I had to wait about 45 to 60 minutes before it had any real effect.  Eventually it was between 80 & 105, but anytime he moved it would shoot right back up to the 150's.  Grrr!  He had a heart cath done on Monday which was negative.  So who knows what is going on with him.  My second patient was an older woman who had been admitted a month ago.  She went into cardiac arrest at home, the paramedics revived her, she coded again in the ambulance on the way to the hospital so the paramedics revived her again.  She was admitted to ICU where she had yet another cardiac arrest - they saved her.  Eventually she was moved to PCU (my unit), she went into cardiac arrest again!  Revived & back to ICU...cardiac arrest once more, revived yet again.  This all happened in about a 1 to 2 week span.  By April 9th, she became a DNR & wouldn't you know it - she hasn't gone into cardiac arrest since then!  She slept pretty much the entire night & was discharged before I got to work yesterday. 

My third patient is an older woman also who came in with a UTI, sepsis, aspiration pneumonia & altered mental status.  She was perfectly alert & oriented both nights.  Had to crush her meds & feed them to her with pudding.  Not much to really say about her. 

So my first night on my own, I had 3 patients - everything went pretty smooth.  Last night (my second night) I had 4 patients.  The same two above minus the one discharged yesterday.  My two other patients were a gentleman that was admitted with chest pain R/O MI.  He was on a zillion meds, but no complaints of pain or discomfort.  And my second patient was a new admit - an 81 yr old woman admitted with a possible TIA.  She had been in the ER since 9:30 am & didn't get to my floor until about 10 pm!  I would go crazy sitting in the ER for that long.  She was perfectly fine with me....no signs of neuro deficits & her labs were great. 

I did have a funny episode my first night.  I had received a wet read of an ultrasound that showed one of my patients had DVT's bilaterally in both lower extremities.  So I call the Dr. - it was about 10:30 pm when I called for the first time.  I got no call back.  So I wait 20-25 minutes & call again.  No response.  I wait another 20 minutes & call again.  This time the answering service puts my call right through to the Dr.  So I say "Hello Dr., so & so's ultrasound reading came back & this is what it says...".  He then proceeds to ask me if she's on any aspirin.  I reply "yes she is."  He asks if she's on any Lovenox.  I reply "yes she is, but it was held today because her hemoglobin was too low."  Then I hear silence.  I'm waiting & waiting for a response figuring that he must be thinking what to do next.  Nope, he fell asleep on the phone!  I say "Hello, are you still there?"  He wakes up & has me reread everything we just talked about.  Silence again - not a peep out of him, not even a snore.  I say "Hello????"  He wakes up & we repeat the conversation yet again (beginning to feel like I'm in my very own version of the movie Groundhog Day...lol).  So we repeat the conversation & his reply now is "What would you like to do?"  Huh????  What would I like to do for a patient that has blood clots in her lower extremities?  I didn't know I had the authority!  As much as I wanted to say "I would like to go home", I explained to him that the reason I was calling him was to find out what to do for this patient considering the results.  He gave me an order of Lovenox twice a day instead of once a day & said he'd follow-up in the morning.  Awww, those poor tired doctors!  <g>  Needless to say, it was later discovered that she already had a Greenfield filter put in a couple of months ago & thus the doctor discontinued the Lovenox & isn't worried about the clots. 

So that was my past 2 days in a nutshell.  I am pretty tired & heading to bed......sweet dreams!

I am a nurse.

My last night with a preceptor went well.  I pretty much handled everything on my own, but I think I'll always have a few questions to ask here & there.  It was my first night having 5 patients.  They were all ladies - very nice ladies.  My first one was in with an allergic reaction.  She's 49 yrs old, was in a motorcycle accident last year that pretty much destroyed her left foot.  She was on antibiotics to control the infection & even though she had been taking the antibiotics for over 6 months, she somehow developed an allergic reaction to one of them.  The thing is - they don't know which antibiotic is causing the reaction.  So they have taken her off all antibiotics for a few days & will restart her on them one at a time to try to figure out what is causing the reaction.  She has to have antibiotics in order to fight off the infection, so they need to figure out what will work for her.  I felt bad for her, she was itching all the time.  She had a red rash all over as well as a prickly type rash where you could see the red raised bumps.  She did a show & tell with the x-rays of her left ankle & leg.  It's unfortunate, she'll probably never be able to bear any weight on that leg because it was so mangled in the motorcyle accident. 

My next patient was a new admit, an older woman (in her late 80's) that came in with difficulty breathing.  She was exhausted from being in the emergency room for so long, she just wanted something to eat & to get to bed.  She had a really bad cough, one of those where you cough so much it actually hurts your body.  I showed her how to use a pillow to splint while coughing.  She said it helped a little. 

My third patient was another older woman.  At the moment I can't even remember why she was there.  Aacckk, I'm losing my short-term memory!  Oh wait, she came in because of syncope (dizziness).  She has muscle spasms that travel from one leg, then across her back & down the other leg & she loses her ability to stand.  Her & my first patient were fixated on having a bowel movement - funny how people in the hospital are so focused on that.  Gave her a little prune juice & she slept pretty quietly through the night.

My fourth patient came in with a nosebleed that would not stop along with pneumonia & a COPD exacerbation.  The bleeding had finally stopped the day before, but now instead of coming out her nose, it was going into her intestinal track & she had a consult with the GI doctor today.  She kept asking me for a back massage - as if I was a massage therapist.  Needless to say, that didn't happen.  I didn't have the time to devote to giving massages.

My fifth & final patient was a woman on reverse isolation.  Her WBC count was 0.5 - that is very, very low.  She also was very pruritic (medical term for itchy...lol).  They didn't know what was causing her to be having that reaction, but luckily the medication we switched her to finally kicked in after a couple of hours (Atarax).  After being in her room & my first patient's room - I was suddenly starting to feel itchy after watching them scratching all over - weird how that happens, isn't it?  Although I think my itchiness is from changing both my laundry detergent & fabric softener.  Thing is, I'm not sure which is causing the reaction.  I guess I'll throw them both out & just go back to my usual. 

Anyways, another uneventful night.  Uneventful - I like that word.  It sounds so meaningful & descriptive, doesn't it?  Basically it means the night went well & there were no crazy episodes that had me running around not sure of what I was doing.  My preceptor filled out my final evaluation form & my check-off skills pages (so to speak).  And that is it.  The past 10-12 weeks have flown by.  Amazing how much I've learned & how much confidence has been built up.  I'm no longer a student nurse, no longer a grad nurse, no longer an orientee.  I am finally on my own.  I am a nurse. 

This is it!

Tonight will be my last night with a preceptor!   We had a department meeting last night.  Afterwards one of the clinical leaders asked me if I thought I was ready to be on my own.  I do feel ready, for the most part anyways.  I know I'll encounter situations in the future that I haven't dealt with yet & that makes me a little nervous, however, the only way to deal with it is to experience it first hand, right? 

One nice thing about this hospital, we get to set our own schedules.  So I'll be working Sun, Mon & Tues for the next 2 months.  I like it because I still have my weekends free for the most part.  Gina pretty much has the same schedule.  I wonder if they'll split us up (our dept is on 2 floors).  I hope not, it would be nice to help each other out if we need help. 

Work went well over the weekend - pretty much uneventful with my patients.  When I arrived at work Sunday night, there were 2 patients on the floor that needed to have a thorocentesis.  I observed the first one & then assisted in the second one.  It was interesting.  The doctor was polite, welcomed me to the hospital & explained what he was doing step-by-step.  My patients on Monday were pretty easy to care for.  I had one that was confused & had to have wrist restraints on so she wouldn't pull out her IV or try to get out of bed.  She even tried to bite me!  It was like dealing with a toddler.  So strange how some people do revert back to being a child as they age.  One of my other patients asked why I was checking on her so often.  I said I just wanted to make sure she was ok (I had the time to check on them).  She replied "The other nurses I've had hardly ever came into the room."  How sad!  I felt like a mama bear checking on her cubs...lol. 

My friend Julie's grandmother passed away yesterday morning.  I'll always remember her saying to me years ago "Who are you keeping company with?"  My thoughts & prayers are with you Julie!!!

Ok, time for me to get some sun.  It's another beautiful day here in Florida & I've already slept for nearly 10 hours - so I'll probably be up the rest of the day & rely on some caffeine to keep me up through the night.  Gina's working tonight also, so I'll have someone to chat with.  See ya!

Beautiful Day

I'm just getting ready to head to work in about 10 minutes.  It is a beautiful day here in Florida - sunny, breezy, cool - just beautiful.  I hope it's like this during the week so I can get some sun & maybe even a little yardwork done. 

I worked last night - it wasn't bad.  Only one episode of chest pain (not mine) that lasted approx 5 min.  Her cardiac enzymes (2 sets) were both negative, so I don't believe it was heart related.  I had another gentleman that came in because his left hand had been numb & he was having a hard time moving his fingers.  While filling out the admitting assessment form, there is a question regarding "drug use" - as if anyone is actually going to tell me they do pot, cocaine, heroin, etc.  They all say "No, never" or "many many years ago."  I got the same response from this gentleman, but people - anytime you come in with stroke like symptoms, they are going to do a drug screen on you.  I won't say what his results were, but he was lying to me <sigh>.  By morning, he was able to move his hand/fingers & was feeling better.  We'll see how he's doing when I return tonight.  My other two patients were pretty manageable - another lady admitted with chest pain & a gentleman with a pneumothorax.  Both rested quite well through the night.  I'm hoping for another good night tonight. 

On a good note, Dale Jr. finally placed in the top 10 in today's race in Texas.  Go Dale, go Dale - win it next time!  #8

Peace, y'all!