Why be mad?

I don't have all that much to write about today.  I started back at work last night.  It was busy, I think I was on my feet the entire time between 7 pm and midnight.  I discharged one patient and got 2 new admits as well as having 2 other patients.  Somehow I managed to keep up with all of the paperwork and was actually looking for things to do to waste away the night.  We're encouraged to give baths, but I am in total disagreement regarding waking a person up in the early morning hours to bathe them.  Personally, I think sleep is more important.  We wake them up enough through the night with vital signs, respiratory treatments, medications and blood draws not to mention the numerous times if a lead from the telemonitor comes off.  So unless they really, really need a bath, I opt for sleep.

I'm not going to even go into the patients I had last night.  There is nothing that really stands out other than I don't understand the attitude one gets when they are admitted to the hospital.  Did you not come to the hospital because you were experiencing a problem so severe that it caused you to seek help?  Why are you mad that the doctors want you to stay the night and run some tests to see what caused the problem?  Both of my new admits were pissed they had to stay the night.  The thing is...you don't have to.  It's not a prison, you can leave if you want...you do have that option.  I realize the hospital is not a lot of fun, but neither is having a problem that worries you so much you seek medical help.  Rather than be mad, be glad that you live in a country that allows you to freely seek medical help.  Be glad that there are resources around you that want to ease your mind & find out what is wrong.  Basically, be thankful for your blessings.  They could very well be the reason that you see another sun rise.

I did pick up another shift tonight - so it's time to go get ready for work.  Have a good night y'all. 

Something cute...

It's Sunday & so very weird that I'm not sleeping in preparation for working tonight...because this is the week my schedule has changed due to being forced to work every other weekend.  I am not scheduled until Wed, then Fri & Sat.  I just might like having the beginning of the week off.  :)

I had my youngest niece & nephew from Friday night to Saturday afternoon.  I took them out to lunch & as I was paying, my 7-yr old nephew Magnus says to me "How do you make your money?"  Before I could answer he says "Oh, that's right...you save lives."  It was so cute! 

I went out last night with Kelly - we had some awful drinks & saw an awful movie, yet still managed to have fun.  I ordered margaritas...but what I got was nothing close to tasting like a margarita.  We saw Talladega Nights - simply because there is nothing else to see.  It was dumb. 

And to take it a step further, my favorite Nascar driver missed the race for the chase.  Darn it!  That's ok, I still love Tony Stewart anyways.  Next year he'll do better.

Hope everyone's having a great weekend.  Peace!

 

 

 

"Code Gray"

Another work week finished up by Wednesday - this is why I prefer to work Sun, Mon & Tuesday nights....so that I've got the rest of the week off. However, due to our new manager, I am being forced to work every other weekend for the next 2 months (at least). Well, unless I finally get motivated enough to leap into travel nursing...I'm still working on it...lol...that's my excuse! So for now, I will try working at the end of the week rather than the beginning. Who knows, maybe I'll like it. I am going to get back into playing volleyball with my friends on Monday nights.

I went into work Sunday evening only to find out I wasn't on the schedule...again...grrrrr. The charge nurse told me she would keep me, that I could be the unit secretary until 11 pm & then she'd send one of the agency nurses home & I could take over that nurses patients. Being the unit secretary on a Sunday night is beyond boring...because we rarely see a doctor in the building (other than the ER doc) on a Sunday evening. I got a call from the charge nurse about 20 min later saying one of the nurses didn't show up & I could take her patients. So I go to that floor & the clinical leader is telling me about one of the patients: "He's out of control, he is threatening to hurt people, rip off body parts of anyone that gets near him, swearing, yelling" and she followed it up with "Whatever you do, don't go into that room alone." Lovely...I'm thinking I should have just gone home when I found out my name wasn't on the schedule. This guy sounded like a lunatic!!!

So I get report from the day nurse & she tells me he just started acting like that when they tried to get him to go from the chair back to bed. He didn't want to go back to bed. Guess what - as far as I was concerned, he could sit in that chair all night long if he wanted...especially if it made him happy. He came to the hospital because he passed out at the nursing home & they wanted to rule out a stroke.

I had 3 other patients in addition to him. I had a male with a hematoma in the abdomen, he also had expressive aphasia (he had a stroke yrs earlier & was unable to speak...he could make noises & a couple of words like yes or ok, but that was about it). Another patient with an infection in his leg as a result of a fem-pop bypass. He also had a MRSA infection in his blood. He was really sick & weak. My last patient was a man that had a right knee replacement who was also confused...but at least he was pleasantly confused. They put him in the room with the lunatic. Nothing like having two confused people in the same room, right?

My assessment of the first patient was done from afar. He was yelling, he was moving his arms & legs and he was asking appropriate questions - he also knew who he was & where he was. As soon as I came in the room he was saying "Oh noooooooooo." He was afraid I was going to make him get back into bed. I assured him that he was welcome to stay in the chair if he wanted. He had wrist restraints on, so it's not like he was going to go anywhere or fall. He kept demanding to have his pants & shoes. The tech & I finally gave in...handed them to him in which he put the pants halfway on (since he couldn't stand up) & he put on his shoes. It was kind of comical to walk in & see that...but hey, he was happy....so I was happy. I managed to get him to take his pills, we gave him a snack & before I knew it....he was telling me jokes & stories. He didn't want me to leave the room! I was kinda cracking up inside comparing the description I had received of him & comparing it to how he was behaving now. Later on in the night, he pulled out one of his IV's. So the tech was giving him a bath & I got him some warm blankets, wrapped him up & he was so very comfortable & just smiling. I was thinking "Wow, I really have the right touch! He's nothing like they described earlier."

Welllllllllll, I threw that thinking right out the window the next night. He had turned back into the lunatic. This time instead of wrist restraints, the day nurse simply had a posey vest on him. I wasn't comfortable with that because he looked like he could slip out of it at any time. He started yelling at the change of shift. The day nurse told me to get his evening dose of Seroquel (antipsychotic medication). I got it, but I was pretty convinced no one would be able to talk him into taking it & I was right about that. When I got back to the room, the day nurse had called a Code Gray (an emergency request for extra manpower). I don't know why she did that because he was still fully restrained with that posey vest on. About 15 people showed up...mostly men. A Code Gray generally works to settle down an out of control patient, but in this case, it made my patient even more confused & agitated. I felt bad for him. Eventually most of them left & I was told to forget the Seroquel, give him Haldol IM (injection). So there was 4 of standing there looking at him while he yelled at us - we were trying to figure out how we were going to give him a shot. They were telling me to put it in his thigh, but I knew that was not going to work. I decided to get behind him in the chair & they would hold his arms & I'd inject him in the arm. I was worried he'd flail around & I'd end up jabbed with the needle...but he was so busy yelling at them, that he didn't even notice me behind him nor did he even feel the injection (what can I say...I'm good...lol).

We then make a decision to move him closer to the nurses station because there were only 2 nurses (me & another) on this unit. We try to tell him what we're doing & he just continues yelling about who knows what. He was already in a chair that had wheels on it, so as they started to push him to the door, he was trying his hardest to stop them by pushing back with his feet on the ground. They turned the chair around & then raced him down the hallway into the new room. It may sound awful, but I could not stop laughing....it literally looked like some type of race they were competing in & the poor patient...the look on his face like "What are these women doing to me?" It was priceless. I decided to leave him alone in the room & watch him from the nurses station...hoping he'd calm down. The respiratory therapist went in to give him a breathing treatment & the patient told him he was f'n useless & to get the hell out. The resp therapist came out saying he gets the same treatment at home from his wife. It was funny.

I'm noticing that now my patient has taken off his gown & is making a really good attempt at getting out of the posey vest. I say to the other nurse "I think we should put the wrist restraints back on him because if he gets out of that vest & is loose...who knows what will happen." So I call my clinical leader to assist us & while we're in there...he's yelling...then starts trying to punch & kick. I called another Code Gray. From that point we moved him (with a lot of assistance) from the chair into bed & put restraints on both his wrists & his ankles so he couldn't punch or kick us. I called the primary doctor to get him something more for his agitation. I really felt bad for my patient as he knew he had no more control & gave up yelling at me & was saying "Please let me out." I can't even imagine all that was going through his mind. The primary doctor asks me what the neuro doc said. Well, I didn't think to call the neuro doc as stroke had been ruled out and the conclusion was this patient had dementia. He gives me an order for Ativan. I call the neuro doctor to see if he wanted anything different....instead I got a lecture that agitation is not a neuro problem & that I shouldn't have been calling him. He orders the same thing & then asks me why this patient hadn't gotten his Seroquel. Ummm, what part of "This patient is out of control & very combative did you not understand?" So he tells me to give the Ativan & just give him the Seroquel later when he calms down. Well, that Ativan knocked him out the entire night. Not another word out of him...he slept through vital signs & even when the lab tech drew blood. I was relieved that at least he was at rest.

That second night was an easy night...both myself & the other nurse only had 2 patients each the entire night until 5 am when we each got an admit. It was a different story on Tuesday night....same nurse & I...only this time we had 5 patients each & no tech....grrrr. Well, we did get a tech around 2 am = Gina, but by that time, we really didn't need any help & she'd disappear for long periods of time anyways. It was the beginning of shift that was so busy & where we could have used the extra help.

My patients were not too bad to take care of...I liked them very much, but their medical conditions scared me. I think at any other larger hospital, half of them would be in ICU rather than PCU. I just had this uneasy feeling that at any time, they could take a major turn for the worse. That was the main reason I didn't go back tonight for overtime. It's not bad when you have 1 or 2 patients that are critical, but when 4 out of the 5 have major issues....the stress gets to me....especially when it's respiratory issues.

One patient was my new admit from the night before...he is at the hospital quite often for respiratory distress. He was on 5 liters of oxygen & sooooooo out of breath. His respirations were labored, you could see his abdominal muscles were doing all the work & he was shaking non-stop. He said he felt fine, but he definitely did not look fine. Another patient was one that just had a new tracheostomy. I don't like trachs...at all. I don't like any "ostomies." I don't know what it is, but I feel pain in my throat area when I see trach. This guy was coughing non-stop & I was worried something was going to get stuck in his trach. I called the respiratory therapist in to have her assess it. He did have a big ol mucus plug (ick...just the word mucus kinda grosses me out...see, even nurses do get grossed out) in the trach. Luckily. the respiratory therapist cleaned it all up even though technically...the nurses are supposed to do it. Which makes no sense to me...why can't the respiratory therapists do it? It is a respiratory issue.

Another patient was a new admit with congestive heart failure. He was a sweetheart, we got along great. I knew he was aggravated from being in the ER for so long & they were super busy down there so none of the patients were getting any food. He was starving, so I made it a priority to get him some food. He was happy. A little shortness of breath, but overall ok for the most part.

I still had the patient from Sunday with the hematoma in the abdomen. He was easy to care for as he mostly slept. I also had a female that had breast cancer & a right mastectomy. She was in the hospital because of nausea, vomiting & diarrhea from chemotherapy. This poor lady had the worst skin breakdown I've ever seen (not including pressure ulcers). The skin on her thighs & peri area was pretty much non-existent...it was so red & so raw & cracked, she cried when she moved her legs. I had to clean her up since she was having diarrhea & my heart was breaking listening to her cry from the pain. I talked to my clinical leader & we decided it would be best to put a fecal bag on her so the diarrhea wouldn't continue to hurt her where the skin was so raw. I tried my best to calm her & make her feel better, but I don't think it was really working. Even the inside of her mouth was all broken down & sore. The poor lady...so sad.

My confused man had been sent back to his nursing home. I don't know how those nurses that work at nursing homes do it. They really are special people to be able to endure dealing with alzheimer's & dementia....not just endure it, but also be able to develop a good relationship with their patients.

Someone commented earlier about my post with the ER nurse. I never intended to make it seem like I am anti-ER nurses or anti-ER department. I know they are super busy down there & don't have the same priorities that I do. I am against nurses that don't do the basics - which is to at least know your patient's labs & why they are at the hospital. As well as against doctors that also don't follow up with critical lab values. 671 is an extremely high glucose level & for it to go unnoticed by every medical professional that saw him before I spoke up about it...it's just wrong. We are lucky he had no ill-effects as a result.

This has been a good week....I've gotten so much positive feedback regarding my journal....thanks y'all. :)

A new season of Nip/Tuck has begun = strange, strange show, but I can't stop watching.

I had dinner this evening with one of my best friends...Maria. We met when we were about 13 yrs old & have been best friends ever since. It's kinda neat to look back & see how many people come in & out of our lives and value those that are here to stay for a lifetime.

Just Can't Believe It

I worked Sunday night & like I usually do...I was checking out People Magazine online around 6 a.m. for the latest stories & gossip...only to find out that Steve Irwin aka The Crocodile Hunter had died. I was stunned. I still can't believe it...even after being drawn to the tv throughout the night last night (at work) & seeing CNN talk about him non-stop as well as replay interviews & episodes they had with him. He was so likeable & charming and had the most amazing enthusiasm & energy for not only interacting with wildlife animals...but allowing us to get a glimpse of things we would never encounter in our own lives.

I just can't believe he's gone. :(

Tributes

I got the most amazing email the other day from a gentleman named Joe. With his permission, I want to share it with everyone...

Hi Jenn,

My name is Joe; After I retired from an Occupational Health career with the State of New York my wife and I decided to move to Florida (where else). That was 4 years ago. Anyhow, I spent some time volunteering at our local Wildlife Park but had this passion to return to bedside nursing.

At 59 and after 30 years away from clinical nursing I decided to take a 200 hour refresher course, a 35 hour IV Therapy course and my BLS. After completion, I interviewed with a local hospital and got the job. I have been there a month and I can honestly say that most of my fears about returning have been eliminated (the only thing I fear now is doing a female Foley)

OK, the reason for this email. About 6 months ago I started reading Allnurses.com and came accross a post of yours that had your journal website attached to your signiture. I got so hooked reading your entries that I went back to your original journal entry and read every one of them. I have got to tell you, it was your words that got me back into nursing and I am forever gratefull to you for that. You are so easy to read, both smart and funny...very funny. I learned so much from you...

Well anyhow, I posted all of this on the allnurses website (my first post on that site). I can't remember the Subject line but it had "Jenns Journal" in it. It lasted about 4 hours before it was pulled. When I asked why they told me it was because it looked like I was promoting your website...uh. The email said that a moderator had to review it.

Just let me say again Jenn, thanks so much for your inspiration. My wife would also like to thank you because I out of the house more often, lol.

Oh ya...Go JR. He came in a strong 3rd last nite at Bristol.

Take care,

Joe

Thanks, Joe. Your email put a smile on my face. :)

Rainbows & crying wolf...

On my way home from work this morning, I saw a beautiful rainbow in the sky. Rainbows amaze me - I love looking at them. They are a good reminder that in order to see the rainbows in life, you have to endure the storms that come your way .

I am sooooooooooooooo tired of newscasters. If I hear one more thing with the word Ernesto in the story, I will scream. They have blown this tropical storm out of proportion. News coverage began on Saturday. I'm not talking just a little update here & there, I'm talking that 99% of the newscast was all about this storm. This is the problem when it comes to hurricanes - newscasters blow it out of proportion so much that people don't believe a word they say. Even with 7 hurricanes in 4 years, I still don't believe them because they don't really know anything until about an hour before the storm is about to hit. However, just like most trainwrecks in life, it also gets to the point that you can't help but watch. Then the stress sets in because you begin imagining the worst....until reality strikes again to remind you that weather forecasters are only right like maybe 1% of the time.

It is raining here...but is that uncommon? Nope. Besides, Florida needs the rain. And it allows me to see the rainbow. :)

Ok, my tough 2 days at work...yep, that's all I'm working this week - well besides the computer class I have to take tonight for 8 hours. I can't complain, my patients were relatively easy to care for. I learned a little bit...way more about tapeworms than I ever really wanted to know. I've seen one of my patients get news that is devastating - her lung cancer has spread to her bones. Once it gets there, it's all pretty much downhill. She started out a little grumpy (who can blame her), but I charmed her & took time to talk with her. I still don't really know what to say when someone gets news like that. I find it's better to try to get them to express how they're feeling, because I know nothing I say will make a difference.

I had some interesting conversations with a couple of docs. The first one....my patient was on Heparin, her PTT (lab test) came back at 154 = extremely high. Protocol says to stop the Heparin immediately & call the doctor. So I did...at 5 am. I could tell I woke him up...but so what...this is a critical lab value. I tell him the PTT level & he says "Well, what does the protocol say to do?" As if I had never bothered to follow it or something. So I tell him "Stop the Heparin & call the doctor & here I am...talking to you now." It's like he didn't know what to do & was hoping the protocol would give him a clue. His wise answer..."repeat the PTT in an hour & follow whatever the protocol says to do." Ummm, ok.

My second doctor incident was regarding a patient I just got report on last night. He had been there for a week, had a surgical procedure when he came in & everything was going well - until 2 days ago when it seems he had a stroke as he has the facial droop & is unable to move the right side of his body. They ran some tests & it is looking like a stroke. Welllllllllll...no one has bothered to talk to the family about what is going on. All they know is that their once fully functioning family member is now unable to move the right side of his body. His speech is slurred & they want to know why. They were point blank asking me if he had a heart attack. I was able to tell them no, that his heart is ok. I can't tell them the real test results because the doctor has not talked to them regarding what's going on. So they ask me for the doctor's phone number. I give them his answering service number & tell them to call during the day because it's unlikely they would hear back from him at night (it was after 9:30 pm). About an hour later I get a call from the doctor. He says "This is Dr. so & so"...I said "hello Dr., let me find out who called you." Because 99.9999% of the time a primary doctor calls at night - it's because someone has paged him. He says "No, no one paged me." I say "Oh, ok." He says "You know, you really should take the time to find out why I'm calling." My response "Ummmm, ok." Have I mentioned that I really can't stand this doctor to begin with??? He goes on to tell me that a family member called & wants to know why. Well....wouldn't it make more sense to call the family member & ask them why??? It irritates me how some of them will avoid the family & their questions. I told him they basically want to know what is going on with the patient, that they don't understand what is going on because no one is telling them anything. He asked me how the patient was doing & that was that. Who knows if he ever called them back.

Ok, time for me to get a little sleep before computer class tonight. Peace all!

Blood glucose of 671

I had computer training on I-Connect this week. I'm not sure what I think of it overall. What I don't like though is becoming 100% reliant on a computer. Our trainer told us we no longer need kardexes, report sheets or MAR's (med sheets). I think that's insane. I plan to keep using my report sheet. I prefer to know what's going on with my patient by just glancing at the info on my report sheet rather than scrolling thru a computer trying to find the info. I caught on rather quickly, many people did not. It's gonna be a mess whenever we do go live. Supposedly the date is October 22nd, but I get the feeling it will be pushed back.

I worked on Sunday - but don't remember much of anything about my patients. It's that short-term memory loss! I worked again last night. I had a patient in his early 60's who will be told today that he has stomach cancer. I don't like knowing information that my patient doesn't know. He was so happy & friendly last night & all I could keep thinking is he has no clue what he's about to be told today.

I also got a new admit diagnosed with chest pain. I looked up his labs before I got report from the ER nurse. I noticed his blood glucose (sugar) level at noon was 671. Wow...not a good number. This is basically the way report went with the ER nurse around 8:30 pm...

ER nurse: I have a patient for you being admitted with pneumonia.

Me: Pneumonia? I thought it was chest pain.

ER nurse: Oh, well maybe it is, yeah...pneumonia & chest pain & possibly even asthma.

Me: Asthma?

ER nurse: Yes, I think so.

Me: You think so? What do the orders say?

ER nurse: They say chest pain & asthma exacerbation.

Me: What about pneumonia?

ER nurse: Oh, I guess he doesn't have pneumonia after all. We also gave him Tylenol for a fever.

Me: How high is his fever?

ER Nurse: I don't know, let me check. Oh, it was 99.1. I guess we didn't give it for a fever, must have been some other reason.

Me:

ER nurse:

Me: So has the blood sugar been addressed?

ER nurse: Why would it need to be addressed?

Me: Because it was 671 at noon when he came in.

ER nurse: It was?

Me: Yes, did you not look at the labs?

ER nurse: No, I don't know, I just got this patient at change of shift.

Me: Did the ER doctor not address it?

ER nurse: I guess not.

Me: Don't you think it should be addressed before the patient comes to the floor?

ER nurse: Well, the admitting doctor saw the patient too.

Me: The admitting doctor did not notice the very high blood sugar? (and the fact that the patient has been admitted 5 times in the last 6 months for elevated blood sugars)

ER nurse: I guess not. I'll recheck it & cover it.

Me:

That was how it went. Isn't it sad that the floor nurse (me) who has not even layed eyes on the patient nor spent one minute conversing with him knows more than the ER nurse who is caring for him? Or even more about the patient than the doctors that are treating him? She brings him to the floor, says his blood glucose was 384 & she gave him 10 units of regular insulin. Ok, I'm a sucker, I believed her. I decide to give the insulin a little time to work & recheck his blood sugar about 45 min later. It's now 462. Just for those of you who aren't sure what the normal range for blood sugar is...it's 70 to 99. Anything over 400 requires a stat lab draw & a call to the doctor. So we order a stat lab draw...which they come & draw right away.....yet takes an hour to get a result - that's only because I kept calling & bugging them to give me a result so I can call the doctor. Their reading was 447. So I call the doctor...or more like the doctor on call for the doctor that admitted him. I explained the scenario. He orders 5 units of regular insulin IV now. Ok, should I do accucheks on him more often than AC & HS (before meals & right before bedtime)? No, stick with the AC & HS accucheks. So that means I'm not supposed to recheck his blood sugar until at least 6 a.m.????????

I'm not comfortable with that so I have my patient care tech recheck it 2 hours later. It's now 432. Ok, slight decrease, but I still wasn't thrilled at that number...only now I'm stuck. I can't call the doctor & get more orders because I wasn't even supposed to be rechecking it. I run it by my clinical leader, she isn't sure what to do. I decide to give it a little time & hope that it continues to go down. We rechecked it at 5:30 am & it was 226. I'll take that. I'm glad I didn't cover him with anything more as he was NPO (not allowed to eat or drink) & that extra coverage could have made him hypoglycemic (low blood sugar). He was doing fine, just a little irritated that he wasn't allowed to eat or drink anything because of the chance of having a stress test today.

I had to turn in my schedule today for the next 2 months. As I was filling it out, I was thinking "Will I even be working here in 2 months?" I'm really getting that itch to branch out & try something new. I like my hospital, but there is so much change going on not to mention I'm on the low end of the pay scale there. The plus side is that there is plenty of work & our busy season is coming up. Actually, this past week has been super busy. I'm not sure why, but we are completely full in PCU & that's something like 60 beds. I think I will get the ball rolling with a travel nurse agency & at least see what they are offering.

I'm getting sleepy.......bye y'all.