I hate being sick!

I have been battling a cold for about the last 2 to 3 weeks. Just when I think it's gone - it sneaks back up & is even worse than before. Some nights I can barely sleep, other nights anything less than 8 hours is not enough. I've been congested, achy, chills, hot - all this from just a cold! If anyone else is going through this, I sympathize with you. I usually have a pretty good immune system, but I think spending time with my niece & nephew while they were sick is what got to me. Oh well, it was worth it.

It hasn't stopped me from working. Well, it has stopped me from overworking, but I haven't the need to call in sick. I've been off on the nights when I felt my worst. I'm working 60 hours this week. Actually my week is almost over. I work Friday & Saturday night. Should be a piece of cake...lol.

I can't complain about work lately - I've had pretty good patients and we've had a patient care tech all the time too. It just works better when we have proper staffing. Our hospital is full as always as far as patients go. Lots of respiratory problems - pneumonia, respiratory failure, COPD, etc. There also seems to be quite a few people either attempting suicide or taking pills & saying they want to die - but not actually taking something that could kill them. It makes me sad that there are so many people out there that would rather kill themselves than live. We are just a small hospital - I can't imagine how many are showing up in emergency rooms around the country or around the world. I hope their families find them the proper help so they can live a positive life.

Nothing much was going on with my patients this week. I've noticed that I really don't get too rattled anymore by someone claiming chest pain or difficulty breathing. I just do what I need to do to relieve their problem. I did have one patient whose heart rate jumped up & sustained at 150 while he was sleeping. I ended up having to call the doctor at 4:30 in the morning. Doctors love that! I tell him what's going on & he orders "A 500 ml bolus of normal saline and then normal saline at 75 ml/hr." He was ready to hang up. I said "Are you sure you don't want something for his heart rate in the 150's?" I understood his line of thought - that perhaps the patient was dehydrated...but still...lets give a medication that will at least slow the heart rate down a little. He ordered Lopressor 50 mg PO. Again, I asked "Are you sure you don't want something IV?" Nope. I was looking for some quick results & IV is the best for that. I didn't argue....gave the patient the Lopressor & started the bolus. Within a half hour his heart rate was around 100 and by the time I left at 7 am it was in the 80's. Problem solved...pat myself on the back...lol.

I received a new admission Tuesday night - well, actually he came from our new "Express Admissions Unit." Instead of having a patient wait in the ER for a bed, they transfer them to this unit - another nurse does the whole admission process & then they transfer them to wherever a bed opens up. So I'm getting report on my new patient & I'm told he is a convicted sex offender & no one under 18 is allowed in the room. They had no private rooms that night so he'd have to share a room until a private room opened up. I didn't think it would be a problem as my other patient in the room was in his 80's & the only person that ever visited him was his elderly wife.

Still though - it made me feel a little uneasy. Not that I thought this guy would do anything to me or anyone else...but the fact that here is his roommate - an elderly man having to share a room with a convicted sex offender & not being allowed to know that information. It creeps me out. I never thought about situations like that. You never really know who you are sharing a room with when it comes to these semi-private rooms. Yet another reason all rooms should be private.

In a way I wish I hadn't been told that little tidbit of info about my new patient, but it is important that we are aware since children do come to the hospital to visit their relatives. I didn't want it to cloud my mind or have me treat him differently than any other patient. He was in a lot of pain when he was transferred over to me as well as having a high blood pressure (204/98), a fever of 101.7 and an extreme headache. None of it phased me...I treated the temp with tylenol, the pain & headache with Dilaudid and the blood pressure with some medications that were ordered. I got him a cool wash cloth, plenty to eat & drink and took the time to talk to him - to try to give him some emotional support that soon he would be feeling better.

He ended up surprising me by being very appreciative. He must have said "thank you" to me at least 50 times that night. I did all I could for him - now I just had to wait for the medication to do its job. Within a couple of hours he was feeling much better. By 4 am he was afebrile, blood pressure around 146/78 and the pain and headache was subsided. It's nice to see results. We don't always get to see them in such a short amount of time.

I'm hoping Friday & Saturday night go just as smooth. It's hard to believe I've been a nurse for 3 years. In some ways it seems much longer and other ways it seems like it's flown by. Only 30 more years to go to retirement...haha!

Have a good weekend everyone!!!

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Reflections

I've been working quite a bit lately. In fact out of the last 7 nights, I will have worked 6 of them. The good news is that after tonight - I'm off until Sunday night. Yay!

I'm not going to go into all of the different patients I had over the last month practically - but there are a few that stand out.

Two of them are related to cancer & we all know that word cancer is not a pleasant one. I had a patient in her early 30's that had come in about 10 days before Christmas. I didn't actually get to meet her until Christmas Eve, but regardless - she came in with the diagnosis of pneumonia. When it wasn't resolving & she began complaining of a sore throat & trouble swallowing her food - they ran more tests. Come to find out she has esophageal cancer...stage 4. She has tumors all over her esophagus. With it being stage 4, there is literally nothing much they can do for her. It is too far gone. We're talking about a mother in her early 30's with 3 kids at home. Sooo heartbreaking! She was going to go ahead with chemo to buy herself a few months. I can't even imagine what it is like for her. You go into the hospital thinking you have pneumonia & get the news that you only have a couple of months left to live. That is so not fair!

My other patient with cancer came in last week. She is in her late 60's & has uterine cancer. She's gone thru 2 rounds of chemo & it's not helping. She started to open up to me about it & I didn't know the right words to say. I told her to try to stay positive - that anything is possible, but I thought to myself how easy that is to say when you're not in her situation. I thought about it a lot the next day & when I had her as a patient again that night, I encouraged her to talk about how she felt. I figured that she felt uneasy doing that with her family as they were very emotional considering the diagnosis and she seemed to want to open up to me. This was also the night in which the doctors informed her that the cancer had spread to her liver....that is really, really bad. She doesn't have much time either. So she told me about how her family was feeling & reacting. I asked her how she was feeling. She told me she was numb. That she's all out of tears. That she doesn't understand why God would take her this way. I told her I didn't understand either. I realized at that moment that she wasn't looking for answers - just someone that could listen without getting upset.

I had another patient - this one didn't have cancer, but boy did she scare me. She had a GI bleed and the GI doctor had found a large stomach ulcer & he cauterized it (to stop the bleeding). My first night with her was began a few hours after she had this done. She was a quiet lady - didn't really ask for much. After a couple of hours, she started vomiting dark colored blood. Not a huge amount, but enough for me to worry. Then she had to go to the bathroom & if anyone is familiar with a GI bleed - you know it has a particular foul scent. This patient definitely had it. So much so...her roommate went running out of the room! I decided it was time to call the doctor because the patient was pale, clammy & cold although her blood pressure and heart rate remained stable. Luckily I had requested another blood count when I started the shift because she had received a unit of blood earlier that day and it was never rechecked. I had the results back by the time I called the doctor. In the meantime, my co-workers were moving the patient to a private room because of that GI bleed odor.

I called the doctor & he was relatively calm. He said he expected her to bleed a bit more and explained to me why he thought this. He asked me if I thought she needed to be transferred to ICU. I told him I wasn't sure - her vital signs were stable, but she was definitely bleeding. He decided she needed something for the nausea/vomiting and another unit of blood. I was worried about her - she was sooooo cold & clammy...yet was complaining she was hot.

I gave her the medication & started the unit of blood rather quickly. Within an hour she had regained her color and now she was freezing instead of hot. I'll take that - much easier to warm someone up than cool them down. I had her the next 2 nights & she did wonderful. What a comeback. I thought for sure she was going to end up coding on me that night. My co-workers are so wonderful - they all helped out in getting her back to feeling better.

Those are the 3 patients of mine that have really stood out and I'll probably never forget those experiences. It's a quick reminder not to take life for granted & whenever I start feeling down about my problems - it shows me that my problems aren't so bad.

Time for me to get some sleep so I can be wide awake tonight. Have a good week everyone!

Happy New Year!

Happy New Year!!!  I know I'm a few days late, but that's better than never.  I will catch up soon - gotta get some sleep.  Tonight will be my 4th shift in a row. 

Have a great weekend!!!

 

Mixed up schedule

I've mixed up my schedule this month from my usual Sun, Mon, Tues nights. This week I worked Sun & Mon and this weekend I'll work Sat, Sun, Mon night. It's nice to have a little variety and the patient acuity level has been high - so anything more than a couple of days can be really tiresome.

Both Sunday and Monday nights were very busy. Our hospital is completely full to the point that they are holding patients in the ER because there are no beds available. And as usual, at my friend's hospital - they are empty and calling nurses off. It seems seasonal like that - when my hospital is busy, hers is a ghosttown and vice versa. Just weird!

I started off with 3 patients Sunday night. One was very stable - she had come in with chest pain and congestive heart failure. She had a heart attack while in ICU and was recovering. There wasn't much to do for her besides assessment, medications and make sure her needs were met.

My second patient was an older man admitted with pneumonia. He had a history of dementia and alzheimer's. Patients with that history tend to confuse day with night and sleep all day while up all night. He was no different except that he would continuously yell for things - like his wife. It didn't matter how many times I went in and reoriented him to place and time, five minutes later he was yelling for his wife. Nothing can be done for that and unfortunately he kept most of the patients up all night with his continuous yelling. Finally around 4 am he decided it was his bedtime and he layed down and went to sleep. I was told that was his routine.

My third patient was very sick, but I'm not even sure she realized how sick she was. She had a tumor in her stomach removed and was on post-op day 5. The surgeon had written orders for her to walk four times a day - no exceptions, but of course the nurse before me put her off claiming she was "too busy" to walk with her. We're always too busy - when isn't a nurse busy? She asked me to walk with her at 8 pm and even though it wasn't an ideal time for me, I made sure she knew I was committed to helping her get better. She had an NG tube and a couple of IV medications running. She was weak on her feet - which is to be expected after surgery. She did well ambulating and I could tell just by not giving her an excuse or putting her off to walk later - that she was beginning to trust me.

The reason she was on our floor as opposed to the med-surg floor is because that day she had spiked a temp over 102 and they were worried she was getting septic. A few hours later she asked me if the nurse tomorrow would be as willing to walk with her as I was. I told her I would definitely make it a point with whatever nurse was coming on - that it was important to make sure she ambulates. I then asked her if she wanted to walk again and there we were at midnight walking the halls. Getting up and walking after surgery is one of the best things you can do for your body. It may hurt like hell - but the benefits outweigh the cons. Too much bedrest can do more harm than good.

I got a fourth patient right before midnight. I was a little worried as he was admitted with nausea/vomiting/diarrhea and altered mental status. I was picturing a confused person that was throwing up & going to the bathroom at the same time. He was nothing like that. He was totally alert and oriented - never had any nausea or vomiting and had one episode of diarrhea while in the ER. After the initial assessment & 3920348023 questions we ask on admission, he was content with getting some sleep for the night.

So two easy patients and two a little more intense. Not a bad combination, but it was time consuming which made the night go by quickly. I contemplated whether to refuse to take the dementia patient back again on Monday night. Mostly because it affects me when I can't make someone feel better. I decided to leave my name up by his on the board & just deal with it when I came back that night.

I went home - slept the entire day & went back. Turns out the elderly yelling man had been discharged. Yay! I still had the other three patients plus one that was admitted with a possible stroke. This poor lady - what a rough night she had. It started out when they drew blood for a D-dimer test....it's a test that checks to see if someone has a pulmonary embolism. The test isn't 100% accurate meaning just because you test positive with a D-dimer, it doesn't mean you definitely have a PE. It means that the next step is to do a CT of the chest to rule out PE. I sent her down around 10 pm for the CT only to get a phone call that when they went to inject the contrast - they blew the IV and now her arm was swollen and they were unable to do the test so they were bringing her back. Her arm was sooo swollen. I call the doctor and inform him of what happened. He orders for a Lovenox injection (blood thinner) and a VQ scan - which is another test to check for a pulmonary embolism. It's not quite as accurate as a CT, but it's doable. So I have to call nuclear medicine in because they aren't there 24 hrs a day. They come in - not happy at all with me - as if any of this is my fault. It takes them about an hour to do the test. I finally get my patient back around 2 am. The test results still couldn't tell me if she had a PE or not. It said "intermediate probability." I spoke to the doctor & he ordered antibiotics - I guess he thought it was more of a chance of pneumonia than a PE.

I got a fifth patient in the middle of all this - a woman with a GI bleed. She had been admitted during the day in the ER and while they were holding her there - she luckily had a good nurse that made sure she got 2 units of packed red blood cells. Usually the ER will get the order at say 2 pm and we'll get the patient around midnight without any of the blood transfused. I was impressed that she had gotten both units. After the initial assessment, she went to bed for the night.

It was an easier night, but still busy. My surgical patient had to have 2 units of blood transfused. She had spiked a 101.8 temp for me, but luckily the Tylenol brought it back down rather quickly. I hope she's ok. I don't like to see surgicalpatients with abnormal temps.

So I've been off since Tuesday - time flies by. I'm doing my Christmas shopping in the morning & planning to get it all done tomorrow - from start to finish. Christmas for me is about the little ones - my younger niece & nephew and they are pretty easy to buy for. I'll meet up with them tomorrow afternoon after they get out of school and I think I'm going to take them to the Scholastic Books Warehouse sale. Everything is 50% or more on sale and it's a huge warehouse. They've never been there and lately they have really been into reading - so I may as well take them so they can pick out exactly what they like.

I went out Tuesday night to this Italian restaurant and wouldn't you know it - a lady two tables down starts choking. It was impressive to see the waiter jump right in with the adbominal thrust (aka Heimlich manuever) and save her. I also saw the movie "Awake" after dinner. It was ok, but really far-fetched. Anyone in the medical field & even those not in the medical field could see how inaccurate it was...but that's the movies for you.

Hope everyone has a great weekend! Stay warm up north! Stay cool down south - I love the 80 degree temps, but I would like to see some cold weather since it is the middle of December! Careful what I wish for - I know!!! :)

Morning Prayer

Wow, I didn't realize it had been awhile since I last posted. Where did November go???

I had a wonderful Thanksgiving with family and friends over at my parents house. I guess there was about 30 to 35 people. It was the first Thanksgiving in quite a few years that I didn't have to work - so I enjoyed that.

I've been at work since Saturday night. Amazingly we have been staffed pretty good - especially since the hospital is pretty much completely full. When I left this morning, they had 3 or 4 people admitted that had to be kept in the ER because there are no beds available. This usually doesn't happen until January. Tonight is my last scheduled night for this week, but I think I'm going to pick up a few more shifts for the overtime money.

My patients have all been alert & oriented this week. It's nice to be able to have conversations with them - especially since I've been working so many nights in a row. I think they feel better having a familiar face rather than a different nurse every day & night.

I think the highlight of my mornings are when our chaplain shows up in each unit and says a prayer. I don't realize how special that is until he's away for whatever reason and the morning is quiet. It's nice to take time out to say a prayer together. It also reminds me that my shift is almost over & I can go home!

I'm definitely going to try to work more this week. I have Christmas shopping to do next week & I want to pay cash all the way.

I plan to take more vacations. That's what life is about - taking the time to enjoy it. I'll never be a work-a-holic!

Ok, time to get some rest....so I can get back to work tonight. Have a good week everyone! Stay warm up there in the north!

One of those Weeks

It was one of those weeks where the last place I wanted to be was at work. We all feel that way about work sometimes, don't we? Thursday night was the toughest - I found myself thinking negatively and not really treating my patients the very best that I could. It's not to say I mistreated them or ignored them or anything like that - I just didn't make that extra effort that I often do. The night was going by so slowly. Too slowly.

My first patient had been given discharge orders as soon as I got there. So I had to arrange transportation and verify the medication reconciliation form with the doctor and work with the social worker - discharges can be time consuming! This patient had come in with chest pain - she lives in a nursing home. I was starting to get the impression that she did not want to be at the nursing home...but really...who really wants to be at one?

My second patient was in her 90's - in with congestive heart failure. She was able to get up on her own - which still amazes me when someone is in their 90's.

My third patient - she had a blood clot in her leg and for some reason, they decided to remove the vein the clot was in. I didn't get to read much of a history to find out why they went that route, but when they took the tape off of the dressing covering her staples - her skin came off too. That was worse than the actual incision. It was frustrating to see that she was taking the attitude of not wanting to do anything for herself. She didn't want to cooperate with physical therapy so that she could start walking again, she didn't even want to use a bedpan - she'd rather just go in bed & have us clean her up rather than use a bedpan. She had a foley catheter so luckily that part was taken care of - but who willingly would rather lay in their own stool as opposed to asking for a bedpan? It's not that she wasn't capable - she was more than capable - I just don't get it. The next night she was getting where she didn't even wantto make any effort with her medications. She would have preferred I put the pills in her mouth than for her to do it herself. I wasn't having that. I have no problem assisting someone who needs help, but laziness or lack of desire isn't a good enough reason. Needless to say - she remained this way all three nights I had her. No desire to get out of bed, no desire to start doing things for herself.....BUT she was able to put on her own makeup and this bright shade of lipstick. I don't get it (shaking my head)!!!

My fourth patient - this poor man - this man had gotten a colostomy back in May because he had an intestinal blockage. Now he came back in September to have it reversed - he no longer needed the colostomy. So it was an elective procedure & our top surgeon was performing it. What could go wrong? Ummmm....everything!!! This patient has been in our hospital since the beginning of September. Through the last 2 1/2 months he has knocked at death's door a number of times - but luckily he has survived. It's scary thinking of these elective surgeries & how they could easily take your life.

This patient still has a colostomy and he has a drain because he developed some kind of abdominal abscess and he has a huge incision on his abdomen that is also giving him problems. He has had renal failure, respiratory failure...even sepsis & I admire him - because even with all that going on - he wants to get better & go home. He is getting up & out of bed, he is taking walks unlike my third patient. He was also on a ventilator while in ICU & as a result, his throat muscles are very weak so he can't swallow productively. He also has a hard time coughing - so the phlegm and saliva get built up & he starts to gag. That is not my strong point. I don't like respiratory issues, I can't stand the sound of gagging or spitting. I hooked him up so he could suction himself to help get that stuff out. With all he's been thru, I did what I could to make things better for him.

I was finally able to discharge my first patient around 10:30 and I got another one around midnight. A frequent flyer in with chest pain. The patient himself told me he's been there 50 times for the exact same thing. He was complaining of chest pain as soon as he got to the floor & what do you know - he's allergic to morphine - the pain med usually given for chest pain. On top of that - I had no order for any nitro or any pain medication. The ER nurse was agency & had no idea about pathways or what to even ask the doctors when getting admission orders. So I called the doctor around 1 am to get some medication & luckily the doctor was familiar with this patient and didn't seem too worried about the chest pain. I think he needed something for anxiety more than pain - but I gave him what I could.

I only got 4 hours of sleep on Friday, but my attitude was a little better. I was actually thankful that I am healthy, that I am able to get out of bed with no problem, that things are good. My patients were fine - no real emergencies. I did hear some sad news - a patient that was at our hospital quite often had passed away. She was only 40 yrs old, but had a lot of respiratory issues and needed a lung transplant. Even with all of her breathing issues, she continued to smoke - so although I feel sad she passed away, I have to wonder how much of an effort did she make to improve her life? I don't want to judge - perhaps she had the mindset that her days are numbered & turned to smoking for one last pleasure in life. I don't know. She was found dead at home, but for some reason they called 911 and brought her to the hospital where they ran a code and then pronounced her. I think she had just been discharged from our hospital like 5 days earlier. Sad.

My niece & nephew have been over since Saturday. I knew their mother wouldn't last taking care of them on a daily basis. They are here until Wednesday beause it's her year to have them for Thanksgiving. They'll probably be back here on Friday. It's nice having them around again. Expensive! But nice. :)

Have a wonderful Thanksgiving everyone!!!

Ahhh I don't wanna

I have been off of work since last Wednesday & I don't wanna go back. I work Thurs, Fri & Sat night this week. It's been a nice break - I finally got to spend some quality time with my niece & nephew. Guess the ex-sis-in-law was told she could go to jail for breaking a court order. I'm not sure if that is true or not - but it seems to have worked. I spent way too much money in the last few days on them, but I'm trying not to think about it too much. Just need to get back to work & find some time to work overtime.

I can't believe Thanksgiving is practically a week away. Time is just flying - seems like I say that all the time, but it's true - where does the time go? I don't feel like I'm having fun, but time is still flying by. Oh well - guess that's what happens as I get older.

My brother is doing better with his spider bite or whatever it was. Shay is getting bigger - not too much, but still growing. She got plenty of time at the dog park over the weekend. It's interesting to watch dogs - they just walk in, sniff each other & start playing. Too bad adults couldn't make friends that quickly, huh?

That's about all that's going on over here. Hope everyone is doing well!!