Ouch

Help...I'm in pain & it's taught me a valuable lesson - raise the pt's bed up to a comfortable position for you when giving injections or doing anything.  I was giving one of my pt's an injection of Lovenox in the abdomen, I bent over slightly & heard "crackkkk."  I don't know what exactly I did, but it hurts.  I'm debating about whether to go see a doctor or chiropractor, or simply trying to rest so it feels better.  I'm ok when I'm sitting, ok when I'm walking - but going from sitting to walking is where I feel the most pain.  I probably need an adjustment, but I've never been to a chiropractor before & not sure I want to go.  I have had back pain like this in the past & I know it will heal eventually, but right now it seems like I'll never be the same (awwwwww...lol).  Anyone need any tissues to cry for me???

Even with the pain, I did manage to get to my nephew's baseball game.  His team was in the state championship.  Unfortunately, they lost.....but he pitched so well.  He only allowed 2 hits the entire game.  It was the 2 pitchers before him that allowed 7 runs to be scored until he was called in.  I can't knock the other team though - Key West (who thought they'd be such a baseball powerhouse).  I read today that they have won 10 state championships & this was #11.  No wonder they were so good!  I have a feeling my nephew's team has a good chance at winning next year.  They are only losing 3 seniors & the seniors are not the strong ones on the team.  So we will see - maybe one day my nephew will make the pros! 

I had a wonderful week last week having some time off.  Got a little too much sun, but that's Florida for you.  I got to spend some time with my younger niece & nephew too.  Then it was back to work on Sunday.  I had 4 patients both nights...three out of the four were wonderful. 

My first patient was in with chest pain.  Turns out he had a heart attack in the past & he didn't even know it.  As a result, part of his heart muscle is destroyed & there isn't anything they can do other than manage it with medication.  So that's his game plan. 

My second patient came in with a BKA (below the knee amputation) that was done earlier this year & his diagnosis was sepsis.  By the time he became my patient, they had already went from a BKA to an AKA (above the knee amputation) to remove the infection that had set in.  I was very impressed with the surgeon, he did a good job.  I didn't see any signs or symptoms of infection & the patient wasn't in any pain. 

My third patient was a wonderful man.  It's weird how with some people you can instantly bond with & others it's like mixing oil & water.  He was an 84 yr old man that came in with chest pain.  While they were running tests on him, a chest x-ray revealed a mass in his right lung.  The doctor wanted to biopsy it, the patient didn't want to.  He didn't care if it was cancerous or not, he wasn't going to have chemo or radiation.  In fact, he already had signed DNR papers.  The pulmonologist asked me why wasn't the test done.  I told him "Because the patient refused."  He asked "Why did the patient refuse?"  Well, because he didn't want to have it done.  Isn't that the usual reason people refuse to have something done?  So he goes in there & somehow manages to talk the patient into having it done so that at least he'd know what he was dealing with.  If it were me & I were 84 yrs old, I'd rather not know.  This was a gentleman that still takes care of his wife who is in the early stage of Alzheimer's & is volatile towards him.  Perhaps his choices would be different if his home life were different, but he accepted that this is the way things are.  He had a good sense of humor & often said things to make me smile, even though he couldn't see very well.  I really liked his spirit.

He was sharing a room with my fourth patient - my confused guy.  I went in on Sunday night to do an assessment & asked him his name & if he could tell me where he was right now.  He knew his name perfectly, but he seemed to believe we were in the middle of the civil war.  So much so that he was fixing his uniform (hospital gown) in preparation for battle.  This patient was 88 & obviously he did not participate in the civil war.  WW II possibly, but who knows.  His admitting diagnosis was a small bowel obstruction & he had surgery to resolve that.  Again, the incision site was flawless - different surgeon this time, but still no signs or symptoms of infection.  It was open to air, had staples rather than sutures & looked about as well as an incision could look.  My hospital does have a couple of good reliable surgeons.  This patient was restless, I don't think he slept at all on Sunday night.  I had just finished charting around 5:15 Monday morning that he was confused, but made no attempts to get out of bed.  I jinxed myself - within 45 min, he had attempted to get out of bed & fell which resulted in pulling out his IV.  Thankfully that was the only injury & my co-workers jumped right in to help me out.  We ended up restraining him with wrist restraints.  I still don't like doing that, but he definitely showed me that for some people, it's the only way to keep them safe.  I had to fill out my first incident report.  :(  He was kept in restraints Monday night & he didn't like it one bit.  He even managed to get out of them one time & pulled out his other 2 IV's & chewed off his hospital ID bracelet.  He said he thought we were playing a game.   Huh???  I made sure the restraints were on better & he was unable to remove them on his own.  He was interesting, even offered me $50 to remove them, when I said no - he then said "How would you like to spend your last days on Earth tied up like this?"  So heartbreaking.  He couldn't understand that it was for his own safety. 

That was my week at work - I didn't make it in on Tuesday because of my back.  I may pick up Friday or Saturday to make up the hours - depends on how I'm feeling.  Right now it's not looking too good, but hopefully I'll wake up & be fine (yeah, right!).  One can hope, can't they???

"Called in"

It's late Tuesday night - I should be at work right now.  Instead I called in "sick."  I'm not exactly technically sick, rather I'm sick of the patient assignment I had.  I can't complain, the patients were stable & quiet most of the night.  In fact, Sunday night was a good night - both Gina & I were on the same floor - which was great.  The night went smooth. 

I had one patient that had been downgraded from ICU.  She was originally admitted with the diagnosis of respiratory failure.  She was fine by the time she got to PCU.  Her main care plan was focusing on her discharge for today.  She was a friendly 81 yr old woman that did not want to go to rehab & a skilled nursing facility.  She wanted to fill out her living will & sign a DNR.  I have to respect that - at 81, I would want a DNR also.  I just don't think there is a high quality of life left when you are reaching that age group.  That's just my personal opinion.  I know there are plenty of 80 & 90 yr olds that have a high quality of life & that's fine.  That's why it usually is your decision as to what you want carried out should that time come.  I just know for me personally...I don't want to live to be 90 or 100 years old.  I think it's great that technology has made that possible, but sometimes you have to wonder when you have these patients that are 85 or 99 years old & they are a full code.  Families should discuss this way in advance of something happening.  Anyways, she was very easy to care for - she was happy just watching tv.

My next patient was a man in his 70's who had C-diff.  It's not a pleasant diagnosis by far.  He was also in for sepsis after a BKA.  He wasn't a man of many words.  Getting him to talk was like pulling teeth.  So once again, a relatively easy patient to care for as he was also content watching tv & sleeping.

My third patient was a 91 yr old man - another full code - in with recurrent syncope (dizziness).  He was somewhat confused & we had him restrained in a Posey vest.  He was a sweetheart - even kissed my hand last night as I was doing my assessment.  Hehad orders to be discharged today from his primary doctor, but as usual....the orders were not complete.  There was no order for social services consult, no order as far as what meds to continue on at home, etc.  Some of these doctors are annoying - especially this one's primary doctor who I will not name.  Funny thing is, earlier that day on Sunday I was filling out my forms to get health insurance & I had to pick a primary doctor.  So I picked this guy - not really knowing all that much about him.  I got to the hospital Sunday evening & he was there - making somewhat negative comments about nurses.  The nurse I was getting report from was questioning an order on another patient - it was regarding testing a patient's intrinsic factor & whether there were any antibodies.  I know all about that stuff because I have pernicious anemia.  This doctor jumped in & started explaining it, which is great - until he made a comment about how nurses do not know this stuff because they don't teach us anything in school.  He went on to say that these days nursing school from start to finish is a year & a half.  It was like an episode from Ally McBeal where I just wanted to reach out & smack him or strangle him, but of course I couldn't.  Needless to say, when it came time the next morning to turn in my insurance paperwork, his name was crossed through & I picked another primary doctor.  I just don't have the patience to put up with b.s.  from an old school doctor that thinks he knows everything & disrespects nurses.  I'm sure he is a smart man with plenty of experience in his lifetime, but it doesn't give him the right to put down nurses. 

My fourth patient was one that really began to test my limits.  She was a confused woman that had been admitted with shortness of breath & chest pain.  She had neither when I did my assessment.  And she was also another confused patient that had to be restrained with a Posey vest so that she wouldn't try to get out of bed & fall on the floor.  I felt like I had to repeat everything I said to her at least 5 times before she would understand what I was saying.  Then I'd leave the room & come back & have to say everything at least 5 times again.  It wasn't so bad Sunday night because she slept through the night.  But Monday night - it was ongoing & of course I had a tech that was nowhere to be found when it came to helping out. 

Between her & my fifth patient - a gentleman admitted with pneumonia & coughing in my face continuously (I know he couldn't help it but that doesn't make it any less gross), they were wearing me down.  Add in the telemetry that would not stay connected because he kept moving around & the pads would come off - I was ready to go home.  I got a couple of hours sleep & then decided I needed a night of rest & relaxation. 

As it turns out, my friend Maria also needed a night like that so we met up & went to Circuit City, Target & saw "A Lot Like Love."  Ashton Kutcher is just adorable.  Anyways, it was just what I needed.  I'm off until Sunday night  - the census is low so I doubt there will be any offers of overtime.  I'm heading to my parents house by the beach & taking a little mini-vacation.  Have a great week everyone!

p.s.  Good Luck to my nephew Eric in his quest for his high school team to win the state championship in baseball.  He hit a homerun the other night with the bases loaded to give his team the victory to move on to the next round. 

So much for that

So much for volunteering to work overtime.  I went in Friday night & my wish was granted - I started out with three patients.  Three easy to care for patients.  One was in for abdominal pain & she was scheduled to have a cholecystectomy (gallbladder removal) Saturday morning.  Another had fallen & broken her hip.  She already had her surgery on Friday & was pretty much knocked out from the anesthesia & painkillers.  My third patient was somewhat of a problem-child (so to speak).  A 50 yr old man that came in Thursday night because he lost the ability to move on the right side of his body for a period of time.  He was admitted with a diagnosis of CVA vs. TIA.  By Friday he couldn't stand being in the hospital & wanted to leave.  I tried to explain to him that it was against his doctor's medical advice, but he didn't care.  So I got the proper forms for him to sign-out AMA (against medical advice).  Took out his IV, removed his heart monitor & told him to take care.  By 9:30 I had already done my assessments, charted all of my paperwork, passed meds & had pretty much nothing else to do.  I chatted a little bit with my gallbladder patient, stocked a few items by the Pyxis & called Gina.  She was on the 3rd floor & seemed busy enough with her four patients.  Around midnight my clinical leader was asking if I wanted to stay or go home.  I told her I wanted to stay.  Heck, it was overtime $$ & my night so far was a piece of cake.  I don't even know why she bothered to ask my opinion because it was clear that she was planning to send me home.  I gave report to the nurses that were taking my patients, went upstairs to take a break with Gina while I also put my clipboard & stethescope in my locker.  I finally left around 12:55.  I was also informed that because the hospital census was low, that I'd probably be called off for Saturday night & I was indeed.  Darn - that would have been complete overtime which averages out to a little over $40 an hour.  Oh well, easy come easy go. 

One good thing about not working was that I got to watch the Nascar race.  I sound like a redneck girl, don't I?  Trust me, I'm not.  There's just something about watching cars go nearly 200 mph, not to mention the "young guns."  I was glad to see Kasey Kahne finally win a race.  I'm beginning to wonder if Dale Jr. will see first place anytime soon.  He better! 

I'm back to work tonight for my regular schedule & once again hoping to have a relatively good night.  I'm also hoping I'm on the same floor as Gina.  It just makes it more fun to have someone to chat with & review things that don't make complete sense in our charts.  It's unlikely that we'll be in the same area as this hospital has 3 separate PCU areas.  One can hope, can't they?

I've gotten a few emails from nursing students around the country.  Thanks for writing!  If you have any questions or concerns, send me an email.  You've chosen a great career path - don't let anything stop you from achieving your goals.  You learn plenty of book stuff in school, but I think the real learning begins when you get actual "hands on" experience.  That's pretty much how it is for most things, isn't it?  You can read all you want on how to drive a car, but it's not until you're behind the wheel that you can say you know how to drive a car.  Hang in there & follow your dreams!

I'm gonna go work on a new patient report sheet & then get in a nap before work tonight.  Have a great Sunday everyone!

Early morning

I'm up early - why do you ask?  Because I agreed to work 2 extra shifts this week.  So I'll be working Fri, Sat, Sun, Mon & Tues nights.  I must be insane!  I'm praying for some great patients that don't take a lot of meds at night.  :)  My patients earlier this week - none of them had any midnight or 6 am meds ordered.  It was nice!  I'll keep you updated on how my 60 hr week goes.

I forgot to add, this past week was "Nurses Week."  My hospital gave us a dinner - which I didn't go to.  I slept instead.  And at that dinner they handed out some Burt's Bees Wax products for foot care - which is important.  I'm finding that my feet are really sore after the end of the week.  I need to find someone to massage them.  Any takers???  <g>  On Sunday evening, they gave us ice cream & a thermos.  And on Tuesday evening they gave us pizza & a drink.  I also got a shirt that says my hospital name on it & the department I work in...that wasn't for nurses week though, everyone in the hospital is getting those. 

We still have JCAHO coming to our hospital - for those of you in nursing, you know those are the big guns.  I am praying they don't ask me stuff I don't know.  I think they are supposed to be here this week or next week.  Rumor has it they've already been there, but I would think we would have noticed - I would hope anyways!  We shall see. 

Ok, enough chit chat, time to go take a shower & then get back to sleep before my 5-day marathon begins.  Ciao!

 

Overtime???

Looks like my week may not be over after all.  I got a call earlier today from work asking if I wanted to pick up extra shifts Thurs, Fri &/or Saturday.  It's so tempting!  I'll make the decision tomorrow - time to get more sleep!

 

All in all

It's mid-morning Wednesday & my work week is complete.  I like working Sun, Mon & Tues - gives me the rest of the week to do as I please. 

I had a very good week - no real problems.  In fact, I think I was the only one on my floor not running around all crazed the first couple of hours at shift change.  I had 5 patients my first night, then 4 the next two nights.  That's another thing I like working 3 days in a row - often times your patients will be there for awhile & getting report is short & sweet.  As soon as report is finished, I do my assessments & then come back & start charting.  Next I get my meds that need to be passed between 8 & 10 pm.  By 11 pm, I'm all caught up on my charting & paperwork - ready to give report to the clinical leader & then spend the rest of the evening checking on my patients, looking up results in the computer or simply relaxing.  I realize that it's not always going to be an easy week like this, that's what makes me appreciate it.  Last night I spent a couple of hours making up a new report sheet.    How exciting!

My first patient was a 72 yr old male that had gone to his doctor's office first because of chest pain.  The doctor told him he needed to go to the hospital for a carotid study.  Turns out his carotid arteries are 50 to 70% blocked & he'll probably be having surgery either today or tomorrow.  He had an arteriogram done last night & I'm sure he was so very tired of me continuously assessing the puncture site & his pulses as well as his vital signs. 

My next patient was an older woman admitted with left DVT.  A greenfield filter was put in place & I'm not really sure why she was still in the hospital.  Her H&H were low so she was given 2 units of packed RBC's.  Nothing was ordered for today.  Turns out she goes to the same doctor I do which is probably the doctor most feared by the nurses because I hear she can be rather rude both in person & on the phone.  I have not had to deal with her personally from a nurse's perspective, but she's always been a good doctor to me.  Should be interesting when/if I ever have to call her in the middle of the night.

My third pt was an older man that had come from the ICU.  I can't remember exactly why he was admitted, but he was a grumpy fellow.  Luckily he was discharged before I went in last night.

My fourth pt was a 40 yr old male that came in because he had tripped & fallen while fishing & hurt his leg.  When he was in the ER, he also told them that the day before he had chest pain.  He had a heart attack in the past (drug related) & has a family history of death via cardiac disease.  This guy loved to talk!  I think I know his entire life story by now.  He was inspiring though, he went from being a drug addicted criminal to "being saved" & now spreads the word of hope to others. 

I had another patient on Sunday night - a 64-yr old woman that came in with chest pain.  Turns out her husband died a month ago & she has not been able to sleep much at all.  She is very anxious & emotional.  She was having difficulty breathing, so I called her Dr. to get an order for a breathing treatment.  He was giving me medication orders & as he was ordering Xopenox, my clinical leader was whispering to me that only pulmonologists can order that medication.  So I inform the Dr. of this & tell him that the pharmacy will automatically change it to Albuterol & Atrovent.  He starts ranting & raving about how no one is allowed to change his order, asks me who made up this stupid rule & proceeds to say that if anyone changes his order - he'll come down there & make them change it back.  I wanted to laugh.  He sounded like a 2 yr old having a tantrum.  I played it off well though, basically telling him I understood but just wanted to let him know that pharmacy would change it.  He ended up ordering the Albuterol & Atrovent after all.  I got respiratory up there right away to give her a treatment & she kept thanking me over & over.  I didn't have her as a patient the next night, but the nurse that did have her started telling me a story about the husband that passed away.  It turns out that I watched him during a code blue back in April.  I'm sure I probably wrote about it on here - he came in fora simple cholecystectomy (gallbladder surgery) & he passed away later that evening.  :(

And my newest pt that I got last night (I sound like I'm talking about something I bought at a store!)...another older male in with chest pain & difficulty breathing.  His cardiac enzymes were negative & he has an echocardiogram scheduled for today - so not really sure what is going on with him. 

All in all, it was an easy-going week.  The big picture is starting to make a little more sense day by day.  I have the opportunity to work overtime this week as well as the rest of the month, but I haven't decided yet.  I am looking forward to enjoying a day off & relaxing.  As my one patients kept saying to me for the past 3 nights - "God bless you!"  Bye!

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.