It sure would be nice...

I'm not even sure how to begin this journal today.  I worked Sunday & Monday night - called in sick for Tuesday night.  Gina & I were both on the 2nd floor both nights - which is nice.  They should have "team nursing" cause we work really well together - especially when we have no patient care tech to help us out.  Which by the way - I'm getting tired of not having the support of additional help.  I'm getting frustrated with administration - it's not that we have a lack of patient care techs, for some reason - they send them home.  That's the main reason I called in sick on Tuesday - I was so sore & achy from having to do nearly all primary care nursing.  It wears on you - I don't care what kind of shoes you are wearing, having to be on your feet for 12 hours, bending over, pulling patients up in bed, helping them to the bathroom, helping them to the chair, etc & having to complete all the required paperwork - it wears you down both mentally & physically. It sure would be nice to have the supportive staff that we need, but I don't see things changing - yet another reason to leave this hospital.

Anyways - my patients were sweet little angels Sunday night.  They were all (for the most part) able to do things for themselves.  I had one that needed assistance to the bathroom.  This was the same one that I had felt bad for because he had an echocardiogram done that showed a 10-15% ejection fraction.  Normal is anywhere between 60-75%.  The ejection fraction is how much blood your heart is able to pump out - there is always a reserve of blood left in the heart to keep it lubricated, but the majority of blood should be pumped out to circulate around the body.  His was 10% meaning his heart was pretty much shot & even with medications, it wasn't going to help much.  My clinical leader told me that at the hospital she used to work at, they would simply send people home to die with ejection fractions as low as his.  He was definitely not a candidate for a heart transplant as he was 67 years old and a heavy drinker/smoker.  Still though, I felt bad for him.  I wondered if he was even aware of his condition, did he realize the implications?  He was on my mind the entire night & the next day.  Not to mention he had a 30-beat run of V-tach that night.  But he was asymptomatic, didn't even notice a thing, called the doctor & told to just continue to monitor.  Ok, I can do that.

My second patient was an ICU transfer.  She was a little itty bitty thing...50 years old, weighs 63 lbs.  Came in with respiratory distress, has severe scoliosis - so severe that she has to sleep sitting straight up.  The neat thing about her...she always had a smile on her face.  She was so pleasant & sweet.  I wish all of my patients were like her.  Needless to say, she was doing very well & ended up being discharged on Tuesday. 

My third patient was a retired OB nurse.  I was told in report that she has some psych conditions, that she's depressed, has a flat affect, etc.  Her admitting diagnosis was renal insufficiency.  After assessing her, I did notice that she was pretty quiet.  I encouraged her to talk, asked about the book she was reading - not getting a whole lot out of her.  She had q12h H&H's ordered.  She had received blood during the day, but by the next morning her H&H were low again.  So they called in the GI doctor to see if she was bleeding internally somewhere.  The nice thing about her, the second night I had her - I managed to get her to talk & smile.  I would like to think it's because I'm so sweet & wonderful, but who knows. :)

My fourth patient was a new admit that showed up about 1:30 am, diagnosed with syncope.  She was brushing her teeth that night & passed out.  She was tired & just wanted to sleep.  Who am I to stop her?

So my night went well...or "uneventful" as one would describe it.  Meanwhile Gina had 4 total cares & she was whining about it to me every chance she got (right, Gina?).  She ended up jinxing my patients because Monday night was not as wonderful as Sunday night had been. 

The guy that I had been thinking about & feeling bad about his ejection fraction - well my attitude changed pretty quickly.  I'm not sure if it was because when I came in I saw that he was eating food from Long John Silvers (so much for the 2 gm Na diet restrictions) or if it was because this man somehow "accidentally" (and I use that term loosely) pulled out THREE iv's.  He had a dopamine/dobutamine drip running into one.  I had checked earlier in the night & saw that it had good blood return - things were great - until about a 1/2 hour later.  He calls me & says "I forgot I had an IV & when I got up from my chair, I pulled it out."  Ok, accidents happen - no big deal.  Clean up the blood, cover the site, get him back into bed & bring in an ICU nurse to get a couple new IV's in him.  He was a tough stick - that's why we resorted to the experts = ICU nurses.  Two new IV's, dopamine/dobutamine drip going again, pt is comfortable in bed...things are good.  Sweet dreams & good night.  Nope, about an hour later I hear a loud noise come from his room - not a good noise.  I walk in & he's on the floor, a distance from his bed.  I say "What are you doing?"  He replies "I was using the urinal at the side of my bed & lost my balance & fell."  Needless to say - IV #2 is ripped out & he's bleeding all over the floor.  Luckily he wasn't injured - landed on his butt, didn't his his head or any other body parts on anything.  Stop the bleeding, back into bed, start the dopamine drip into the spare IV site - put on the bed alarm so that this doesn't happen again.  About a half hour later, the bed alarm sounds.  I go in, patient is sitting on the side of his bed using his urinal.  I turn off the bed alarm & I hear him ask "What is that?"  I explain the bed alarm & he says "no, that!"  And he points at his pillow - there is blood all over it where his arm had been.  I thought maybe the last IV he pulled out was still bleeding - but nope, he pulled out IV #3.  I was getting frustrated, he was aggravated - as if it was my fault this was happening.  My clinical leader took over, gave him a bath, got him back in bed, brought in the ICU nurse again.  The ICU nurse says to me "Did the dopamine infiltrate?"  Ummm, I don't think so.  He told me it looked as though the skin was irritated & red & it might be from the dopamine.  His advice "You probably want to get some regitine just to be safe."  Regitine!  We heard all about that in school & all about that in nursing orientation.  I was kind of excited to see how this stuff worked.  I told my clinical leader about it, she called the nursing supervisor to bring us some regitine.  I'm thinking this is really important & time is of the essence.  Nope, I sat & waited for this medication to arrive.  Finally I gave up waiting & Gina & I went to do vitals on our patients. 

I had to do orthostatic blood pressures on my syncope woman.  Well, her blood pressure was up around 200 to 222 over 76.  Not good.  Which is my priority...high BP or dopamine infiltration?  My clinical leader did not seem alarmed by either, but then again, it doesn't seem like much alarms her anyways...lol.  Looking back, I think my priority should have been the high BP.  Instead we focused on getting the regitine administered & then I put in a call to the cardiologist for my high BP patient.  When he finally called back (45 min later), he orders (or at least what I heard) was Quanidine.  I look it up to make sure & it says it's used for heart arrythmias & malaria (what a combination).  I figure ok...it's for her heart.  I fax over the order to pharmacy & they called to question it saying he probably said Clonidine - which they were right. But why do they make drugs that sound so similar (Quanidine/Clonidine...don't they sound alike?) - especially when someone with an accent is saying it & is not happy that I am bothering him so early in the morning?  Oh well, we got her the right med - glad pharmacy caught it. 

That was my Monday night.  My feet were so sore - I need to find a massage therapist or at the very least get a pedicure.  Poor Gina though - I called in Tuesday & they never bothered to get a replacement nurse.  So Gina & one other nurse were left with 10 patients & no tech.  Ridiculous!!!!!  And she had her first death occur.  I haven't had to deal with that yet.  She was telling the doctor what happened & she started crying & he was trying to comfort her...awww.  As much as I would have wanted to help her out, I'm glad I was home sleeping. 

Now I'm off until next Tuesday night...sweeeeet!  My non-paying renters moved out...yay!  But the house is a mess...ugh.  Oh well, I'll look at the bright side - they left without causing a scene.  I can't believe it's nearly the 4th of July.  Where is the time going???  Happy 4th of July everyone!

Too good to be true (sigh)

We'll start with the non-medical issues first.  Mostly meaning...my rental house.  Remember back to the home invasion & shooting?  Then a nice man asking to rent the home?  Well, the nice man took off & left without telling me & left people he knew living in the home....people that can't afford to pay the rent.  People that I had never even met, people that have no clue how to keep a clean house.  My dad went to collect the rent & that's how we discovered this change of events.  There are two families living there - with children & dogs.  We looked around the home yesterday & there are clothes all over the place, stuff all over the floor, no sheets on the beds, dishes piled up in the sink - how do people live like this?  It was gross.  I'm not the most organized person, but this was beyond me.  Anyways, we basically told them they have to move out by this weekend or we will be calling the police & have them arrested for trespassing.  Because that is what they are doing.  We offered them $100 cash to leave the place clean (unlikely), but we shall see what happens.  If they didn't have children, I think calling the police would have been the first option - but since they do have kids, we didn't want to see the families disrupted, the parents taken to jail & the kids put into protective custody.  We're being the nice guys & giving them a fair chance to move out  gracefully.  Plus we don't want to cause any type of situation in which they would want revenge - since they know where I live.  I think back to the mass murders last year that took place because of squatters being kicked out & I definitely don't want a situation like that.  Ya never know these days!  Hopefully things will go smoothly & they'll be out by Sunday.  With that being said, I also signed a contract to put my house up for sale.  I don't want to deal with renters anymore.  I'll be happy if it sells for what the realtor believes it will sell for.  Time will tell. 

Ok...back to the medical jargon.  My week was good...lots more self-discovery going on in the world around me.  I'm seeing that nurses that appear to know what they are doing sometimes are the least mentally stable people that I know.  I don't know why people I barely know tell me details of their life that if it were me...I'd never tell a soul.  It still shocks me what people will reveal.  So nursing students - when you're in clinicals & you're dealing with staff nurses that aren't so nice, it's because they have their own issues going on.  DO NOT take it personally & do not let it change your beliefs.  One day you'll understand what I'm saying.  :) 

On a different note, my patients were wonderful.  I had one patient that I had in the past - the one with the abdominal wound that I had to pack & apply the wound vac.  Why she is still alive, I don't know.  She is basically just rotting away from the inside out & it's sad that anyone has to live like that.  The family needs to let go, she has no quality of life anymore.  And this is a family that will try to intimidate & nag the nursing staff with no end in sight.  Luckily they weren't around the night I was assigned to her.  I managed to trade assignments the next night & didn't have her as a patient.  It's just too much work because she is unable to do anything for herself.  It wears you down both physically & mentally.  She is septic all over...has three abdominal wounds - two are hooked up to wound vac.  The third is where her feeding tube was removed & now there is a hole into her stomach & her NG tube feedings are coming out of that hole (ickkkkk).  Plus her arms & legs are weeping fluid continuously.  Her arms are wrapped with Kerlex because the skin is all broken down.  She has a really big sore on her bottom area that will never heal because you can't cover it with anything.  So everytime she goes to the bathroom (which is a lot), that stuff is getting into the wound & it hurts her.  It's just a bad situation that is being dragged out because the family won't let go. 

My other patients were more self-sufficient, not that they were totally walkie talkies, but mentally they were with it.  One had open-heart bypass surgery a week earlier at a different hospital & that pushed her into CHF & her left lung was filling with fluid.  Dr. did a thoracentesis & she was doing much better.  I was amazed at how much she was moving around after having heart surgery, although I know they try to get them up & moving right away - bedrest is not good for a surgical patient.  I also got to remove the staples from her legs.  That's the first time I got to do that - it was like using a staple remover & just popping those staples right out.  It was kinda fun!

My next patient was an older woman with a fecal impaction.  Lovely!  Doctor's order - "manual removal of fecal impaction."  Uhhhhhh, yuck!  I love how the doctors just write the order & leave.  I think they should be the ones sticking their finger up their patient's butt & removing the impaction, don't you?  Lucky for me, the day nurse took it upon herself to attempt this & found no impaction.  She also gave her a fleets enema - the woman was having a numerous amount of bowel movements, I didn't see how a doctor could determine there was an impaction because plenty was getting out even before he wrote that order & before the enema.  Oh well, just glad I wasn't the one having to search for this impaction. 

My other patient was an older man with syncope.  His cholesterol level was only 88 & he wasn't even on any cholesterol meds.  88 is too low, so not sure what they do for that.  His HDL & LDL were too low also but all of his other labs were normal.  They were running tests on him, but so far nothing to really determine what was going on. 

My last patient was a transfer from ICU.  She came into the hospital with a blood pressure of something like 242/110 & wasn't responding to any of the blood pressure medications.  Finally they put her on a nitro drip & that helped.  She had a left carotid endardectomy done also.  When I got her, the pressure was 170/74.  I still didn't like that, gave her some medication & got it back into a normal range.  She slept most of the night.  In fact, most of my patients were sleeping the entire night & I was bored!  I didn't dare mention I was bored though cause I know that would jinx me.  The night went by so slowly...that's the only good thing about being super busy - the time flies by.  It's nice to have a slow night though.  Even my clinical leader had fallen asleep.  Nice, huh? 

I work this coming Sun, Mon & Tues nights & then have an entire week off.  Yay!  I love the freedom of flexible scheduling.  I'm also getting closer & closer to making that call for an interview at the other hospital.  I just heard they are offering a $5,000 sign on bonus...yessssss.  Hopefully I'll qualify for that.  I'm trying to prepare myself for changing facilities.  Just when I was getting comfortable here, it's time to go somewhere else.  I simply don't like the way this hospital operates.  Their gallop scores are so low...like in the bottom 1% of the area hospitals.  That just leads me to believe that these other hospitals have it a little more together & hopefully the staff is a bit more happy than where I'm at now.  Still though, change is hard but must be done.

Bad, bad idea & SLACKERS!

It seems that my department's customer satisfaction gallop scores are down. So what is administration proposing? Getting rid of all patient care techs & switching over to primary nursing where the nurse does everything for the patient. Sounds wonderful in a fantasy world, but when you have 4 or 5 patients in guarded condition - it just isn't possible. Add in the numerous amount of paperwork (all done by hand)...forget it! They are saying they'll limit us to 3 or 4 patients, but we know that is a joke because they have a problem finding staffing right now, how in the world are they going to add nurses so our patient load would only be 3 patients to each nurse? Why in the world would they eliminate patient care techs & hire more nurses to do what patient care techs are trained to do? Doesn't make sense. Personally, I think we could use more patient care techs, not less. Oh well, I skipped the meeting last night that addressed their new plan. I was too tired - went to sleep around 7 pm & woke up this morning at 4 am. Guess I needed a little bit of sleep.

I'm also frustrated with my renters - the rent check was due yesterday & it's not here. I'm not having a good feeling about this & really don't want to have to go to them to get the check, but I guess that's my only option. Grrrrrr!

Work was ok this week - nothing real spectacular going on. I think one thing I enjoy is seeing the vast range of personalities. I had one guy that was writing down the results of every blood sugar taken, every BP, every temp, everything he ate & even the amount he was urinating. He had it all written on this tiny note pad. I just had to laugh when he showed it to me. I had another patient that was on reverse isolation airflow - he has aids, was neutropenic & TB. I don't think he ate very well outside of the hospital either - so while he's there, he is eating anything & everything he possibly can. After a couple of days, it caught up with him & he had the worst stomachache. He was such a drama queen also...by the third day, I requested to not have him. I can only take so much drama.

I also had my first incident where I was called in by the clinical leader to discuss a situation. I had a post-op surgical pt that needed blood (his morning H&H were like 7.1/21). I called the surgeon around 5 am to get the order...wrote it up, put it into the computer, faxed the order to the blood bank & waited for the blood to be ready. After an hour of not hearing anything from the blood bank, I decided to look it up on the computer & I see that the order is there but still waiting.

I go to pass my 6 am meds, come back & check the computer & see that the order has been cancelled. I call the blood bank & ask what's going on with my order. It's now 6:30. They explain that since he had surgery, they had already had blood available for him & didn't need another order. Would have been nice if they had told me this an hour ago, you know? So now it's 6:30...do I run & get the blood & hang it by 6:45, stick around the 15 minutes observing the patient while the blood is started as well as delay everyone that is to get report on my patients? Or do I clearly tell the oncoming nurse of this patient that his blood is ready & that I already prepared all of the IV tubing & it's hanging on his IV pole just waiting for the blood? I opted to pass it along to the next nurse because a patient needs to be monitored closely when the transfusion begins. I tell her about it & we redline the orders together as well as look at his H&H lab values - so no doubts that she isn't aware of his orders for blood. Well, silly me for thinking this nurse was capable of doing her job. The blood did not get hung until after 9 am that morning & she is saying it's because she didn't know he needed blood. Ugh!!!! It's not enough that we reviewed the labs & redlined the order for blood? How about seeing tubing prepared for a blood transfusion hanging on his IV pole? Is anybody home in there?

So the clinical leader for the day shift wanted to talk to me & she says something like "I know you're new, blah, blah, blah" as if me being a new nurse is the reason this happened the way it did. She says I'm not in trouble & that it's the surgeon that was upset about it, not the hospital. I felt like saying whatever!

I've learned a valuable lesson though - don't trust other nurses to do the job right. I'm seeing more & more of how there are quite a few that are big time slackers & they either don't do what was ordered & then pretend they didn't know about it or they act as though they did it when they really didn't.

I had a patient Tuesday night that I had to hang blood on.....I questioned my clinical leader why it took until 8 pm to hang blood when the lab results were from 4 am that morning? Her H&H was awful...but the night nurse that got those 4 am labs ignored it as well as the day nurse who took over that patient. It wasn't until the doctor made rounds at 1 pm that he saw the lab values & ordered the blood. But again...why did it take another 7 hours to get the blood to the floor & the transfusion started? Slackers I say, slackers!!!!!!! Don't trust anyone to do the job right other than yourself!

Confirmation

Is it just me or is time flying by?  It's already June!  Today is my mom's 63rd b-day - Happy Birthday Mom!  My parents 45th wedding anniv is on Saturday - Happy Anniversary Mom & Dad! 

I've had a pretty good week - started off on Saturday (I know Saturday isn't the usual beginning of a week, but this week it was for me).  I went on a date with Scott.  We went to the Inlet Harbor for dinner & live entertainment, then a walk on Daytona Beach & spent a couple of hours talking & getting to know a little about one another. (Thanks Scott!)

Then it was back to work Sunday night.  They had Gina on a different floor than I was, but at least one good thing about that is we can take breaks together & have lunch.  Our hospital has this stupid policy that only one nurse is allowed to leave the floor at a time - even if we have 5 other nurses on the floor as well as a clinical leader.  Ridiculous!  And now we have assigned lunch breaks.  We used to be able to go when we wanted to or we could eat at the nurses station - not anymore - no drinks, no food, no nothing at the nurses station.  They keep telling us this is JCAHO's policy, but we aren't stupid because other hospitals are not this strict & have better ratings than our hospital.  Oh well, the countdown is on - I'm getting the itch to spread my wings & gain more experience in another hospital.  I want to have at least 6 months at this hospital so it looks ok on a resume (as opposed to 4 or 5 months), then make the switch.  I want to learn more about cardiac nursing as well as work at a hospital that is working in the 21st century = computerized charting. 

Anyways, my first two days at work were good - decent patients even though 2 of them spoke only spanish (or so I thought).  I tried my best to talk to them & to figure out what they needed.  One of them said to me out of the blue "You are a good nurse - you give love & that makes you a good nurse."  Awwww!  So she did know a little english, but I was surprised.  I can't even remember the specifics of the patients I had those first two nights because on my third night - they moved me to a different floor...grrrr.  The only reason I didn't try to have that changed was because it was the same floor that Gina was on & I figured we'd get our work done & have some time to chat or help each other out. 

It was one of the most aggravating/frustrating nights I've had since I began work.  Maybe part of it was me being a little tired, but when I got there - I got report on 3 patients, did my assessments, was starting to get meds & my clinical leader gives me a new admit.  I don't mind new admits - just prefer it not to be that quickly.  So I pass meds to my first patient who had just had 2 toes amputated & had MRSA.  Very pleasant woman, but she had generalized edema - I felt for her.  She could barely move & didn't want to bother me.  Those are the patients I could spend all shift taking care of - the ones that don't want to bother their nurse...as opposed to the ones that think that they are staying at a 5-star hotel & you are their servant. 

Then my new admit was brought to the floor - pleasant woman with a possible stroke, but so time consuming & full of drama.  I kept my cool, she was upset about family problems & I was trying to give her some emotional support - telling her to try to relax, that worrying right now isn't going to make things better & all that good stuff.  This woman kept touching me & then would apologize for touching me & then she'd touch me again...lol.  I didn't care, it wasn't inappropriate touching or anything like that.  Got her situated, went over her orders, called the doctor for her Xanax (much-needed). 

At the same time, I had another patient & her son wanting answers - what was wrong, what did the doctors decide, what do the tests say, etc.  I explained to them that I had just gotten report from the day nurse, that I hadn't been able to read through the chart at this time & the person they really need to ask as far as test results & all that is the doctor - because I didn't know what he had or hadn't told them.  She was an 88 yr old woman that was just tired of the whole medical thing - tired of being in the hosp, tired of the tests, tired of lab draws, tired of mediations - I can't say I blame her.  At 88, I'd be tired of it too.  I'm tired now & I'm only 36!  I don't even remember what she was in for...my mind is shot.

My third patient was easy to care for - a walkie talkie.  Other than meds & a snack, she really didn't need much from me.  So now it's midnight & I'm finally able to sit down & get some paperwork done (did I mention I am so tired of having to do all the paperwork by hand???).  It takes forever to do all of that repetitive paperwork.  Tick, tick, tick...the countdown is on.  Around 2 am my clinical leader says "I have another admit for you."  Sigh...noooooo.  A woman with chest pain.  Not more than 2 minutes after my clinical leader tells me this, ER is on the phone ready to give report.  Ugh!  No time to prepare which really sucks because 95% of the ER staff are, for some reason, unable to give a decent report.  She tells me this patient's potassium level was 2.7 on admittance, but she has given her 60 mg PO.  Ok great, she says that's the only concern at this time.  As I'm getting the room ready for the new patient, my 88 yr old is making a mess in her bed (if you know what I mean).  So we get her cleaned up, my new admit arrives, the paperwork is given to my clinical leader to put in the orders & my new patient is situated.  I come back to the nurses station & my clinical leader is saying something about how this patient's magnesium level is low = 1.4 & that I need to call the doctor right now.  I have no problems calling doctors now, but I prefer to at least get a chance to look over the orders & the labs before doing so.  Nope, she called his answering service at about 3 am & he calls back - I was so overwhelmed at this point that I forgot what the heck I was even calling him for.  So I'm stumbling through the words (gotta love me...lol) & rather than the usual doctor/nurse conversation where the nurse is trying to understand what the doctor is ordering - this time the doctor is trying to understand what I am even talking about.  :)  So he orders 2 magnesium tablets to address the problem & hangs up.  I had so much paperwork to do...I was scrambling to get it done.  Gina helped out so much with doing other things that I needed done - thanks Gina! 

Then the morning labs come - a lazy nurse wouldn't even look at the results, just push it off on the day nurse.  Unfortunately, I'm not a lazy nurse.  One of my patient's K+ was 5.7 and my 88 yr old woman's K+ level was 2.0 and her sodium was 151....uh oh.  Gotta address that.  No wonder she was saying some weird things to me such as "Is the refrigerator plugged in?  My husband just plugged it in so we could have cold soda later."  I was so out of it that I just started agreeing with her...sure the refrigerator is plugged in!

So I put out a call to a different doctor, but luckily it was the same doctor for both patients.  He finally calls back, Gina answers, attempts to transfer it to me & somehow hangs up on him.  Good going Gina!  And he never called back.  At that point it was near 6:45 & I figured the day nurses could handle it.  The low K+ woman was on an electrolyte protocol so the IV potassium was started, just had to notify the doctor. 

I could not wait to go home & get some sleep.  I went & saw my Dr. today because I needed my thyroid prescription renewed.  I hadn't seen her since November.  She asked if I graduated...I said yes & told her where I was working.  She drops her pen, looks up & says "Why are you working there????"  She has privileges there but she really doesn't like the hospital either.  She named the hospital I should be at & I told her that's where I'm headed (hopefully).  We chatted for awhile, she told me she was glad I became an RN.  She was in a real friendly mood.  It's funny, I think she's a great doctor - been going to her for 15 yrs on & off, but most of the nurses at my hospital are afraid of her.  They fear calling her at anytime, not just the middle of the night.  I hear she isn't the friendliest.  I haven't had to call her yet, but if I have to - I will be throwing in my last name so she remembers I'm also her patient, then maybe she will be nice.  :)

There was some sad news this week...a guy I went to high school with died last Friday.  He collapsed at home & they are thinking it was a heart attack.  He was 38 yrs old...so weird to think someone around my age has died from that this young even though I have patients that come in that young with chest pain.  Just sad!

We also had a patient in the ER that died the other night from taking an herbal diet supplement - he was only 44 yrs old.  I don't like those herbal things - they aren't regulated & who knows what you are really taking.  So not worth it!!

Ok, time to go back to relaxing, I'm still tired!

 

Another week down

Another week of work completed.  Yay!  It was a pretty good week too.  Gina & I were on the same floor, which was nice - makes it easier to have someone you know & can depend on around to help out. 

My first night I had a patient that had been hit by a snow plow when he was 20 yrs old which left him paralyzed from the neck down.  He was also unable to speak.  He moaned a lot & was able to look at you & look around, but couldn't actually communicate with anyone.  Makes me wonder if he is there mentally or not.  I cannot imagine what it would be like to be trapped in my body & unable to communicate.  Anyways, he came into the hospital about 2 weeks ago for pneumonia.  His family takes care of him at home (he's close to 50 yrs old now) & he had absolutely NO sign of skin breakdown.  His family does a remarkable job of caring for him.  Unfortunately his mother (who was his main caretaker) passed away about a month ago.  His father & sister remain very much devoted to caring for him, but I imagine after awhile it must really take a toll - between the hardwork, the stress & the lack of sleep.  I really don't know how they do it, but I suppose no one knows how they would do it until they are faced with having to be in that situation.  All I had to do for him were his physical assessments & hang any IV medications.  The family did the rest.  I can definitely see where the customer service side of nursing is needed as this patient's father clashed with my clinical leader one night.  I was able to hear both sides of the story & it was amazing how differently they perceived one another.  Regardless, I did my best to smooth it over so that there would be no further incidents & I encouraged the father to voice his concerns to the hospital administration.  His complaints should be addressed & taken care of.  I had this patient all 3 nights & it was a good experience for me.

My second patient was a man with a really long-worded disease that I can't remember but it ends with dysplasia.  Basically it's the "broken bone" disease.  His bones are so fragile that they easily break.  I believe he came in for chest pain, but after doing a chest x-ray, they found a mass & were doing further tests to figure out what it was.  He was a pleasant gentleman.  He ended up being transferred to med-surg the second day so I only spent that one night caring for him.  He explained a lot about the disease he had.  I think it's pretty neat to actually meet people with conditions that you've read about or studied while in school - especially rare conditions. 

My third patient was the one that kept me on my toes.  She was a 57-yr old female with end-stage renal disease.  After she had dialysis at home, she fell & fractured her skull.  Along with that she has diabetes.  I would feel comfortable calling it uncontrolled diabetes.  My first night with her was fine.  Her blood sugar was something like 340 - treated her with regular insulin, no problems.  The next night the doctor had changed the type of insulin she was taking & the dose as well as starting her on Prandin.  Did an accucheck at bedtime & it read 506.  Not good at all, in fact - rather high.  A fasting normal glucose level is somewhere between 70 & 99.  Since she wasn't fasting, I did expect it to be a little higher, but definitely not 506.  I gave her 12 units of Lantus (long-acting) insulin as ordered.  Rechecked her blood an hour later & it was 440.  Getting better, but still not enough for me to feel comfortable with so I went ahead & covered her according to the sliding scale which was 12 units of Novolog (faster-acting) insulin.  She was somewhat lethargic, but I wasn't sure if that was due to her glucose being out of whack, the skull fracture or the fact that her electrolytes were screwed up.  I kept a close eye on her & rechecked her glucose level around 4 am.  The accucheck machine read "hi."  I rechecked it again using a different accucheck & it still read "hi."  So I put in an order for a stat glucose level from the lab.  They called me back about 45 minutes later & informed me that her gluclose level was 899.  Eeekkk!  One of the other nurses who has also worked in the ICU said to me "I don't think I've ever had a patient with a blood sugar that high."  How comforting...not!  I called her primary Dr., explained the situation to him & his reply "Doesn't she have a consult with an endocrinologist?"  Oops...yep, I forgot.  He says "Call that doctor" & hung up.  It was a little difficult reaching the endocrinologist, but with the help of another nurse (M.B.)....we managed to track down the Dr. who ordered some more insulin sub-q.  That helped her get back down into a better range as the morning shift was taking over.  When I came back that evening, she was doing ok - more alert, but still a little out there.  Checked her evening glucose & it was 261 - that's not too bad.  Gave her the prescribed medications as well as a snack of graham crackers & milk (per dr's orders) & then left her to get some rest.  I went back in to check on her & she was saying some wacky stuff & seemed a little agitated.  I was told that was the norm for her.  I decided to recheck her glucose level around 4 am...just to be sure she was ok.  Her level was 59 (I can't win...lol).  Now it's too low.  Gave her some graham crackers with peanut butter & some more milk.  Rechecked an hour later & she was 116 which was pretty good.  I'm still wondering how in the world her earlier gluclose level was at 899.  It's not as though she had been eating anything other than the 2 graham crackers I had given her.  Bizarre! 

My 4th patient was a man in with chest pain.  During assessment, he mentioned that his back had been itchy - turns out he had red spots all over it.  I called the dr. & described the spots as well as I could "multiple red, itchy spots all over his back - smaller than a dime, but not pinpoint."  The Dr. had no clue what I was describing.  I'm sure there are better ways to describe his condition, but that was my best way.  Anyways, the Dr. ordered a dose of Solumedrol & the patient seemed to respond pretty good to it.  He ended up being discharged the next day.

So with one patient moved to med-surg & another discharged, that allowed for me to have a couple of new patients Monday night.  I had a 62 yr old woman in with shortness of breath & chest pain.  Her cardiac enzymes were negative & other tests still had to be run in order to figure out what was going on with her.  My other patient was a gentleman admitted with Altered Mental Status.  He also had MRSA in his urine (infection).  I tried to spend a little extra time with this gentleman as it was clear that he wanted/needed the attention. 

Gina & I were able to watch a Code Blue on the med-surg floor early Monday morning.  This is one of the main reasons I don't want to work on med-surg....the way this patient was discovered not breathing is when it was time for vital signs.  So who knows how long ago he truly stopped breathing, you know?  I would be so paranoid if I were working with patients that were not on telemetry (heart monitors), because I'd have (generally) no clue ahead of time that something wasn't right.  Needless to say, he did not survive.  :(

I went out to dinner earlier tonight with my friends...Happy Birthday Maria, Dorene & Julie (yes, I know it was a month ago for you Julie, but still...Happy Birthday).  We went to Red Lobster & ended up talking for 3 hours.  It was a really nice time.

I'm tired now, heading to bed & hoping to relax the next few days (my days off).  It's been very rainy out, so definitely a good time to relax.  My back is a little sore, but 99.99999% better than last week.  Yay!

 

 

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.