Archive | November, 2008

Lupus~ the body killing itself.

27 Nov

I am still trying to read about Lupus because I vaguely remember learning about Lupus in school. I had my first patient this week with a serious flare of Lupus. I was shocked to find out that this disease is so debilitating, awful, ugly, painful, heartbreaking. The patient could not even swallow, the throat was inflamed with thrush, canker sores, and the mouth was inflamed with herpes sores. The patient could barely talk. The patient was paranoid, and exhibited signs of what appeared to be high dose steroid induced psychosis. The patient eventually went to the ICU and I am not sure what the outcome will be. I am just so disturbed by this disease and this experience for this patient and family. For more information about lupus click here. It can be just awful! It is the body killing itself.

It is hard to be hospitalized.

26 Nov

It is hard for most people to be hospitalized, I can empathize with that~ That feeling of losing control of your daily life and needs. A person no longer eats, washes, takes medications at will, it is all done for them, or controlled by the NURSE, and hospital routines. I had this patient last week who treated my like the enemy. I understood the psyhco-logic to the patients trying to “micro manage” the care given and trying to manipulate me at the same time, but the end result will be unfortunately to the patients poor outcome. I made so many attempts to rationalize, educate, support this patient..to no avail. Finally the cardiologist transfered the patient to a medical floor because the patient was so non compliant. The patient was admitted for congestive heart failure and yet refused the treatment the second the patient got “one ounce” better. It was as if the patient thought, “I can sort of breath better now,” so I will refuse: my Lasix that is prescribed twice a day(even though I have rales in my lung bases), I will refuse my daily weights that are standard for CHF patients, I will refuse my blood pressure medications, I will refuse any respiratory treatments, I will refuse to reduce the sodium in my diet because “my body craves salt.”  The patient will accept: Meals on demand, Vicodin on demand, and ambien at night. Wow! You can eat at home,  take ambien and vicodin at home, and eat all the salt you want!

It was the perfect example of non alliance that I ever experienced. I wasted my breath for 3 twelve hour shifts trying to treat this patient as prescribed. It was exhausting and I felt so defeated because I was sure I could educate this patient!

Heart Transplant

19 Nov

After about 18 months of nursing I had my first patient that came under my care that was a heart transplant recipient. I was so amazed at first. I thought  after everything this patient has been through the patient must be a great patient! Well…I was wrong. The patient was post heart transplant over ten years ago~ Which is great but I was worried, the patient was bossy, irate, would not take medications as prescribed, just “wanted to get out of the hospital”, which made me wonder why the patient came to the hospital in the first place. The patient looked like a bum, was messy, unkempt, and smelly. It was so bizarre. I am not even sure what the outcome was~ As I was leaving the cardiologist on call was trying to get the records from the patients cardiologist in another state. So I am not sure what was going on with this patient. It was strange.

To preserve bedside nursing.

14 Nov

I find it ironic when administration “lays off” plenty of people and then they say that they are doing it to “preserve bedside nursing”, it is just ridiculous. Unless they think that somehow by getting rid of middle management, education and ancillary staff is going to somehow affect the number of nurses that are always going to be needed at the bedside. It really is a no-brainer. To maintain the ratio a certain number of nurses are always going to be needed when the house is full. Things are certainly not looking good at community hospital. When they start laying off everyone except bedside nurses the place must really be in bad shape. It just annoys me that they try and pacify us bedside nurses by labeling the lay offs as “preserving bedside nursing” GIVE ME a BREAK~ The hospital is broke so they take away all of our help and then do it in the name of preserving our jobs! What a farce.

A great week!

6 Nov

I am so tired! I worked extra this week plus stayed up late on Tuesday watching the historical event of Barack Obama get elected to the presidency.

Understaffed

4 Nov

Last week the problem was not lack of beds it was a lack of nurses that kept the ED at community from bedding the ED “holds”.

It was just a slow hot mess on the floor.

Bedding

1 Nov

When I was in nursing school they never taught us about “administration.” I guess they figured we would learn that ourselves soon enough. Well..it is that time of year again! It seems that all the “prn” staff has quit. I wonder what new jobs they have found. Oh…the weather is changing and somehow our floor is full~ every bed taken. Administration likes to come on down to the floor from these tidy little office and they start staring at the bed board as if that was going to miraculously “open” up beds for the patients being “held” in the ED waiting for a bed. Now I understand the situation, I know those ED admits need beds. Here is the thing though. Administration turns the place into a “feeding frenzy” Nurses are rushed to get the patients to regular floors to open up for the new admits. That means badgering the MDs starting with the cardiologist~ “Does this patient still need tele?” or “Can this patient go to a general medical floor?” If they say yes~ Another call needs to be placed to the attending to get the final approval as well. Now I am a busy nurse with 6 patients, understaffed and under appreciated just TRYING to keep my patients safe. I do not have time to keep making all these phone calls! I think that the Nursing Supervisors should start making those phone calls. I am sick of it.

Ironically I came across this article here by way of Kevin MD~ It is a merry-go-round. I have no problem accepting patients from the ED in a timely manner if there were just enough NURSES and enough BEDS to take them! Sometimes the ED nurse will think that we on the floor are “stalling” or taking our time. The patients on telemetry can only be moved off telemetry with orders from an MD and it takes time in the midst of doing other things to get those orders.

I really “feel” for the ED~ it should not be a holding area and the flow should be appropriate for everyones safety. I hope it gets better. We need more staff. That is the bottom line.

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