Archive | February, 2009

The Life Vest and other report blunders

25 Feb

So I get report from one of my favorite night nurses (seriously, I luv her) It goes on and on about the patient, one part sticks out in my mind though, ” The patient came in wearing a holter monitor that she is not wearing now because she is being monitored on our monitors and she also has a chest tube to 20cm of H2O suction, status post lymph node removal in the operating room yesterday.”   I go to the room and find “LIFE VEST” batteries plugged into the wall, and I am thinking what is this?

The real story: Patient came to the hospital wearing a life vest due to an increased risk for sudden cardiac arrest,  and is status post  thoracotomy for partial lung removal with a chest tube to fix the ensuing  pneumothorax.

Two very different scenarios and care.

Blue Nail Polish

20 Feb

blue-nails I am sitting in the nail salon and in walks this woman who is like 350 pounds, she is short of breath on exertion has an increased respiratory rate and is pursed lip breathing, huffing and puffing, trying to get into the pedicure chair but needs help as she can not lift one of her legs that high without assistance. My immediate reaction is to go to her, but realize that I am not at work and I better let the pedicurist help her out. She settled down pretty good though and her respiratory rate when back down to normal and my anxiety went away. It returned though because she kept complaining that her big toe hurt and I just wanted to go and look it at (I did not though). I at least wanted to tell the pedicurist that this person probably has diabetes, her legs are as big as trucks and she probably has poor circulation and I would not cut those toe nails without the person signing a consent and waiver of liability. Seriously.  I have nothing personal against the obese population. It is just such a risk factor that leads to so many health problems, ie: coronary heart disease, Diabetes, sleep apnea. I am not even going to mention the emotional and practical problems such as self care deficits and altered body images etc…

My first loss of a patient was an obese male over 350 pounds. That was a code blue this new nurse will never forget and now the fear of the obese patient circling the drain will never go away. The intubation was hard, the chest compressions (ahhhh) the 2 inch backboard seemed useless, central line insertion in the groin nearly impossible.  I was only 2 weeks off of orientation, I remember the family wailing in the background, the intensivist asking me questions, and the patient turning a greyer shade of blue every single minute till the end…ashen. It was over and everyone left except me and the aide, to extubate and clean up the body and the floor and the bed and all the empty vials of epinephrine and sodium bicarbonate. Wow…the implications of obesity go beyond the risk for diseases, the obese patient is harder to treat and any treatment carries increased risk.

So yeah..that is where my mind was while the manicurist polished my nails to a high shine metallic blue. Perfect.

So what is your BMI?

Pharm Loves Nurse

19 Feb

Unlike the Pharmacist hates nurse there are many times when you just love your pharm. Like the day that you got smart and realized that the decrepit IV compatibility chart hanging in the medication room may not be up to date, so you call your Pharmacist and ask if Heparin and Cardizem can be run through the same intravenous line at the same time and the pharmacist tells you YES, they are compatible!  Wow, you are speechless, and you wonder how long this has been going on, you remember all those patients you laboriously put in that extra line for the Cardizem when your new onset of atrial fibrillation already on heparin starts to get all crazy on the telemetry monitor with a rapid ventricular responsein the 150s. With eternal optimism and happiness of knowing you will not have to do this anymore for these 2 commonly infused medications, the smile is contagious, infectious, and you spread the news around the unit! Whilst some are not excited because they already knew this little compatibility secret, others like you relied on that old outdated chart all ripped with the pen marks tracing heparin an cardizem in the “L” shape meeting at that little blank box that indicated “no data available”….True, no data available probably ten years ago!

Wow…you feel small like a nanocrystalor a quantum dot for not knowing before, but so happy at the same time for the future of infusion giddiness.

Sundays

17 Feb

Could be restful sunday at the local community hospital  turned into “micro manage me” family  member who was probably rotten to her mother her whole life…plopped her in a nursing home 12 years ago and rarely visited…and now on the brink of the end of life is coming around the bend…she thinks…, ” I will show up at the acute care setting, demand to know why my mom has pooped twice today (normal), when is the podiatrist coming to cute her toenails? (what?) Freak out that mom is forgetful sometimes and demanding from the nurse(me) a neurologist be consulted(are you serious where have you been for 10 years?), frantically fix and fluff the pillows and rearrange the blankets with FIERCEurgency while sneering at the nurse (me) as if I am not doing anything for mom, (is she manic?) Demand to know when is the DOCTOR coming, (as if I have that answer and if I had an guestimate time she would be the last to know.) And just generally call me every minute via the call bell to tell me how terrible to food is or that her mom needs the bedpan, (if that was my mom…I would put her on the bed pan myself) Whew!

In my mind: “Get over it lady! Micro managing the RN on during your Mom’s last days is not going to make up for your obvious rotteness (if there is such a word).”

stop sucking up all my time and energy on your GUILT plagued mind. JUST sit down in the chair at the bedside and HOLD her hand. Tell your Mom that you love her and care about her and that you are with her. Leave me out of your mind!

But if you insist…if it really makes you feel better…just know that I know what is going on in this scenario and I will run, and run and run for YOU (your mom has been well cared for allready by ME).

I will kiss your ass so you feel better and you will not even know that I know what is going on.

The END.

The Time Sucker

12 Feb

iphoneWell….I did it. I went and bought and iPhone. I have been deliberating since the summer time, “To get and iPhone, to not get an iPhone…that is the question.”

My last phone…a blackberry…was, well, a nightmare for me. I did not like it at all…in fact, I despised the blackberry. It just was not what I thought it was going to be. I had so much trouble. I could not sync the blackberry to my computer, could not import my calenders, could not download the medical software that I spent tons of money for the palm I already had…It was just awful. I had to carry 2 devices instead of one.

So of course I was afraid to purchase the iPhone…was it to be another “let down”,  just like the blackberry?

So far…I am not let down. I have been with my iPhone since tuesday, it is now Thursday. Where has the time gone? Is this some sick techno love affair? Will I save my money now for an apple computer? Am I obsessed? Have I browsed every possible app created yet? The choices are driving me into a frenzy!  Time has a way of escaping me everysince I met my new iPhone. The hours just roll into one hour, meals have been missed! Is there a psychotherapy app for the obsessed?

Hours upon hours….of organizing photos, and art work and apps. This is a full time job! To bad I have to go to work tomorow, but luckily there is an app for that!

Telemetry nursing

10 Feb

I survived another week at work…Now I have off for four days before going back. It is weird, just when I think I want to try something new I end up having a rewarding week at work and my mind changes.  I was seriously thinking about a change, perhaps Emergency, ICU or even Renal specialties were in my mind and I was actively researching.  Well it has been almost 2 years on telemetry for me, it seems natural to eventually travel my way to ICU.   My idea is however, I really do like telemetry nursing. It can be a dizzying experience some weeks, but I like the busyness. I like having 4-5 patients that are challenging, but not as critical to require intensive care. It is sort of like a shift on the brink all the time, a constant infusion of adrenaline. But well…I just had a good week, there are those weeks where it seems that all 5 of my patients seem closer to critical care needs and I feel drained anxious, and wrecked by the end of the shift.

Yeah well… it remains to be seen.

The bad nurse

6 Feb

 Since I work in a hospital…

I have hospital-o-phobia. That in turn helps me to be super nice to my patients, because just imagine being in a hospital bed, stripped of all freedom and independence, loss of all control. Everything is at the mercy of….the nurse. Nurse, nurse, nurse, Just call the nurse, can you ask her nurse, your nurse will get that etc…Your medications…your nurse will bring them…You have to go the bathroom…your nurse will walk you (do not get out of bed without pushing this button). Whenever you want to do something…your Nurse will surely interupt you with something, “It is time to check  your blood pressure, change IV, obtain samples etc.. time to go back on your bipap etc”

Whoever thought that a hospital was a place to heal is seriously mistaken.

There is no sleep, no rest in a hospital bed.

Even when it is time to leave you can not until your nurse discharges you with your paperwork.

Sometimes we look like the enemy.

How about the doctors that order tests….and do not explain or tell the patients about it. CT scans are the best!

They leave and in goes the nurse with 3 bottles of readi cat. fot the CT scan that you were never told about.

That evil nurse made me drink this!!! 

Sometimes at the end of the day I feel like a rotten person.

If I were the patient in the bed…I am not sure I would be able to lose that control.