Archive | March, 2009

Night Shift??

31 Mar

014HA!!!

I am so busy in the morning. Especially during weekdays when patients go for more testing etc…I am making morning rounds and this i s what I find at the entrance to one of the rooms…

Telemetry art..using electrodes folded into eyes and a nice face.

I am always is hot pursuit of the creative endeavours but at least get your work done first!! (Like all the daily weights that are not documented)

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Chest Pain

30 Mar

Chest pain 10 out of 10 for 2 weeks- drinking fifth cup of coffee–eating italian hoagie–who packed her bag to come to the hospital last night! No ECG changes–Troponin negative–Chemistry and CBC perfect.

Allergies: Everything except Dilaudid.

Sure! Admit to telemetry with Diagnosis chest pain rule out MI.

Perfect.

MD orders: CCU labs times 3, ECG in the am, 2dECHO, Dilaudid q4 hours.

Are you serious?

Blood clots

26 Mar

Ok. I am on my feet for more than half the 24 hour day for 3 days in a row.

I spend alot of time at home in front of a computer, reading and writing (mostly reading)

My legs are crossed and I am like so afraid that I will get a deep vein thrombosis leading to pulmonary embolism leading to long term rat poison, anticoagulants that I immediately realize these implications and spring out of my seat and start walking and pumping my calf mu ascles and give myself a fluid bolus of 240ml through the mouth of course. Ha.

Asking for Help

23 Mar

Who you work with on any given shift sometimes can make your day better or crack your twelve hours to pieces when you when you find your assignment in crisis.

I walked in on day one to crisis #1 in respiratory distress admitted to the floor by night shift RN who got ABGs and the patient on bipap but um….5 hours later I walk into this (the bipap is not helping) and the patient is getting tired with a breaths per minute greater than 40 who needs immediate intubation.  And I am stressed out but somehow managed to be calm and I even surprised myself with how clearly I “knew” how to do what I needed to do, restraints, suction, versed….very different scenario 2 years ago when I could barely find my voice in a crisis and just wished I could blend into the wall and let someone else figure it out and speak for me. I have to add that I had the awesome st respiratory therapist by my side, the calmest critical care nurse across from me, the loves to teach physician  keeping it all in perspective, as well as all the other helpful staff.

I walked into day #2 with a blood pressure in the 60s Systolic, clearly septic, on no antibiotics, and platelets count of 19 also struggling to breath and I knew and I felt sad. Blood was everywhere.

I walked into day #3 with a  patient made npo in the night, diabetic on insulin and pills with a blood sugar of 30 and no IV access due to infiltration and no palpable vein in site or touch. I learned that the glucagonIM works in about twenty minutes.  

The insanity is that I felt the adrenaline and I kind of liked it although of course it is a paradox as I would never wish that to be the norm. I think I am gearing myself towards emergency nursing or maybe intensive care at some point, sooner or later.

So the fake seizure in room #2 was annoying, but I regress.

Picture this: I am in the nurses station, the ICU RN has taken care of my intubated patient on day 1 while waiting for a bed to be available on the unit. I am officially relieved of my major responsibility for the patient and nurse A says to me all super loud, “You always get the worst group with sickest patients!” I am still trying to piece together what just happened so fast and my 4 other patients have not seen me except for my quick morning assessments and not one patient has been medicated.  Nurse B gangs in and starts chiming the same tune and I am thinking what fresh hell is this? Nurse C starts ringing in with her sympathy for me and I lose my temper! They sounded like a bunch of cackling hens pecking at me…their morning bird food. So I flipped out and demanded the cacklers get out on the floor and start medicating my stable patients so I can catch up.

It worked! They scurried out and passed all my morning medications. I was able to assess my patients and spend ions charting in detail the crisis and all the interventions provided.

My Embrangled Day

21 Mar

Yes embrangled is a word. (you can look it up I am actually to lazy right now to post the link even though my spell checker does not believe me).

One  code blue.

One Respiratory distress.

One acute seizure.

One performance evaluation that did not end in a pay raise due to an administrative policy.

One transfer that never came because the patient walked out AMA.

One discharge that could not understand his medications after an hour of teaching.

One admission who was needing a cigarette.

Ending in one nurse crying in her car when it was all over.

All right I still love my job but….wow…this is insanity.

ED Holding

19 Mar

So I worked an extra shift today and how do I get thanked? By getting pulled to the holding tank where every patient that is admitted goes to that does not have an actual bed yet.

It is in the holding tank that you are stuck between a rock and a hard stone because the ED wants those rooms so they can assess more patients and clear the waiting room, (naturally) and the floors are stuck in a quagmire bottleneck half the time discharging and moving patients around and of course the nurse on the floor who is busy and refusing to take report right away…and your day is just a ball of angst.

Not to mention the fact that you are seen as the “intruder” sucking up the space of fast track…as if you really wanted to manage about 15 patients total, 4 at a time, see the patients for like one hour, not chart at thing and send them to the floor where you get bitched at by the floor nurse because you have had the patient for an hour and know little to nothing except what the previous nurse told you as they whisked the patient into your holding tank in the hallways!

Wow…the shift goes by really really fast.

Managing Pain in Family Members

16 Mar

I just feel so terrible.

I feel so “unethical”.

I had a patient this week, a man with cancer everywhere recovering from palliative surgery who was admitted to telemetry for blood pressure control with IV medications.

There was a note on the chart that said, “Please medicate the patient with pain medications around the clock per families request” because the “patient will not ask for it”

OK the patient does not appear to be in any pain. The patient did not verbalize any pain. The patient denies having pain and is resting comfortably.

Then…the family arrives and storms to the nurses station and demands to know when the last time the patient was medicated for pain which was over twelve hours ago.

They flipped out on me and now I feel disgusted with myself because it just does not seem right and only added to the patients confusion. Next time I am going to stand firm against these types, but the patient did verbalize pain after the daughter coaxed him by asking over and over again till the patient finally broke down and aggreed with them. err.

I tried to educate the family that pain medication is given as needed, not because you want to feel that you can control me and therefore control the decline of your loved one.

I guess me medicating the patient with pain medication was really medicating their emotional pain.

The one family member in particular was just so nasty to me!! And yet every time the patient needed hygiene care, such as changing the linens, changing his pads, they ran out of the room super fast.