Archive | September, 2009

i hurt my back

29 Sep

somehow and I was not even at work. I can not move greater than 15 degrees to each side or bend forward more than 10 degrees. I broke down in pain and went to the *gasps* doctors. The NP thinks it is just a muscle spasm, and now I am taking: ultram, flexeril, lidoderm patch and REST. ughhhhhhhh. I never have had any problems before and I hope I am better in 3 days before my next shift: ouch

coffeeeee

25 Sep
Lasix 40mg PO bolus

Lasix 40mg PO bolus

20 meQ KcL PO

20 meQ KcL PO

I seriously think that all the coffee inducing diuresis* requires some sort of electrolyte replacement.
I am going to start monitoring my I/O.
Eternally nerdy.
as if i have time to pee!
 
*peeing your brains out.

Dynamite

15 Sep

During the 1860s workers at Alfred Nobels dynamite factory who suffered from heart conditions noticed that (opposite to most of us) their chest pains eased once they once they came to work. It was eventually discovered that nitroglycerin dilates the blood vessels, which provided relief from clogged arteries.

From: the complete idiots guide to Fun Faqs.

Nitro is cool.

Burned out neurons

13 Sep

I feel sick.

I always rant and rave about how much I love telemetry nursing and usually I do, but right now after these last few shifts I am on the cusp of burning out.

I do not keep active in the health care debate, but I do know this:

Where I work: everyone is admitted for every small and minor complaint. Everyone gets huge diagnostic workups that take days to complete with at least 3 consultants. Internal medicine MDs are afraid to discharge, consults leave it up to the internal meds to discharge and yet the tell the patient they can “go home”.

I know this: when everyone is standardly admitted, noone seems triaged.

And when someone is sick and it all rests on the nurse caring for non-acute other patients: the nurse gets burned out.

People are dying all over the world of treatable diseases and over here at community I had a patient tell me today she was “shopping” for a  new hospital.

And yet: I get an admit from the ED with HTN, dizziness, nausea refusing blood pressure medication and could not “tolerate” the indicated CT of the head due to her being nausea when she lays flat.  Well, wow…what can I do for you?

Helloooooooooo. Is anyone out there feeling this? My neurons are burned to a crisp.

IV lamps

9 Sep
These are so cool

These are so cool

I want one in my living room!

I want one in my living room!

Ok. I love my job. Call me  crazy but I think these mock intravenous pole lamps totally rock! Sure most house guest may not even realize the mock IV pole lamps but who cares! I think they would make interesting decor! They should have wheels though, that would make these lamps even cooler, but they are just ice as is. Found over here:http://www.coolhunting.com/archives/2008/03/lichtinfusion_l.php

As the tele pack turns

8 Sep

Telemetry packs often look like this. We hook those wires up to patients and can see at the nurses station a continuous reading of heart rhythms and some even have blood pressure monitors as an added bonus. tele pack

Speaking of ICU nurses before I describe my last shift I want to mention a great blog post that introduced me to Nurse Sean: the post that summarized exactly how I was feeling at exactly the same time can be found here and the blog is here. Nurse Sean has been in my sidebar for awhile now and honestly I stopped clicking on his name for awhile but it appears that he is writing and I am clicking and reading.

Sometimes as a telemetry nurse things get crazy. Some of the patients are on the cusp of being critically ill while some are apparently stable, with unstable angina seemingly on the stable range of the shooting field. Some are admitted honestly by MDs to telemetry because we take blood pressures every four hours and they feel that the patient is closer monitored even if they do not need continuous rhythm strip analysis.

Resources. Working in a community hospital resources are a precious commodity to me, a telemetry nurse. And that is why I felt guilty after my last shift. I got report from the night nurse that a patient was admitted from the emergency department after going to the doctors office for being “shocked” multiple times within the last few weeks by his internal defibrillator: after interrogation it appeared the patient was having sustained ventricular tachycardia hence the AICD was doing its job. Anyway he arrives to the floor with a systolic pressure in the sixties. The night nurse gives a 250ml normal saline fluid bolus bringing him up to systolic in the seventies. I check his labs and see that his creat doubled since yesterday, and of course I was concerned. I assess the patient who is completely awake and orientated, only complaint was “a little dizzy” and his pressure is again in the sixties. The patient appeared to be in no distress at all: no pain, no tachycardia, no shortness of breath, clear lungs, making urine,  just a “little dizzy”.

Every nurse on telemetry it seems is so afraid to run in fluids: mostly because more than half our patients are in heart failure or have a history of it. Every nurse who has seen their patient go from breathing just fine to acute pulmonary edema will know the fluids can be frightening: but giving a dizzy patient with a blood pressure in the sixties only 250ml of fluids and calling it a night is not quite right!

So here I am on day shift with the maximum nurse to patient ratio of 1:6 ( a crime). Tending to this patient giving multiple 250ml fluid bolus over an over again (slipping in a little extra here and there)  when I really just wanted to run in the whole liter in an hour. Wasting my time doing the whole sepsis workup when internally I felt that the patient was just dry: but I was not willing to risk that assessment alone. When at the end of the liter going in (in 250 increments) the patient was finally transferred to ICU for the inability to maintain a decent pressure in spite of a liter of fluids: with scheduled anti-arrhythmic  medications to prevent further ventricular tachycardia that would lead to another “shock.”

Needless to say the patient received another liter in ICU: and was transferred back to telemetry the next day with a normalized pressure, and guess what? BUN and creat back to normal! and no other problems.

I honestly felt guilty like I misused a valuable ICU bed for some gentle fluid resuscitation. But in the end the guilt goes away because to many times, the call is not made early leading to poor outcomes. And to many times in community the ICU bed is not available, and transfers into ICU are actually triaged for the sickest to go in first while the other less sick patients ( but still critically ill) stay or get transferred in to telemetry waiting. When that happens the shift becomes a circus riot and your stable patients hardly see you.

So the census is back to normal. The revolving door to telemetry is open for monitoring. I started my last shift with 6 patients. 2 went home, 1 went to a medical floor, 3 stayed with me, 1 admission from the emergency room and transferred to ICU before shift change and 1 was stepped-down from ICU into telemetry: and that was just my assignment, my group: the story repeats for every nurse that shift and we call it: as the tele pack turns.