Archive | March, 2010

Labile Stress

31 Mar

This is Stress by Bleedingbird found on deviantART.

I think I felt like this artist above last week, only I was not struggling over calculus homework, although I imagine that is very stressful.

I was on the verge of a Telemetry RN breakdown, one of those tear inducing shifts, where the patients are sick, the emotions are full, and the turnover is fast.

It was just before noon when I realized that the third patient out of my five patients were to be discharged, and since I was discharging so many: I had to have an admission. That is just the way it works, if not I would only have two patients, and that just would not be fair.

I can safely discharge rather quickly, I am used to it, that is what we do: admit, transfer and discharge.

Why was I so emotional this time? I think it had to do with the nature of the patients being discharged. All three had poor social support, all three were being discharged to home. Only one had visiting nurse referrals, and all three had labile blood pressures.

That was me, in the picture above, trying to figure out: how to stagger the medications for the patient going home on: Clonidine, Labetalol, and Hydralazine all together now, all three patients! And these medications are all three times a day. Forget about all the other medications: It is a rare  elderly patient that can administer medications to themselves the way we do it in the hospital. I often wonder if they take their medications at all.  I think about this because I see the revolving door of heart failure and hypertension. The same patients come in again and again, and suddenly get better while in the hospital. It is not a secret that the medical management is a fix, so they get the medicine as prescribed, maybe some extra Lasix, get sent out with the little piece of paper that tells them when to take their medicine, and they sign the paper stating they understand, and sometimes, I know they will be back.

When there is no family around, it bothers me. I am not diminishing the capability of the healthy elderly, but these patients are sick, with chronic sickness that needs looking after.

I guess what bothered me is that, they signed the papers, but I know they did not understand, and I felt helpless. Starting teaching early is not to be underestimated.

I suppose that I can not imagine a person taking Clonidine, Labetalol, and Hydralazine and not checking their blood pressure or pulse.

A family member picked up a discharged patient and seemed shocked when I asked if there was someone to check on the patient, after the patient was home.  I wanted to cry.

Maybe I was overreacting inside, I don’t know. I think it was just that the management of these three particular patients equals a level of  complexity, that from experience, I find it difficult to imagine the patients sticking to the regime.

I find myself saying till I feel blue in the face: Do you have a scale at home? You need to weigh yourself daily and if you gain more than two pounds in one night, you should call your doctor.

So, I felt the surge of stress hormones tearing up my vasculature. And then I got lucky and had a piece of  luscious (with a capital L) cake from my favorite ICU nurse, that released some sort of endorphins and pleased my limbic system greatly. It was a huge piece, I shared it with someone else, but still ate the bigger piece.

I still love my job.

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Green eyes can turn blue

22 Mar

 

If you click on the artwork you will be taken to the artist for credit at deviantART: Blue by ~Magic-Photos!

 I have not been writing much, I find myself falling into that lazy nurse blogger girl again. The end of winter brought much discomfort, but it is over now. The rain outside today will surely cover up my tears, bring on the green of spring, and hide the green eyes that turn blue from the contrast of red secondary to saline droplets that pour out of my lacrimal glands. At least my eyes are clean with all those lysozymes rinsing them. That is why I do not get eye infections.  Try and figure out the connection between sad thoughts that trigger this storm from my eyes, and the relevance to neurology and I will give you an A+ for explaining it to me. I am just not in the mood to figure it out for myself.  The problem with rain is that it is lacking salt. I am looking out the window and I love the rain, but it looks so hard compared to soft saline drops. Saline is just so comforting, I always say I love normal saline.

We are on the way to healthcare reform, the newspapers say. As a healthcare worker, I sleep with the uninformed about this issue. I have a passive view on this, and feel like the low man on the totem pole. It is not that I do not care, I just can not find the energy to get excited about it.  I am still going to be bedpanning the same bottoms and trying to improve the health of sick people via: medications, treatments, interventions, education to better the lives of the patients I encounter, and in turn their families as one unit to promote wellness. Who will pay? I do not know.  I am  irresponsible: I am just a nurse attitude is where I dwell. The easy way out, is the way for me: I am lost burying my brain learning things that might not even help me in nursing practice such as: cellular respiration, the production of ATP, and glycolysis. <sigh>  I realize there are problems, I would like to see resolutions, but I do not have the answers.

As I sat through a 3 hour meeting last week that was mandatory for work, almost got a blood clot from sitting so long with my legs crossed, and irritated because sitting hurts my ass, I felt: I am looking at the masterpiece of wasteful spending, while they are ironically preaching about cost control. The speech went on about service emphasis, and how health care is a market, and patients are our consumers. This consumerism idea just annoys me. I had a patient this week that said: “I am sick of waiting for my meal trays, I called 15 minutes ago and it is not here yet, I am NEVER coming to this hospital again.”  The ranting patient went on about how the food was always messed up. Like a good server, I called the kitchen supervisor and bitched her out till she brought up the  meal tray for my patient STAT because, we do not want a bad comment on the press-ganey survey or something like that. People are dying all over the world for lack of antibiotics and the simplest of health care provisions, and I am stressing out over a patient with mild CHF that could probably be treated at home after the switch to oral medications, but no, the patient was still hospitalized for over 1 week, stabilized on minor medication adjustments. That patient was actually in the range of : partially acceptable acute care needs, there are many examples I see on a weekly basis that hardly need the lengthy admissions: that is till we get them sicker. MRIs for EVERYONE. Nuclear stress testing for ALL. Or the patient the other day says: I am not leaving the hospital till you fix my urinary stress incontinence that I have had since I birthed 6 kids, and now I want you to fix it even though that is not what I was hospitalized for: STAT urology consult please.  Do I think that someone needs to control this wasteful, costly situation? Yes. Do I think that the government should be in control of this? I doubt that is the answer.

I never had health insurance, or even health care growing up. I remember my Dad always saying: I should be able to get health insurance in six months or something like that. It was always: in six months. The mind-set and the verbalization was always: we do not get sick. Luckily, I never have broken any bones or something serious. I had a few sore throats as a child. I suffered with terrible plantar warts on my feet for years, till my Dads girlfriend took me to the doctor for the prescription to get rid of them, I took the ointment and scraped the warts off myself with a scalpel that I sterilized with fire, so that I did not have to ask my Dad to take me back for follow-up. I had dental insurance for a few months from my stepfather, my Mom took me to the orthodontist and had braces put on. When I moved out of their house and lost the insurance coverage, I stopped going to the orthodontist and ripped the braces off my teeth with a pair of pliers. Now I like my crooked toothed smile. I did get a physical exam when I was 14: so that I could get “working papers” and find a job. The doctor was so sweet. He made me do 10 jumping jacks in his office and then signed the papers.

It is hard for me to postulate any opinion really. I will go on to educate myself about health care reform in the near future. I can not ignore it forever. I have a hard time splitting away the political rhetoric that surrounds the issue, so I stay away.

I never signed up to go back to school.  😦

It is just a system. Think about: ACLS guidelines recommend Amiodarone over Lidocaine, probably based on a study funded by the makers of  Amiodarone. I am just wondering if Lidocaine works just as well or not. Will I EVER know? Right now I do not care much as long as the code cart is stocked with the Amiodarone. I will worry about there being no Amio, when there is no Amio left. Who will pay?

I will try and go get educated right now.