so i was put on call this morning. (yes, i did the happy dance at 5 am lol). this is only because i was off this weekend and am off the next 2 days as well. BUT i had to go in to work at 3 pm. it was the middle of the day... but i could already tell the moon was going to be full tonight. as i am sure that most people understand, the full moon brings out the best in people. right?? :)
first off, the first patient i go to see has like an airway obstruction. sats are 82% on 3L. yay! HR 155. beautiful! temp 102.2. getting better? ng tube with tube feeding. so in the middle of all of this... i put him up to 4L.. sats only go up to 86% even after he coughs up some of the yummiest sputum out there. seriously. the respiratory tech and i argue about whether or not it was tube feeding. i stand my ground.. it was much too yellow to be tube feeding. yes, tube feeding is a shade of yellow/brown, but this just looked purulent and not like any other aspirated tube feeding that i have ever seen. his lungs were full of rhonchi down to the bases.. which is another reason i didn't think it was aspiration. anyhow.. sats weren't better, so i preoxygenated him with 6L of O2 and then suctioned the mess out of him. sats instantly to the mid 90s (yay!) and put him back down on 3.5L where he stayed well oxygenated. Now the doozy.. during this time, the man is calm, has some chills, but is alert and oriented and not a problem. once i got the sats up.. he was plain nutty! usually, it is the other way around! not today :) gotta be the moon.
so once he is fixed.. emergency in the dialysis room. pt is bleeding out of the graft site. plts are 18. doesn't take a neurosurgeon to figure out that one. but the surgeon that responded to sew up the graft site wasn't too thrilled about it. luckily i got to monitor the rhythms and the phones during all of that. i have already seen one person bleed out in real life.. i really prefer not to see anymore. this person in dialysis was stablized but she is a dnr and probably won't make it through the night or much longer than that if she does. because i know her well as a patient.. she will really be in a much better place than where she is right now. because right now she is miserable and there is nothing that we can do to prevent it. not even treat it.
and i cannot forget about my country patient. alcoholic.. lethargic... just a plain mess. he was actually better back on friday when i had him. he had woken up some then.. was more alert. today.. hallucinating, lethargic, weak, speech so slurred that you couldn't understand a word he said. hardly a response to pain unless you count that evil glare he gave me with deep nail bed pressure. he sure didn't move his leg back in response to it. i can't imagine that he is going to pull out of this anytime soon. he must certainly be visiting liver land or something to that effect because he is well past the time to go through dt's. either that or it's just the moon. heh.
and now i am off for a couple more days. hopefully by the time i get back to work.. the moon will wax or wane itself away, and we on the floor can get back to the normalcy of our pleasantly confused patients without the added effect of the moon.
27 August 2007
21 August 2007
Much Ado about Nothing at all.
Well my 2 whole days off have flown by and again, I didn't get too much done around the house. I had to go out to my mother's house and fix their computer. I tried to charge them $50 for technical support, but all I got was a breakfast that you can't even get at the Waldorf (inside joke in the family lol).
My oldest son is very.. lucky.. to be alive. Got the cell phone bill and voila... he sent 775 text messages last month. I hadn't put him on the unlimited plan yet but you bet your ass that next month he will be on it. So he is grounded from his cell phone until then. I would so much rather pay the extra $10 a month than $100. Geez.
My last few days of work have been fairly uneventful. Nothing much to even write about at all really lately. I guess I need to get a real life. 'nuff said.
My oldest son is very.. lucky.. to be alive. Got the cell phone bill and voila... he sent 775 text messages last month. I hadn't put him on the unlimited plan yet but you bet your ass that next month he will be on it. So he is grounded from his cell phone until then. I would so much rather pay the extra $10 a month than $100. Geez.
My last few days of work have been fairly uneventful. Nothing much to even write about at all really lately. I guess I need to get a real life. 'nuff said.
15 August 2007
etoh... cause and effect
they show the teenagers the shock value of drinking and driving.. what can happen in those horrible wrecks to shock them out of the idea of drinking and driving. in my experience as a nurse, even though it may be limited compared to others out there.. what these kids need to see is what happens when you drink.. and keep drinking.. and keep drinking. sure, it won't make a dent, because teens believe that they are untouchable. we need a way to reach these people when they are bit more mature and able to comprehend that life doesn't go on forever.
a case in point would be the pt that i cared for last week. a male, just 7 or 8 years my senior. came in with pneumonia, but through his history, found out that he was a drinker. and he drank a lot. so 48 hours later, when the behavior changed and the tremors came, so did also a myriad of problems. i spent 3 days of hell with this man. he was acutely confused, had difficulty swallowing anything at all.. so that his liquids had to be thickened so that he wouldn't aspirate them. how do you continually reorient someone who cannot comprehend at the time what is going on? and then when his abdomen became distended after a few hours of vomiting feces, and having to put in the ng tube that was replaced time upon time again, because as i said, how do you reorient someone who cannot comprehend what the hell is happening here? he would go through spells in which the librium would work for him, but other times, it wouldn't touch him. as a person, i felt for the man because he was truly ill and he may not even make it out of this hospital stay alive because he was just that sick. was it all to drinking? i believe so. i can understand that from the problems in which i encountered with him that his pneumonia was most likely due to aspiration. i cannot confirm it, it is just the gut feeling that i have. he was eventually transferred to icu because his condition deteriorated over the weekend and he was a full code. they would be able to give him more attention in that unit than those on floor were able to do. personally, i think it was a wise decision to transfer him. part of me wishes the md would have done it sooner but it is not a decision that we take lightly either. i was able to care for him when we was in my charge. that is not saying that he did not frustrate me, because he wore out just about every bit of patience that i had as a person, but he got very good care with me. i do also believe that if people were to see this aspect of alcohol that they might be more inclined to just leave it alone or touch it in moderation before it becomes a problem. then again, i could very well be wrong, too. unfortunately people never believe it will happen to them.
a case in point would be the pt that i cared for last week. a male, just 7 or 8 years my senior. came in with pneumonia, but through his history, found out that he was a drinker. and he drank a lot. so 48 hours later, when the behavior changed and the tremors came, so did also a myriad of problems. i spent 3 days of hell with this man. he was acutely confused, had difficulty swallowing anything at all.. so that his liquids had to be thickened so that he wouldn't aspirate them. how do you continually reorient someone who cannot comprehend at the time what is going on? and then when his abdomen became distended after a few hours of vomiting feces, and having to put in the ng tube that was replaced time upon time again, because as i said, how do you reorient someone who cannot comprehend what the hell is happening here? he would go through spells in which the librium would work for him, but other times, it wouldn't touch him. as a person, i felt for the man because he was truly ill and he may not even make it out of this hospital stay alive because he was just that sick. was it all to drinking? i believe so. i can understand that from the problems in which i encountered with him that his pneumonia was most likely due to aspiration. i cannot confirm it, it is just the gut feeling that i have. he was eventually transferred to icu because his condition deteriorated over the weekend and he was a full code. they would be able to give him more attention in that unit than those on floor were able to do. personally, i think it was a wise decision to transfer him. part of me wishes the md would have done it sooner but it is not a decision that we take lightly either. i was able to care for him when we was in my charge. that is not saying that he did not frustrate me, because he wore out just about every bit of patience that i had as a person, but he got very good care with me. i do also believe that if people were to see this aspect of alcohol that they might be more inclined to just leave it alone or touch it in moderation before it becomes a problem. then again, i could very well be wrong, too. unfortunately people never believe it will happen to them.
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