So report went something like this: This patient coded on the way in, but we revived them and now they are coming to you, on the vent, here are the settings... here are the labs... here is the monitor pattern... here are the meds they got down here.... here are the ivf's running... hx and allergies, family is with them, will bring them up in a few minutes. General report.. nothing special or out of the ordinary. Lots of sunshine, butterflies, and rainbows.
None of it prepared me for the patient they wheeled around the corner to come into the unit. They forgot to mention... the patient was... not even cyanotic, but more of a raspberry color. They didn't mention that... the patient was... having uncontrollable decerebrate muscle spasms. They forgot to mention that... the patient coded at home, over 40 min. away from the hospital. Oh and they forgot to mention that they actually coded the patient downstairs, called the code, and suddenly they got a rhythm back on the monitor and so they reconnected all life support because the family wanted everything done.
I yelled at my colleague when they wheeled the patient around the corner... "I didn't get report on that!" We laugh about that now, but it certainly was not funny at the time. The attending md was actually on the unit at the time, and this patient was one of his for a very long time, and he knew them very well. I have to say that he was speechless, and this certain md is never speechless. He just stood there and stared while we went to work on this neurologically devasted patient who was only kept alive by the ventilator.
Lesson learned. Beware the sunshine, butterflies, and rainbows... there is usually a storm brewing on the other side.
Showing posts with label work. Show all posts
Showing posts with label work. Show all posts
24 August 2009
23 March 2008
Just how sick are you?
We have had our fair share of super sick patients recently. And this is not necessarily a good thing. In all of the cases, each patient waited too long to seek medical attention.
Patient 1; late 20s: presents to the ER with difficulty breathing, fever, chills. Pt is sent to ICU with RR in the 40s and with an insulin drip. Pt is alert, able to talk, but is very uncomfortable. Throughout the night, I keep a close eye on this patient because I had a really bad feeling in my gut. Sats say upper 90s but I tell the other nurse with me that I just don't believe it. White count is over 40. While working through the admission, I ask the other nurse to please see if she can get me a couple more IV sites. BP stable, but HR increasingly tachycardic, in the 120s. As the night progresses, RR goes up to the 50s, HR goes up to sustained 180s. Sats and BP bottom out in a flash. Pt is in respiratory arrest, and is subsequently intubated. This happens at shift change. Later that same evening, the patient goes asystole and is coded, but is brought back. And what is brought back is not the same person that I admitted. This newer version of the patient has gross neurological deficits. This patient, who was able to talk at admission, is now pretty much a vegetable. We were sure that they wouldn't make it. Now, a month and a half later, the patient remains in the hospital with a peg tube and will need long term care for the rest of their life.
Culprit? Strep pneumonia.
Patient waited 2 weeks before seeking medical care.
Did you realize that 30% of pneumococcal patients become septic and then 30% of those die?
Patient 2: Patient in their 80s, presents to the ER with fatigue, weakness, and cough for 1 wk. Pt is transferred to the ICU due to hypotension and tachycardia, but was admitted to the hospital with pneumonia. Upon arrival to my shift, I listen to lung sounds and all I hear is water. Everywhere. Pt is alert, but a little nauseous. Nailbeds are dusky. O2 @ 6L per nc. White count 1.0. History of CA, but not currently. + Blood cultures. No urine output. As the night progresses, pt is unable to sleep,but is alert and talking. I teach the patient how to use the yankauer to suction the secretions out so that they would not have to use tissues, which in turn, dry out the mouth. It almost seems that the patient is getting better? Which I know is not necessarily a good sign. The next night, the patient expires. I heard it on the radio.
Culprit? Strep pneumonia.
I recently read that when white counts are low, it is not necessarily speculative of cancer, but in fact can be due to an infectious process so widespread that the body isn't able to produce enough white cells to counter those being used to fight the infection.
Patient 3: Late 30s, presents to the ER with abdominal pain for 3 days. Yeah, a regular presentation, but after testing, the patient is rushed to surgery as this patient has a perforated ulcer. Comes to the ICU post op and on the vent. I didn't personally have this patient, but I assisted with the care for 3 nights of hell. BP won't stay up, has to be on dopamine and then an epi drip. Pt is in renal failure. Continues to be on 100% FiO2 on the vent because this patient cannot tolerate any type of weaning before the sats bottom out. Pt is now in multi-system organ failure and expires 2 nights after my last shift that week. Died of pulmonary edema.
Culprit? Septic from a perforated ulcer.
Sad case, really.
Patient 4: mid 70s, presents to the ER with abdominal pain for at least a week. Admitted to the floor and to see the GI doctor, who subsequently schedules surgery for the next morning. Arrives to the ICU on the vent, but doing well. Surgeon tells the family that this patient waited too long to seek care, that it was possible that this patient would not survive this. Pt has so much ischemic small bowel, that there is nothing left at this time to take out and put together. 2 days later, the surgeon goes back in for another ex lap, and finds pink bowel. Only has to remove 6 feet and is able to reconnect the remaining so that this patient does not even need an ileostomy. A week later, patient is able to move the floor, completely stable, and completely aware of how close they came to dying. This was truly some type of miracle. This patient attributed it to the praying done at church.
No culprit this time. This patient was lucky.
Patient 1; late 20s: presents to the ER with difficulty breathing, fever, chills. Pt is sent to ICU with RR in the 40s and with an insulin drip. Pt is alert, able to talk, but is very uncomfortable. Throughout the night, I keep a close eye on this patient because I had a really bad feeling in my gut. Sats say upper 90s but I tell the other nurse with me that I just don't believe it. White count is over 40. While working through the admission, I ask the other nurse to please see if she can get me a couple more IV sites. BP stable, but HR increasingly tachycardic, in the 120s. As the night progresses, RR goes up to the 50s, HR goes up to sustained 180s. Sats and BP bottom out in a flash. Pt is in respiratory arrest, and is subsequently intubated. This happens at shift change. Later that same evening, the patient goes asystole and is coded, but is brought back. And what is brought back is not the same person that I admitted. This newer version of the patient has gross neurological deficits. This patient, who was able to talk at admission, is now pretty much a vegetable. We were sure that they wouldn't make it. Now, a month and a half later, the patient remains in the hospital with a peg tube and will need long term care for the rest of their life.
Culprit? Strep pneumonia.
Patient waited 2 weeks before seeking medical care.
Did you realize that 30% of pneumococcal patients become septic and then 30% of those die?
Patient 2: Patient in their 80s, presents to the ER with fatigue, weakness, and cough for 1 wk. Pt is transferred to the ICU due to hypotension and tachycardia, but was admitted to the hospital with pneumonia. Upon arrival to my shift, I listen to lung sounds and all I hear is water. Everywhere. Pt is alert, but a little nauseous. Nailbeds are dusky. O2 @ 6L per nc. White count 1.0. History of CA, but not currently. + Blood cultures. No urine output. As the night progresses, pt is unable to sleep,but is alert and talking. I teach the patient how to use the yankauer to suction the secretions out so that they would not have to use tissues, which in turn, dry out the mouth. It almost seems that the patient is getting better? Which I know is not necessarily a good sign. The next night, the patient expires. I heard it on the radio.
Culprit? Strep pneumonia.
I recently read that when white counts are low, it is not necessarily speculative of cancer, but in fact can be due to an infectious process so widespread that the body isn't able to produce enough white cells to counter those being used to fight the infection.
Patient 3: Late 30s, presents to the ER with abdominal pain for 3 days. Yeah, a regular presentation, but after testing, the patient is rushed to surgery as this patient has a perforated ulcer. Comes to the ICU post op and on the vent. I didn't personally have this patient, but I assisted with the care for 3 nights of hell. BP won't stay up, has to be on dopamine and then an epi drip. Pt is in renal failure. Continues to be on 100% FiO2 on the vent because this patient cannot tolerate any type of weaning before the sats bottom out. Pt is now in multi-system organ failure and expires 2 nights after my last shift that week. Died of pulmonary edema.
Culprit? Septic from a perforated ulcer.
Sad case, really.
Patient 4: mid 70s, presents to the ER with abdominal pain for at least a week. Admitted to the floor and to see the GI doctor, who subsequently schedules surgery for the next morning. Arrives to the ICU on the vent, but doing well. Surgeon tells the family that this patient waited too long to seek care, that it was possible that this patient would not survive this. Pt has so much ischemic small bowel, that there is nothing left at this time to take out and put together. 2 days later, the surgeon goes back in for another ex lap, and finds pink bowel. Only has to remove 6 feet and is able to reconnect the remaining so that this patient does not even need an ileostomy. A week later, patient is able to move the floor, completely stable, and completely aware of how close they came to dying. This was truly some type of miracle. This patient attributed it to the praying done at church.
No culprit this time. This patient was lucky.
22 January 2008
short update
Just wanted to add in real quick that my nights preceptor is completely and totally different. Makes for a much better learning experience. Now I know I haven't posted much lately, just haven't been terribly inspired. Am working on it though.
15 January 2008
Pity Party for One
The party is for me. Because I am pitiful. True. At least I feel pitiful.
The first six weeks of orientation have ended. Not necessarily on a good note. I would go into all of the sordid details, but it would be a book. Really. I just want to say that every person has their own breaking point. Mine was about 2 weeks ago.
Now it's time to reflect, rebuild, and grow. And hopefully my preceptor on night shift doesn't lose focus on teaching me about critical care. Sigh.
I think I will go watch some tv, and indulge in some escapism for awhile. And maybe eat the rest of that pint of Ben & Jerry's sitting up in my freezer, calling my name.
The first six weeks of orientation have ended. Not necessarily on a good note. I would go into all of the sordid details, but it would be a book. Really. I just want to say that every person has their own breaking point. Mine was about 2 weeks ago.
Now it's time to reflect, rebuild, and grow. And hopefully my preceptor on night shift doesn't lose focus on teaching me about critical care. Sigh.
I think I will go watch some tv, and indulge in some escapism for awhile. And maybe eat the rest of that pint of Ben & Jerry's sitting up in my freezer, calling my name.
30 December 2007
fish out of water
Got pulled briefly the other night to go "help" out in peds. It was a nightmare come true, I swear! I always do everything possible to get out of going to that unit. Sick little kids and babies are definitely not my cup of tea. Anyhow, they were getting 3 admits all at once, and since we were empty, guess who had to go on over? We had to move one patient to a different room, clean that room top to bottom, and then assist with the admissions.
Not to bad, but man did we ever work our tails off. We were praying for anyone to become critical in the ER. We prayed for an overhead code blue. Anything to get us out of peds. None it happened. So we were stuck until the peds nurse was caught up.
If it were me, I would have called in their unit manager and told her to get in there and help out. At least she knows what she is doing? Understands all that stuff that goes along with peds: special IV tubing, weights, etc and so on. No matter what people say, kids are not little adults.
Anyhow, it didn't take too awfully long to help them get caught up and we got the hell out of dodge, never to return we hope for a long long time. I found something else to do to occupy my time -- got to go start a few IV's out on the floor. Now that made me feel better!
Off to work I go. Thank god we got some patients again :)
Not to bad, but man did we ever work our tails off. We were praying for anyone to become critical in the ER. We prayed for an overhead code blue. Anything to get us out of peds. None it happened. So we were stuck until the peds nurse was caught up.
If it were me, I would have called in their unit manager and told her to get in there and help out. At least she knows what she is doing? Understands all that stuff that goes along with peds: special IV tubing, weights, etc and so on. No matter what people say, kids are not little adults.
Anyhow, it didn't take too awfully long to help them get caught up and we got the hell out of dodge, never to return we hope for a long long time. I found something else to do to occupy my time -- got to go start a few IV's out on the floor. Now that made me feel better!
Off to work I go. Thank god we got some patients again :)
08 December 2007
orientation
monday began my official orientation to the icu. started with the standard critical care classes, and orientation on the unit. not that i needed to be shown around much, after all, i did work in there as an extern for almost a year.
i just wanted to say how happy i am to get up in the mornings and show up for work. what a difference a change makes, especially a change to an area of your career that really pushes your buttons in the right way.
i just wanted to say how happy i am to get up in the mornings and show up for work. what a difference a change makes, especially a change to an area of your career that really pushes your buttons in the right way.
19 September 2007
alert and oriented guidelines
There have been a lot of posts lately weighing in on patient satisfaction surveys. I agree in the fact that it seems we as nurses are treated more like room service than well, nurses. I believe in participating in your own care if you are able. So you get the survey and are asked if the nurses were helpful or attended to your needs. You may score them low because they didn’t let you go outside to smoke or bring you something to eat in the middle of the night knowing that there isn’t any food on the floor other than graham crackers or unsalted saltines or because you simply cannot eat anything right now. You may even choose to score them low because when you rang your call bell your nurses were in another room cleaning up an incontinent episode, and they didn’t get you in your allotted ‘me now want something’ time. So here are a few guidelines for alert and oriented patients in the hospitals. Please abide by them carefully.
- Assuming that you do not have some debilitating injury, you were able to do many things for yourself at home. We encourage you to continue doing them here at the hospital as well. Please feel free to bathe or wash up anytime you feel like. We will be happy to bring you the supplies you need. Want to walk down the hall? Go for it. Docs love to see ambulating patients. So do nurses, for it means you will be going home soon.
- Please don’t use the call bell for trivial matters. While you are spending time lying around in the bed, think of things you will need as the day goes on. That way when the nurse makes rounds, you can tell her what you need so she can get it at one time instead of being interrupted all day long to get you a drink or ice or whatever else it is that you need. Unfortunately, there are other patients on the floor too that need to feel just as special as you do, only they aren’t able to control many of their own body functions, including their own minds. And then when you do ring, we know that you really do need something that is important and will attend to it as soon as possible.
- Bored? Need something to read? We have a ton of patient education materials at the nurse’s station. You could always ask for materials about your diagnosis to read in your downtime. Also, while you are reading and learning about your illness, you could write down questions to ask the doctor when he makes rounds. This saves a lot of time at discharge.
- Speaking of discharges. So the doc said he is going to send you home today. Great! Now remember that we cannot just unhook all that tubing and iv’s and stuff before we get the definite orders for you to leave. You have to remember that typing up discharges can take a good amount of time depending on what medications you were on and what the doc has ordered for you at home. Instead of standing at your door giving us the evil eye because you have been waiting for an hour, pack up your stuff and wait patiently. Oh and remember that patient education? We need to go over it again, so if you had been reading the information from when we gave it to you earlier, whether you asked for it or not, it could make the discharge time go by much faster.
- Don’t be a complainer or a whiner. As a patient, you have a reputation with nursing staff. Those patients who fall into this category are the ones that the nurses dread going to see. Why? Because we are doing our job as required by the hospital, by the state licensing board, by your medical diagnosis and all you ever do is find something wrong or something that just isn’t quite right according to your personal wants. You have to remember that being in the hospital isn’t about what you want, it is about what you need. And often, you need to rest so that you can heal.
- When we are firm with you, don’t take it as that we are being hateful or just mean. We are being firm because you aren’t paying attention to us. Remember when we told you not to mess with your IV? Well you didn’t listen and now the site is leaking, and so we have to stick you yet again, causing pain. We aren’t being mean. We don’t like to cause pain. We tried to warn you. Now see the point about complainers and whiners.
So the next time you get that survey in the mail, put it all in perspective. As stated above, it isn’t about your wants in the hospital, it is about your needs. Did you have everything you needed? If you did, then score it high. Were the nurses caring? If we were firm with you, was it for your own good? We also understand that not everyone has a great bedside manner, so you have to judge how you acted and how the nurses acted in response to that. If they took care of your needs no matter how ugly you acted, then score them high. Did the nurses answer your call bell in a timely manner? Ask yourself how many times you hit the call bell and what exactly were the things you needed? And then answer this question, did the nurses respond and bring you what you need? If so, score it appropriately. Oh and if you cannot remember the names of all of the nurses who took care of you, don’t single out one person who may have only had you for one shift. We all share in your care, so we all should be rewarded accordingly. This includes not writing down only the name of the discharge nurse because she was the last one you talked to, even if it was me.
Now, starting with that next admission, should you ever be admitted as an alert and oriented patient, remember these couple of guidelines. Your experience is likely to be much improved. :)
I am sure there a few more I forgot to add..
- Assuming that you do not have some debilitating injury, you were able to do many things for yourself at home. We encourage you to continue doing them here at the hospital as well. Please feel free to bathe or wash up anytime you feel like. We will be happy to bring you the supplies you need. Want to walk down the hall? Go for it. Docs love to see ambulating patients. So do nurses, for it means you will be going home soon.
- Please don’t use the call bell for trivial matters. While you are spending time lying around in the bed, think of things you will need as the day goes on. That way when the nurse makes rounds, you can tell her what you need so she can get it at one time instead of being interrupted all day long to get you a drink or ice or whatever else it is that you need. Unfortunately, there are other patients on the floor too that need to feel just as special as you do, only they aren’t able to control many of their own body functions, including their own minds. And then when you do ring, we know that you really do need something that is important and will attend to it as soon as possible.
- Bored? Need something to read? We have a ton of patient education materials at the nurse’s station. You could always ask for materials about your diagnosis to read in your downtime. Also, while you are reading and learning about your illness, you could write down questions to ask the doctor when he makes rounds. This saves a lot of time at discharge.
- Speaking of discharges. So the doc said he is going to send you home today. Great! Now remember that we cannot just unhook all that tubing and iv’s and stuff before we get the definite orders for you to leave. You have to remember that typing up discharges can take a good amount of time depending on what medications you were on and what the doc has ordered for you at home. Instead of standing at your door giving us the evil eye because you have been waiting for an hour, pack up your stuff and wait patiently. Oh and remember that patient education? We need to go over it again, so if you had been reading the information from when we gave it to you earlier, whether you asked for it or not, it could make the discharge time go by much faster.
- Don’t be a complainer or a whiner. As a patient, you have a reputation with nursing staff. Those patients who fall into this category are the ones that the nurses dread going to see. Why? Because we are doing our job as required by the hospital, by the state licensing board, by your medical diagnosis and all you ever do is find something wrong or something that just isn’t quite right according to your personal wants. You have to remember that being in the hospital isn’t about what you want, it is about what you need. And often, you need to rest so that you can heal.
- When we are firm with you, don’t take it as that we are being hateful or just mean. We are being firm because you aren’t paying attention to us. Remember when we told you not to mess with your IV? Well you didn’t listen and now the site is leaking, and so we have to stick you yet again, causing pain. We aren’t being mean. We don’t like to cause pain. We tried to warn you. Now see the point about complainers and whiners.
So the next time you get that survey in the mail, put it all in perspective. As stated above, it isn’t about your wants in the hospital, it is about your needs. Did you have everything you needed? If you did, then score it high. Were the nurses caring? If we were firm with you, was it for your own good? We also understand that not everyone has a great bedside manner, so you have to judge how you acted and how the nurses acted in response to that. If they took care of your needs no matter how ugly you acted, then score them high. Did the nurses answer your call bell in a timely manner? Ask yourself how many times you hit the call bell and what exactly were the things you needed? And then answer this question, did the nurses respond and bring you what you need? If so, score it appropriately. Oh and if you cannot remember the names of all of the nurses who took care of you, don’t single out one person who may have only had you for one shift. We all share in your care, so we all should be rewarded accordingly. This includes not writing down only the name of the discharge nurse because she was the last one you talked to, even if it was me.
Now, starting with that next admission, should you ever be admitted as an alert and oriented patient, remember these couple of guidelines. Your experience is likely to be much improved. :)
I am sure there a few more I forgot to add..
16 September 2007
It was a slow one...
So last night was pretty uneventful as far as the evening shift goes.
So I come back to the floor from eating dinner, and the na who is assigned the other half of the floor tells me that she emptied the bsc for one of my patients. She said that she did a hemoccult because the stool was visually quite bloody before she realized that the pt was in for a lower GIB. She laughs at herself.. but I ask her.. well was it positive?? :)
One of my pts was transferred to hospice care before coming out from the unit as a transfer. This pt was quite young by our standards (age < 50). End stage cardiac failure. EF less than 10%. Respirations cyclic with 20-30 sec periods of apnea. All we can do is make the pt comfortable. It is sad though that the family wasn't quite ready to accept the prognosis, and it seemed that they were quite unsure about the care hospice provides. I did a good bit of educating with the family on heart failure. Not a lot on hospice because I don't know much about their program other than the comfort care and support that they provide to the pt, families and loved ones coping with a terminal prognosis. I wish it were easier to tell a family that their loved one was certainly going to die. I know that the doctors have discussed it with them at length, and they know what is going to happen, but it seems that they are starved for information about what is happening. The disease process, how much time does the pt have? things like that. How can I give definitive answers? I know that is what they are looking for, but no one has that answer. The pt could live a couple of days to a couple of months? I had no answers. All I could tell them about was heart failure and what it does to the body. I did the best I could to provide support, veracity, and caring to this family. It's all I could do.
Other than that.. nothing else really happened all shift. All of my patients lived for those 8 hours :) Always a good thing! Had some stable pts and a couple of really sickly ones. One pt has a creatinine of 11. No dialysis access because 2 days ago, coags were non-existent. Now, after multiple vit k injections, the inr is down to 3.5 but still too high to risk catheter placement. I am afraid though that if it isn't placed soon, the pt is going to take a turn for the worse. Mostly because the pt has stated how much better they have been feeling and has been more alert than about a week or so ago. They always seem to be getting better before it turns. And worse is when the family notices and gets false hope. I try to remind the family that even though the pt seems to feel better, the pt is still very ill. All I can do... after all, I don't predict the future.
Now here is crossing fingers that tonight goes much the same.... uneventful. But we tend to have a lot of admissions on Sunday, usually after church. Crossing fingers :)
So I come back to the floor from eating dinner, and the na who is assigned the other half of the floor tells me that she emptied the bsc for one of my patients. She said that she did a hemoccult because the stool was visually quite bloody before she realized that the pt was in for a lower GIB. She laughs at herself.. but I ask her.. well was it positive?? :)
One of my pts was transferred to hospice care before coming out from the unit as a transfer. This pt was quite young by our standards (age < 50). End stage cardiac failure. EF less than 10%. Respirations cyclic with 20-30 sec periods of apnea. All we can do is make the pt comfortable. It is sad though that the family wasn't quite ready to accept the prognosis, and it seemed that they were quite unsure about the care hospice provides. I did a good bit of educating with the family on heart failure. Not a lot on hospice because I don't know much about their program other than the comfort care and support that they provide to the pt, families and loved ones coping with a terminal prognosis. I wish it were easier to tell a family that their loved one was certainly going to die. I know that the doctors have discussed it with them at length, and they know what is going to happen, but it seems that they are starved for information about what is happening. The disease process, how much time does the pt have? things like that. How can I give definitive answers? I know that is what they are looking for, but no one has that answer. The pt could live a couple of days to a couple of months? I had no answers. All I could tell them about was heart failure and what it does to the body. I did the best I could to provide support, veracity, and caring to this family. It's all I could do.
Other than that.. nothing else really happened all shift. All of my patients lived for those 8 hours :) Always a good thing! Had some stable pts and a couple of really sickly ones. One pt has a creatinine of 11. No dialysis access because 2 days ago, coags were non-existent. Now, after multiple vit k injections, the inr is down to 3.5 but still too high to risk catheter placement. I am afraid though that if it isn't placed soon, the pt is going to take a turn for the worse. Mostly because the pt has stated how much better they have been feeling and has been more alert than about a week or so ago. They always seem to be getting better before it turns. And worse is when the family notices and gets false hope. I try to remind the family that even though the pt seems to feel better, the pt is still very ill. All I can do... after all, I don't predict the future.
Now here is crossing fingers that tonight goes much the same.... uneventful. But we tend to have a lot of admissions on Sunday, usually after church. Crossing fingers :)
12 September 2007
less carbon, more oxygen please
chalk it up to my inexperience, but as i am in the room with the pt attempting to get a urine sample for drug screen, i was much too distracted to look at his nose to see if the nc was correctly in place. story goes like this....
patient has arrived back to his room from getting an eeg. nurse goes into room to reconnect the telemetry after being informed said pt is back. ask pt to pull shirt up over his head so that said electrodes can be reapplied to chest. pt complies. good, he follows commands. tele is intact. knowing that i need to get a urine sample...
..........
-nurse: do you have to pee?
-pt: yes.
-nurse: ok. i need you to pee in this little cup. do you think you can do that?
-pt: yes. yes, i need to pee. i need to pee.
nurse hands pt the little cup, expecting pt to comply and pee.
pt fiddles with cup, then holds it in his hand to side of bed, over the edge.
-pt: i need to put this right here.
pt fiddles with cup some more. nurse takes cup away from pt.
-nurse: if you have to pee, you can pee in the urinal. i will pour it into the cup. can you do that?
-pt: yes, need to pee. hand me my piss bucket.
nurse complies and hands the pt the urinal.
-pt: i have to pee. this is very important for something, but i am not sure what. (pt holds urinal in hand at end of extended arm for me to see.)
-nurse: yes, you need to pee in it.
-pt: no it has another function. i know it does. [sighs] i can't think of it at the moment.
nurse, expecting him to urinate at any moment in time, stares at pt who begins to grab the top that goes on the urinal and takes it off of the handle.
-pt: this is it, i have to get this just right.
pt begins to take the top of the urinal and put it on the handle, twist it around so that it comes back off of the handle. over. and over. and over. for at least 5 good minutes.
nurse attempts to grab urinal.
-pt snatches urinal and exlaims: this is important!
-nurse: let me have the urinal.
-pt: no, let me finish. i have to get it right.
pt once again begins fidgeting with the lid to the urinal, doing exactly the same things as before.
-nurse: give. me. the. urinal.
patient has arrived back to his room from getting an eeg. nurse goes into room to reconnect the telemetry after being informed said pt is back. ask pt to pull shirt up over his head so that said electrodes can be reapplied to chest. pt complies. good, he follows commands. tele is intact. knowing that i need to get a urine sample...
..........
-nurse: do you have to pee?
-pt: yes.
-nurse: ok. i need you to pee in this little cup. do you think you can do that?
-pt: yes. yes, i need to pee. i need to pee.
nurse hands pt the little cup, expecting pt to comply and pee.
pt fiddles with cup, then holds it in his hand to side of bed, over the edge.
-pt: i need to put this right here.
pt fiddles with cup some more. nurse takes cup away from pt.
-nurse: if you have to pee, you can pee in the urinal. i will pour it into the cup. can you do that?
-pt: yes, need to pee. hand me my piss bucket.
nurse complies and hands the pt the urinal.
-pt: i have to pee. this is very important for something, but i am not sure what. (pt holds urinal in hand at end of extended arm for me to see.)
-nurse: yes, you need to pee in it.
-pt: no it has another function. i know it does. [sighs] i can't think of it at the moment.
nurse, expecting him to urinate at any moment in time, stares at pt who begins to grab the top that goes on the urinal and takes it off of the handle.
-pt: this is it, i have to get this just right.
pt begins to take the top of the urinal and put it on the handle, twist it around so that it comes back off of the handle. over. and over. and over. for at least 5 good minutes.
nurse attempts to grab urinal.
-pt snatches urinal and exlaims: this is important!
-nurse: let me have the urinal.
-pt: no, let me finish. i have to get it right.
pt once again begins fidgeting with the lid to the urinal, doing exactly the same things as before.
-nurse: give. me. the. urinal.
..........
at this point in time, i am ready to throw the damn thing across the room.
pt complies and hands me the urinal with the look of a 2 year old whose mom just took away his cookies.
-exasperated, nurse: i will just come back later for this.
pt pulls on his shirt.
-pt: i know there is something important to do with my shirt.
-nurse: no, we already put the monitor back on. put your shirt back down.
at this point in time, i am ready to throw the damn thing across the room.
pt complies and hands me the urinal with the look of a 2 year old whose mom just took away his cookies.
-exasperated, nurse: i will just come back later for this.
pt pulls on his shirt.
-pt: i know there is something important to do with my shirt.
-nurse: no, we already put the monitor back on. put your shirt back down.
..........
i step out of the room and ask cna if she can obtain urine specimen. please????
i sit down to chart, thinking 'this pt did not act like this before he went for his eeg.' i wonder what in the world they did to him in there... and then like some epiphany in my head, i immediately hop right out of the chair and hurry back to room.
observe cna having same difficulty with pt.
this time however, i look directly at pt and see that he does not have his oxygen on. instead, it is tossed to the side on his pillow.
i step out of the room and ask cna if she can obtain urine specimen. please????
i sit down to chart, thinking 'this pt did not act like this before he went for his eeg.' i wonder what in the world they did to him in there... and then like some epiphany in my head, i immediately hop right out of the chair and hurry back to room.
observe cna having same difficulty with pt.
this time however, i look directly at pt and see that he does not have his oxygen on. instead, it is tossed to the side on his pillow.
..........
UGH.
immediately get oxygen back on, attempt pulse ox. pt will not comply and begins to yank on finger probe, saying it has to be on another finger, not that finger, and so i firmly hold his arm to keep it still waiting for sat to show up. sat bleeps on for 2 secs.. sat is 84%. ask another cna to please go get me a peds sticky finger probe asap. crank oxygen up to 4L. wait for cna.
ask other cna to call rt for breathing tx. other cna comes back with finger probe. sats are now 94% on 4L. rt comes in, i ask her to turn oxygen to 3L.. we wait. sats stay steady at 94%, so i ask her to cut it down to 2L. again, sats stay steady. i tell her to go ahead and do the tx and then we will see where he is.
after tx, pt is alert but confused, his baseline. doesn't recall episode. sats are still steady. pt is stablized and moved closer to nurse's station.
and my eyes on that o2 tubing the rest of the shift.
UGH.
immediately get oxygen back on, attempt pulse ox. pt will not comply and begins to yank on finger probe, saying it has to be on another finger, not that finger, and so i firmly hold his arm to keep it still waiting for sat to show up. sat bleeps on for 2 secs.. sat is 84%. ask another cna to please go get me a peds sticky finger probe asap. crank oxygen up to 4L. wait for cna.
ask other cna to call rt for breathing tx. other cna comes back with finger probe. sats are now 94% on 4L. rt comes in, i ask her to turn oxygen to 3L.. we wait. sats stay steady at 94%, so i ask her to cut it down to 2L. again, sats stay steady. i tell her to go ahead and do the tx and then we will see where he is.
after tx, pt is alert but confused, his baseline. doesn't recall episode. sats are still steady. pt is stablized and moved closer to nurse's station.
and my eyes on that o2 tubing the rest of the shift.
11 September 2007
vacation from hell
So yesterday.. I got my vacation from hell. Away from it, that is. I got floated to the unit. My future home. It was such a nice break! After my day last Friday on the floor.. I welcomed the change, even if it was to be only for 8 hours. But this mission just reaffirmed my desire to work in there.
At first, I was to have only 1 patient. Then one of the other nurses in there (the only one in the hospital who puts in PICC lines at the moment got called away to put in a PICC line early that morning). So I inherited her patients. That gave me 3 patients. Grand! I was the second nurse in there. It is a small ICU.. only 6 beds. But I have to say that they rarely ever let the floated nurse have much responsibility... the unit coordinator in there even told me that they must trust me in order to give me that responsibility. (And I have to say, for the first time since I started nursing... I felt like a real nurse.) It was just a welcome change, and I have missed that place so much since I have passed boards. I cannot wait until my time is up so that I can transfer in there.
So, yesterday ended up being a good day. I needed that vaction from hell... hell being the floor in which I work. Today, however, I go back in to be overworked and overstressed. Hopefully it ends up being a good day too. I don't know how many more bad days I can take. Seriously.
At first, I was to have only 1 patient. Then one of the other nurses in there (the only one in the hospital who puts in PICC lines at the moment got called away to put in a PICC line early that morning). So I inherited her patients. That gave me 3 patients. Grand! I was the second nurse in there. It is a small ICU.. only 6 beds. But I have to say that they rarely ever let the floated nurse have much responsibility... the unit coordinator in there even told me that they must trust me in order to give me that responsibility. (And I have to say, for the first time since I started nursing... I felt like a real nurse.) It was just a welcome change, and I have missed that place so much since I have passed boards. I cannot wait until my time is up so that I can transfer in there.
So, yesterday ended up being a good day. I needed that vaction from hell... hell being the floor in which I work. Today, however, I go back in to be overworked and overstressed. Hopefully it ends up being a good day too. I don't know how many more bad days I can take. Seriously.
05 September 2007
Mandatory....
I just wanted to say that mandatory meetings on days off just plain and outright... SUCK. Period. WHO the hell cares about radiation? I don't work in radiology!! I am not exposed to it. UGH. Gotta go.. it's mandatory, ya know.
Just Plain... Mean.
You see, there are just some people out there in this world who are never, ever pleased no matter what you do. Just so happens that I had a patient like this.. we will call (name and identifying information has been changed) her, B. I had heard the horror stories from the nurses who had previously been involved in her care. "She's a witch in the worst sense" they would claim. I didn't doubt them in the least. Patients like these carry these reputations across units.
So my day began with report. I was told that this woman had refused all of her early morning medications, all of her early morning care, to include turning. You also must understand that this was no small woman by any means. And so when I went in to do my assessment first thing.. the darling was sleeping. I took the opportunity to attempt waking her, and telling her what I was going to do, but she just mumbled and kept on sleeping. I got to listen to her heart, her stomach and such. Take a peek at the IV site, looked at her legs which were wrapped in kling. Thought I would come back in a bit to finish up the rest of the assessment when we was more alert. Didn't take long for her to wake up though.. breakfast soon arrived.
And she awoke. And the complaining began. Since I was told she had refused her 0600 meds, I didn't open a single one until I got into the room. Of course, she didn't want to take any of them. Why take vit C? She doesn't need that, she said. I don't want it, she continued, I know you all are trying to just dope me up. I shook my head. I explained each and every single medication to her at that time that I would be giving her. All of the vitamins, the anticoagulants, etc. She mumbled and grumbled... no way was she taking this many pills. She couldn't do it, unless she had applesauce of course. So applesauce she got. And all those pills disappeared down her esophagus. :) Took some maneuvering but it was done. Phew!
It was a never ending battle with this woman. All day long, either she wasn't sitting right or the food wasn't right or the light was too bright. It was on and on and on. It wears your patience down, but I killed her with kindness. I politely explained every aspect of her nursing care when I was involved. But it didn't stop her endless insults to everything and everyone around her. I don't know if she was just miserable or just plain, well, mean.
In the early afternoon, I had queried the cna assigned to her if she had even attempted to give this woman a bath. (of course these are to be done in the mornings.. but this cna.. well she lacks the drive and initiative to do her work). She told me that this woman had refused her bath. (After my many encounters with this patient, I didn't doubt this was the case.. however) I told the cna that this patient could not do for herself, but if she refused her bath, fine. BUT she absolutely must have foley care done no matter what. She had to have it and please go do it. Even if she refuses, just get the stuff ready and do it anyway. She will comply. (see I had this feeling that all the cna had to do was get the bath water and stuff ready and the woman would allow her to wash her up... and guess what? she did!)
Nevertheless, it was a trying day with this woman. Luckily, she took a good afternoon nap after her bath and some scheduled xanax. And that allowed me to focus entirely on another patient of mine... who didn't make a complaint all day long. In fact, this patient was expected to pass at any moment in time. It put the complainer in perspective.. she was lucky that she could talk and tell me how she felt... about everything in the world. My other patient couldn't even tell me she if she was having any pain at all. The only voice she had that day was the "death rattle" and the longer the day went, the louder that voice got. No matter what I did, that voice never faltered. You try to make your patients comfortable, even in their last few hours, but it isn't always possible. Whether because they are miserable humans or unable to tell you what it is they need. All we can do is our best in every situation.. and move on from there.
So my day began with report. I was told that this woman had refused all of her early morning medications, all of her early morning care, to include turning. You also must understand that this was no small woman by any means. And so when I went in to do my assessment first thing.. the darling was sleeping. I took the opportunity to attempt waking her, and telling her what I was going to do, but she just mumbled and kept on sleeping. I got to listen to her heart, her stomach and such. Take a peek at the IV site, looked at her legs which were wrapped in kling. Thought I would come back in a bit to finish up the rest of the assessment when we was more alert. Didn't take long for her to wake up though.. breakfast soon arrived.
And she awoke. And the complaining began. Since I was told she had refused her 0600 meds, I didn't open a single one until I got into the room. Of course, she didn't want to take any of them. Why take vit C? She doesn't need that, she said. I don't want it, she continued, I know you all are trying to just dope me up. I shook my head. I explained each and every single medication to her at that time that I would be giving her. All of the vitamins, the anticoagulants, etc. She mumbled and grumbled... no way was she taking this many pills. She couldn't do it, unless she had applesauce of course. So applesauce she got. And all those pills disappeared down her esophagus. :) Took some maneuvering but it was done. Phew!
It was a never ending battle with this woman. All day long, either she wasn't sitting right or the food wasn't right or the light was too bright. It was on and on and on. It wears your patience down, but I killed her with kindness. I politely explained every aspect of her nursing care when I was involved. But it didn't stop her endless insults to everything and everyone around her. I don't know if she was just miserable or just plain, well, mean.
In the early afternoon, I had queried the cna assigned to her if she had even attempted to give this woman a bath. (of course these are to be done in the mornings.. but this cna.. well she lacks the drive and initiative to do her work). She told me that this woman had refused her bath. (After my many encounters with this patient, I didn't doubt this was the case.. however) I told the cna that this patient could not do for herself, but if she refused her bath, fine. BUT she absolutely must have foley care done no matter what. She had to have it and please go do it. Even if she refuses, just get the stuff ready and do it anyway. She will comply. (see I had this feeling that all the cna had to do was get the bath water and stuff ready and the woman would allow her to wash her up... and guess what? she did!)
Nevertheless, it was a trying day with this woman. Luckily, she took a good afternoon nap after her bath and some scheduled xanax. And that allowed me to focus entirely on another patient of mine... who didn't make a complaint all day long. In fact, this patient was expected to pass at any moment in time. It put the complainer in perspective.. she was lucky that she could talk and tell me how she felt... about everything in the world. My other patient couldn't even tell me she if she was having any pain at all. The only voice she had that day was the "death rattle" and the longer the day went, the louder that voice got. No matter what I did, that voice never faltered. You try to make your patients comfortable, even in their last few hours, but it isn't always possible. Whether because they are miserable humans or unable to tell you what it is they need. All we can do is our best in every situation.. and move on from there.
27 August 2007
when the moon is full....
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.
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.
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.
16 June 2007
yeah.. it's official!!
so i took the leap and took the nclex this past tuesday. never before have i ever been to the almost panic level of anxiety, but i was almost there on monday night! i couldn't even stay to watch my youngest son's final season baseball game because i was so nervous. amazing how one test will do this to you. arrived at the testing center early.... sure didn't want to be late! lol.
went through the entire ordeal of security measures to enter the testing room... took the test. it cut off at 75 questions and then came several days of nausea, nervousness, lack of concentration, etc until i finally gave in and called the bon to see my results....... i was prepared for the bad news, but they told me that i PASSED! i literally cried lol. cried from relief of all the anxiety i had been feeling the past few days. my nausea instantly disappeared. i felt 100 feet tall. how dare them make me feel like that LOL!
i just find it also amazing that 75 questions determines a person's competency to be a nurse. the questions i had were... well HARD as hell. no doubt about it. i felt like an idiot when i left that place. i had medication questions for drugs i wasn't even sure were in the drug book :) lord knows i had never heard of them.. how was i supposed to tell the nclex people what side effects or interventions to look for/do?? but it is all water under the bridge now. i no longer have to sign my name with RN-A (A = applicant) anymore! i can push forward in my preceptorship toward my goal of working the ICU. I externed in there for 9 months, and was hoping to get a job in there after school, but unfortunately, my manager, and probably wisely so, does not hire new graduates to work in the unit. so i will do my time in med-surg. learn my time management, charting, and so on, so that i can move my career forward. i owe them at least 6 months on the floor until i can change positions, but if i do have give my employer 1 year for certain.
i would entertain the possibility of working in the ER, but there are some things that just simply gross me out... like protruding eyeballs for one lol. but other than that, i know i would do much better with a faster paced environment. so we will see where the future takes me. i just know that there are several places i would entertain the thought of working and some places i have absolutely no interest in working. now that i am officially an RN, i hope many doors open for me wherever i choose to land.
went through the entire ordeal of security measures to enter the testing room... took the test. it cut off at 75 questions and then came several days of nausea, nervousness, lack of concentration, etc until i finally gave in and called the bon to see my results....... i was prepared for the bad news, but they told me that i PASSED! i literally cried lol. cried from relief of all the anxiety i had been feeling the past few days. my nausea instantly disappeared. i felt 100 feet tall. how dare them make me feel like that LOL!
i just find it also amazing that 75 questions determines a person's competency to be a nurse. the questions i had were... well HARD as hell. no doubt about it. i felt like an idiot when i left that place. i had medication questions for drugs i wasn't even sure were in the drug book :) lord knows i had never heard of them.. how was i supposed to tell the nclex people what side effects or interventions to look for/do?? but it is all water under the bridge now. i no longer have to sign my name with RN-A (A = applicant) anymore! i can push forward in my preceptorship toward my goal of working the ICU. I externed in there for 9 months, and was hoping to get a job in there after school, but unfortunately, my manager, and probably wisely so, does not hire new graduates to work in the unit. so i will do my time in med-surg. learn my time management, charting, and so on, so that i can move my career forward. i owe them at least 6 months on the floor until i can change positions, but if i do have give my employer 1 year for certain.
i would entertain the possibility of working in the ER, but there are some things that just simply gross me out... like protruding eyeballs for one lol. but other than that, i know i would do much better with a faster paced environment. so we will see where the future takes me. i just know that there are several places i would entertain the thought of working and some places i have absolutely no interest in working. now that i am officially an RN, i hope many doors open for me wherever i choose to land.
23 March 2007
Indecisions
I have been officially offered a job where I work. Not in the ICU like I had hoped, mostly because there aren't any open positions in there at the moment. The job is on the medical/telemetry floor, full time nights. My indecision comes from a potential desire to work somewhere else. I am just not sure if I am making the right decision, although it is possible that I am. At the other hospital where we do our clinicals, there are openings in the ICU, and I really enjoyed my experience in that unit as well as the way that hospital handles things a bit differently. I wonder do all students go through the same indecision as I am about where to work when they are finished, or do they know exactly where they want to work and there is really no other option for them.
We have 5 weeks left of school. 5 long weeks. But only 2 more weeks of clincal left :) I am so excited to be thisclose to being finished. Although the next 5 weeks is going to be full of tests, ATI tests mostly. I think we have at least 7 of them to take. I have mailed my application for licensure to the board of nursing and paid my nclex examination fee. Now just waiting for classes to be done, transcripts to be sent, and receiving my att so that I can schedule my exam. My nerves are shot... shot to hell. I have to finish writing up my part of this huge community assessment that we have had to do this semester (hate all aspects of this project, btw). Have to finish my portfolio for leadership, and study, study, study. In the meanwhile, my oldest son is on the JV baseball team at school, youth league baseball has started and I am only one person able to be in one place at one time. I can't feel more pulled in different directions than I do right now. Will it ever end? I know it will, but what will I do when it does?
I am sure that I will want to catch up on a couple years of lost sleep lol.
We have 5 weeks left of school. 5 long weeks. But only 2 more weeks of clincal left :) I am so excited to be thisclose to being finished. Although the next 5 weeks is going to be full of tests, ATI tests mostly. I think we have at least 7 of them to take. I have mailed my application for licensure to the board of nursing and paid my nclex examination fee. Now just waiting for classes to be done, transcripts to be sent, and receiving my att so that I can schedule my exam. My nerves are shot... shot to hell. I have to finish writing up my part of this huge community assessment that we have had to do this semester (hate all aspects of this project, btw). Have to finish my portfolio for leadership, and study, study, study. In the meanwhile, my oldest son is on the JV baseball team at school, youth league baseball has started and I am only one person able to be in one place at one time. I can't feel more pulled in different directions than I do right now. Will it ever end? I know it will, but what will I do when it does?
I am sure that I will want to catch up on a couple years of lost sleep lol.
23 February 2007
it's just a little different now...
well the nurse manager where i work has decided to fill the open positions in the ICU, so it seems as though I will most likely be starting out on the tele/med-surg unit. Actually, it is quite ok with me. I love working in the ICU, but I am not stupid to think that I shouldn't get good floor experience before moving into a specialized area. It is a bit of a relief because now I don't have to rush to take ACLS or anything like that before moving into there. :)
We got the papers to fill out our official application to sit for the nclex exam after graduation. Just having the papers and the book makes me nervous lol. Just thinking about filling it out makes me nervous. What if I make a mistake? I guess I will really have to review it before filling it out to make sure it is all right when I hand it in. Nervous.
Ahh well, am sure things will work out in the end as they are supposed to be. I won't spend a lot of time worrying about the little stuff because I have too many other things to do and other things to worry about, such as my test coming up on Monday and my other classes as well.
Ok off I go to review a bit before getting ready for work.
We got the papers to fill out our official application to sit for the nclex exam after graduation. Just having the papers and the book makes me nervous lol. Just thinking about filling it out makes me nervous. What if I make a mistake? I guess I will really have to review it before filling it out to make sure it is all right when I hand it in. Nervous.
Ahh well, am sure things will work out in the end as they are supposed to be. I won't spend a lot of time worrying about the little stuff because I have too many other things to do and other things to worry about, such as my test coming up on Monday and my other classes as well.
Ok off I go to review a bit before getting ready for work.
29 January 2007
Oh that quivering heart
Unfortunately we only had 1, yes 1, critically ill patient this weekend. Words cannot describe the letdown of complete boredom when this said patient slept the entire shift, except for a few moments of waking and talking to her family. It was the longest 8 hours ever. Well, almost ever. At least I didn't have to squirt any saline into my eyes to keep them from shriveling up from dryness :)
90 y/o comes into the ER from the nursing home with bradycardia. Turns out the potassium is 8.2 and is also in acute renal failure. Rhythm is oh so regular after atropine... 3 nsr beats and then a nice long sinus arrest pause. And it stayed this way for awhile until turning to sinus brady, rate of 40-50. Wonderfully spiked T waves. Emergency dialysis was scheduled, and a catherter inserted into the femoral vein. 15 minutes into dialysis... those T waves came right on down and NSR emerged with a rate of 70s-80s. Amazing, really.
This was the night before. Now, as my night moved along at the speed of a snail... I continuted to watch the rhythm, if not for a lack of better things to do. Potassium was now 2.3 and some ST depression was evident on the ECG monitoring. Some PACs were thrown in now and again, coming at faster intervals as time moved along. About 6 am...the rhythm went to 2:1 flutter for about 30 seconds and right into AFib. Have to say, that was about as interesting as the night got. Can't say that I have ever seen someone convert to AFib, so got to see something new. I wonder though.. did it stay in AFib or was it just transient?
I don't know where this patient progressed from there... I left at 7 am and didn't have to return until next Friday night. Chances are that this patient will no longer be a resident in the ICU, but moved out to the floor or even back to the nursing home by that time. Perhaps next weekend will be more interesting. Although I have to say that after this last week of clinicals.. it was nice to have an easy night of work.
One last bit of information told to me by the charge nurse: If you have to ask if you should call the doctor, then you probably should.
have a terrific monday! :)
90 y/o comes into the ER from the nursing home with bradycardia. Turns out the potassium is 8.2 and is also in acute renal failure. Rhythm is oh so regular after atropine... 3 nsr beats and then a nice long sinus arrest pause. And it stayed this way for awhile until turning to sinus brady, rate of 40-50. Wonderfully spiked T waves. Emergency dialysis was scheduled, and a catherter inserted into the femoral vein. 15 minutes into dialysis... those T waves came right on down and NSR emerged with a rate of 70s-80s. Amazing, really.
This was the night before. Now, as my night moved along at the speed of a snail... I continuted to watch the rhythm, if not for a lack of better things to do. Potassium was now 2.3 and some ST depression was evident on the ECG monitoring. Some PACs were thrown in now and again, coming at faster intervals as time moved along. About 6 am...the rhythm went to 2:1 flutter for about 30 seconds and right into AFib. Have to say, that was about as interesting as the night got. Can't say that I have ever seen someone convert to AFib, so got to see something new. I wonder though.. did it stay in AFib or was it just transient?
I don't know where this patient progressed from there... I left at 7 am and didn't have to return until next Friday night. Chances are that this patient will no longer be a resident in the ICU, but moved out to the floor or even back to the nursing home by that time. Perhaps next weekend will be more interesting. Although I have to say that after this last week of clinicals.. it was nice to have an easy night of work.
One last bit of information told to me by the charge nurse: If you have to ask if you should call the doctor, then you probably should.
have a terrific monday! :)
20 December 2006
Long Night, Indeed
Got called in to work last night around 11:15. Just told that they really needed my help in the unit, which is okay but that was all I was told. Little did I know that I would be walking into a full code situation, several times over. Seems we spent a good amount of the first 4 hours strictly in that room, only getting about 30 minutes before we had to code the woman again. She was 40 years old and brought in unresponsive. Pupils fixed and dilated. Epi would bring her up, but once it wore off, she would brady down and no perfusion. Finally, the family said, just one more time and then we don't want you to do the chest compressions anymore, but leave her on the ventilator. They got to spend some time with her for about 45 minutes before she brady'd down and went asystole.
At least when dealing with a patient, we are able to compartmentalize our emotions and do what is necessary. It is when dealing with the families that we aren't as able to do that, and emotions can just erupt. Not one of us in there had a dry eye. For me, it was their singing of Amazing Grace that really got to me, and then her 15 y/o son having to experience the death of his mother just a few days before Christmas. We do what we can to be strong for the families, but the truth is, this affects us, as nurses, just the same as it may them because we invest emotionally into our patients.
I wish this night had a different turn out than it did, but we did all that we could do. The only thing really keeping her alive was the epi, and once we stopped that, it didn't take long for her to follow on nature's course. Once we got her cleaned and the family taken care of, we got another new patient. A 24 y/o man with sats in the 80's and LOC of obtunded. Reasoning was unknown other than a possible od on perhaps methadone or benzos. Another sad situation really, and quite a complex situation. Not sure how he will turn out, I suppose that is all in what happens over the next 24 hours. Luckily for me, I am going to Christmas party this evening and am NOT going to work at all. Even told them, don't bother calling because I am not coming in. I hope the night goes well for them, even though I wasn't upset to have to go in last night. Being able to help your colleagues once in awhile makes a person feel good, even if you work your ass off all night for it :)
At least when dealing with a patient, we are able to compartmentalize our emotions and do what is necessary. It is when dealing with the families that we aren't as able to do that, and emotions can just erupt. Not one of us in there had a dry eye. For me, it was their singing of Amazing Grace that really got to me, and then her 15 y/o son having to experience the death of his mother just a few days before Christmas. We do what we can to be strong for the families, but the truth is, this affects us, as nurses, just the same as it may them because we invest emotionally into our patients.
I wish this night had a different turn out than it did, but we did all that we could do. The only thing really keeping her alive was the epi, and once we stopped that, it didn't take long for her to follow on nature's course. Once we got her cleaned and the family taken care of, we got another new patient. A 24 y/o man with sats in the 80's and LOC of obtunded. Reasoning was unknown other than a possible od on perhaps methadone or benzos. Another sad situation really, and quite a complex situation. Not sure how he will turn out, I suppose that is all in what happens over the next 24 hours. Luckily for me, I am going to Christmas party this evening and am NOT going to work at all. Even told them, don't bother calling because I am not coming in. I hope the night goes well for them, even though I wasn't upset to have to go in last night. Being able to help your colleagues once in awhile makes a person feel good, even if you work your ass off all night for it :)
18 December 2006
Asystole?
Typically, when you think of asystole, you would think of a flat line on the cardiac monitor right? Well, our monitors out on the tele floor are just very sensitive to movement and such, and sometimes, the asystole alarm will ring with a rhythm full of artifact. Unfortunately, the nurses on the floor have become a little complacent because these alarms ring off all of the time for nonserious things. But the other night, it so happened that it rang off for asystole, and this time the rhythm was not full of artifact, but instead looked like there was a slight ventricular beat but that was about it. Being the astute student nurse that I am, I said to the charge nurse.. "hey, this one is for real." I took off immediately for the pt's room to check the pt.
He was arousable, and I immediately checked all of his leads. Got him to sit up on the side of the bed, and finally the charge nurse decides to come down to the room. She asks the other nurse at the monitor was it said now, and they told her that his hr was in the 70's, so she left. (not exactly the best thing to do, but it was her last night at the hospital as she was moving away, so i dunno if she cared?) i got a BP on the man, and it was about where he had been running. I told him that his rhythm had changed and we had to make sure he was ok. I told him to lie on his back or on the other side for a bit and we would be back soon to check on him.
I went up to the desk and got the print out of this rhythm and took it over to the unit for the nurses there to look at. They said that his pacemaker wasn't firing, and that is why his rhythm looked like it did. They asked if he was okay, and I said he seemed fine. I went back in to check on the patient, and he was still sitting at the side of the bed. I checked his leads once again, and when he had moved, his red lead had come off, so I fixed that and let him go back to sleep. There were no further incidents the rest of the night.
Now the man was admitted with vertigo and dizziness. When his pacemaker failed for those 3 minutes, the reasoning behind his symptomology became clear the next day for the doctor who evaluated this occurrence and all of the symptoms he had been having. Luckily, we were able to capture it on the monitor for evaluation. His pacemaker was failing and would need to be replaced. He may not have been a true asystole, but it was a serious incident that will hopefully get these nurses at the tele station to realize that they need to pay much more attention to those monitors. (in my opinion, anyhow).
He was arousable, and I immediately checked all of his leads. Got him to sit up on the side of the bed, and finally the charge nurse decides to come down to the room. She asks the other nurse at the monitor was it said now, and they told her that his hr was in the 70's, so she left. (not exactly the best thing to do, but it was her last night at the hospital as she was moving away, so i dunno if she cared?) i got a BP on the man, and it was about where he had been running. I told him that his rhythm had changed and we had to make sure he was ok. I told him to lie on his back or on the other side for a bit and we would be back soon to check on him.
I went up to the desk and got the print out of this rhythm and took it over to the unit for the nurses there to look at. They said that his pacemaker wasn't firing, and that is why his rhythm looked like it did. They asked if he was okay, and I said he seemed fine. I went back in to check on the patient, and he was still sitting at the side of the bed. I checked his leads once again, and when he had moved, his red lead had come off, so I fixed that and let him go back to sleep. There were no further incidents the rest of the night.
Now the man was admitted with vertigo and dizziness. When his pacemaker failed for those 3 minutes, the reasoning behind his symptomology became clear the next day for the doctor who evaluated this occurrence and all of the symptoms he had been having. Luckily, we were able to capture it on the monitor for evaluation. His pacemaker was failing and would need to be replaced. He may not have been a true asystole, but it was a serious incident that will hopefully get these nurses at the tele station to realize that they need to pay much more attention to those monitors. (in my opinion, anyhow).
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