Yesterday/last night was absolutely absurd. First off, I got home yesterday morning at 8am from working the night before and slept from 8:30-1pm. At 1pm, my body decided it didnt want to sleep anymore so I just laid in bed for the next 4 hours hoping that I would miraculously doze off. Didn't happen. Came in to work for night shift #2 after sleeping 4 hours and these are my 4 patients:
Patient #1: Liver transplant, encephalopathic (confused), severely edematous, O2, total care (I'm talking he cant even raise his arms or move his legs), and weighs well over 300lbs.
Patient #2: 80yo female, admitted 2 nights ago for a wound dehiscence (the staples from her surgery busted open). Sweet lady, but very needy; She calls for help for the tiniest little thing and she's terribly afraid of feeling pain. This may be insensitive, but seriously, if you have surgery there's pretty much no avoiding pain. Not only is she a handful to begin with, but the nurse who had her during the day failed to take off any of her orders so I was left to clean up the mess, which meant Patient #2 was going to be on IV medications for the next 6 hours straight. (This nurse is awful. How she is a travel nurse -- no, no, how she is a nurse in general -- is beyond me.
Patient #3: Old small bowel transplant who had his ostomy take down (ask me if you want to know more) with a possible obstruction. Because he's obstructed he's nauseous and to help, he has a G-Tube (tube in the stomach) to decompress the stomach. BUT, he has major pain issues and the only thing he can get is Dilaudid pills every 2 hours (which is not enough to keep him comfortable). The thing with giving pills is that you cannot have your G-Tube suction because you will just suction out anything he swallows. So he has a tube but it's not doing its job because he's taking his pain pills so frequently. If he doesnt take his pain pills, he ends up crying (literally) in pain.
Patient #4: my easiest patient: 70yo female with an abdominal incision that is leaking and therefore needs to be packed and have a dressings applied to it. She also needs IV supplemental nutrition.
So, they're a bit of a handful. Nothing too crazy medically, just all very needy and time-consuming. No big deal. BUT, last night was our "Go Live" night with the computerized system, so the medication pyxis (the machine that holds ALL medications) was down and we had to deal with that at the beginning of our shift. I was passing meds, doing my assessments, charting, etc. and I'm all caught-up with everything by midnight. Pretty good. Well, at midnight, we "went live" and all hell broke loose. The medication machine was still not working, Patient #3 needed his pain meds but I couldnt get them and he needed something to help him sleep but I couldnt contact the doctor to get a verbal order because he was in the middle of a Code. Patient #2's blood sugar dropped down to 51 (low blood sugars = Not Good) and she needed her nerve medication but couldnt get it b/c of the system being down so the only thing I could do was rub her feet. (first of all, gross. 2nd, like i have time to sit there and give you a foot massage, i mean come on.) Meanwhile Patient #1 was confused and needed help going for an MRI (aka two petite girls trying to move very large man who cant even hold his own head up onto a tiny little stretcher with the transporter standing there, useless. Riiiight). All night long we were trying to figure out the medication system, how to chart, and how to draw all of our morning labs, how to check our orders, ALL while still remembering to care for the patients on top of dealing with the computer stuff. It was insane, to the point where it was comical and all we could do was laugh at the situation. I worked from 7pm to 7:45am with no break aka no food. I managed to shove 2 peanut butter crackers in my mouth while running down the hallway sometime around 4:30am so that my stomach wouldnt eat itself but other than that it was basically non-stop all night.
The computer system is good in theory but its all still very new and the transitioning and getting used to everything is the hardest, and at this point there just seems to be a lot of room for error... Which, obviously you do not want when dealing with patients' medications. I'm not back till Tuesday morning so I'm seriously praying that they figure out most of the kinks between now and then. siiiigh, sorry for the rant. Ok, now that I've been awake for nearly 22 hours (and havent eaten in 17), its time for SLEEP.
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