Last night's shift was one of those where you look back on it and say, "Seriously? Did that really happen??" Mr. M had been slightly confused and attempting to get up and wander around during the day so at night we turned on the bed alarm so we would know when he tried to get up. The alarm went off no joke, every 15 minutes. At 11pm he ran down the hallway to the back stairwell trying to escape. At that point the nurse gave him some Ativan to help calm him down, and it worked for a tiny bit. At quarter to 12 he got up out of bed and walked over to the window to "try to escape." We got him back in to bed and thats when things got a little crazy. He started hallucinating and because of it, was swatting at us. We tried to calm him down and reorient him, but nothing worked. He was getting more and more agitated so we paged the doctor. No response. Vitals were stable, but he was just SO confused. There were times where you could reorient him, but for the most part he was mumbling nonsense. Pupils were unequal, but reactive. The patient started swatting and throwing things so much that we just ordered the restraints. when the MD finally returned the page, we had 3 nurses and a tech in the room trying to hold the patient down. The doctor took a quick glance at him and said, "ok, give 5mg Haldol." We gave the Haldol, nothing. We gave another Haldol but then realized that the IV was infiltrated, so we gave Haldol IM. Still Nothing. The doctor ordered to get labs and an IV. Hey doc, how the F are you gonna get labs and put an IV in a combative, flailing patient. At this point security was there helping us. Nothing was working for the guy. The MD didnt order anything, he didnt even go in and assess the patient! He was worthless. He continued to thrash for the next 3 hours. We gave Mr. M a total of 20mg of Haldol and 15mg of Morphine and nothing was affecting him. It was absolutely ridiculous. In the morning he actually got worse and we had to call up 4 security guards to get him under control and we put him in 4-point restraints. When the other residents came in, the R4 looked at the doctor who was on last night and asked him why he never ordered a Neuro consult. ...b/c he's an idiot. Nothing too alarming medically since the patient was hemodynamically stable, but he was just SO agitated and so confused. The resource nurse said he's probably encephalopathic but I've never seen encephalopathy present like that. Confusion and anxiety, yes. But there was definitely something else going on.
It was just the most ridiculous shift. I cant believe the doctor on call didnt do anything. He literally never even went in past the door frame of the patient's room. I was so frustrated with him and I wasnt even the nurse for that patient. Thank goodness the rest of our patients were stable! We were able to spend most of our time in with that one patient. None of us got a break during the night AND we didnt leave till 9am. Ridiculous. Not in the sense that my patients were unstable, but everyone was just in disbelief of what was going on and how crazy the patient was. Oh fun times. :)
Monday, November 16, 2009
Friday, November 13, 2009
Stick 'em.
Usually when we need to draw blood from patients we ask the techs to do it because they have more down time during the day thus they're typically better at it. Now that I'm not a tech anymore, I dont get as much practice, so this morning when it was time to draw morning labs, I had 3 patients I needed to stick for blood, all of whom are really hard sticks. And I got all 3 of them! I was super excited. Plus one of them needed to get stuck twice for 2 different sets of labs and I was still able to get all the blood! I know that doesnt seem exciting and I remember in nursing school my professor said, "Getting an IV, drawing blood, thats a basic skill. Everyone can do it. No one should be getting excited about a blood draw." ...Bullshit, professor. Come work on my floor where every single patient is a hard stick b/c their veins are completely shot from having to draw blood multiple times a day. On one of the patients this morning, I drew his blood from a tiny little vein that popped out over the knuckle of his right thumb. Is that the ideal spot? Nope. Did it hurt? Probably, but it was the only vein I saw. Did I still get the blood in one stick? Fuck yeah.
Thats all. I'm just super excited about my lab draw luck this morning. :)
Thats all. I'm just super excited about my lab draw luck this morning. :)
Thursday, October 29, 2009
tv break
I turned on my computer today to watch last night's episode of Glee online and I'm so disappointed that it was a repeat last night! Dont get me wrong, I thoroughly enjoyed watching baseball, especially since the end result was the Yankees LOSING (hahaha, sorry Ally) but I totally didnt put 2+2 together and realize that I was watching the game on Fox instead of Glee. (Besides, I love Cliff Lee and his behind-the-back catch in the 8th was amazing. Siiigh, baseball makes me happy and I cant believe the season's almost over.) BUT, House wasnt showing on Monday, NCIS was a repeat on Tuesday, and now Glee and Mercy werent on last night. I need my TV fix!! They really need to schedule all these sporting events around prime time tv. :)
Side note: I love Mercy! The hospital drama can be a little over the top, but this show totally makes me want to be a better nurse.
Side note: I love Mercy! The hospital drama can be a little over the top, but this show totally makes me want to be a better nurse.
Thursday, October 22, 2009
Team work
I love the people I work with. Our unit (as I'm sure you can tell from some of my recent posts) tends to be pretty "heavy" at times and sometimes just because of the way the patients are, some nurses end up getting really busy assignments. The fabulous thing about our staff is that everyone is always willing to help out. There are a lot of other units where nurses just watch their coworkers run around like a chicken with their head cut off while they're sitting around doing nothing. Our unit is absolutely not like that.
Last night one of our patients blood pressure started to drop (the same pt. I talked about who got pain medicine every hour is and extremely sick, needing 1-to-1 care). His heart rate was in the 130s, and his BP dropped to 80s/50s while we were giving him blood. We actually ended up pulling the code cart next to his room because we were certain we'd have to code him. We had all 4 nurses in his room at one point and after the first hour of this going on (because yes, this intense ICU-type care went on for more than a hour), we all kind of tag-teamed it so that we were able to have 2 nurses in his room at all times. It was fantastic team-work and I love that on our unit you can automatically count on the other nurses helping you out. You never even have to ask - help is always offered. Believe me, it makes all the difference in the world. Our patient population can be an absolute nightmare, but ask anyone who works on our unit - the nursing staff is what helps you through the day. (Danielle, when you're looking at where you want to work, definitely look out for how helpful the staff is and how all the nurses interact.)
_________
In case you were wondering about our patient... His pressure initially dropped and we brought the code cart over starting at about 0245. We woke up our doctor, Dr. V and starting hanging more blood (he has 2 IV ports and we had blood going in through both of them). He took one look at him and said, "I'll go write the transfer orders so we can get him to the ICU." He came back 10 minutes later and said that the ICU attending did not want to admit him yet - he wanted to wait and see if he responded to all the treatment. Hey Doc, of course his pressure will hold steady if you're infusing 2 units of blood simultaneously at an ungodly fast rate (although really, I wouldnt exactly call 90s/50s all that great). But what happens when we stop pumping all that fluid into his system? Do you really think his pressure is gonna hold? Considering that his g-tube proceeded to put out 450mL of frank red blood, I think not. Dr. V called the guy back at 0400 and gave him the recent update and the doc still said dont transfer. Mind you, we've had at least 2 nurses by his bedside for the last hour trying to keep this guy stable. This continued for HOURS. The stupid doctor refused to transfer him. Thank goodness all other patients were stable and we were able to help out, but its not like we didnt have other things to do. At 0630 we got the managers involved and the patient was FINALLY transferred to the ICU at 0730. FIVE HOURS after all this started. ugh. Have I mentioned that I hate doctors sometimes?
Last night one of our patients blood pressure started to drop (the same pt. I talked about who got pain medicine every hour is and extremely sick, needing 1-to-1 care). His heart rate was in the 130s, and his BP dropped to 80s/50s while we were giving him blood. We actually ended up pulling the code cart next to his room because we were certain we'd have to code him. We had all 4 nurses in his room at one point and after the first hour of this going on (because yes, this intense ICU-type care went on for more than a hour), we all kind of tag-teamed it so that we were able to have 2 nurses in his room at all times. It was fantastic team-work and I love that on our unit you can automatically count on the other nurses helping you out. You never even have to ask - help is always offered. Believe me, it makes all the difference in the world. Our patient population can be an absolute nightmare, but ask anyone who works on our unit - the nursing staff is what helps you through the day. (Danielle, when you're looking at where you want to work, definitely look out for how helpful the staff is and how all the nurses interact.)
_________
In case you were wondering about our patient... His pressure initially dropped and we brought the code cart over starting at about 0245. We woke up our doctor, Dr. V and starting hanging more blood (he has 2 IV ports and we had blood going in through both of them). He took one look at him and said, "I'll go write the transfer orders so we can get him to the ICU." He came back 10 minutes later and said that the ICU attending did not want to admit him yet - he wanted to wait and see if he responded to all the treatment. Hey Doc, of course his pressure will hold steady if you're infusing 2 units of blood simultaneously at an ungodly fast rate (although really, I wouldnt exactly call 90s/50s all that great). But what happens when we stop pumping all that fluid into his system? Do you really think his pressure is gonna hold? Considering that his g-tube proceeded to put out 450mL of frank red blood, I think not. Dr. V called the guy back at 0400 and gave him the recent update and the doc still said dont transfer. Mind you, we've had at least 2 nurses by his bedside for the last hour trying to keep this guy stable. This continued for HOURS. The stupid doctor refused to transfer him. Thank goodness all other patients were stable and we were able to help out, but its not like we didnt have other things to do. At 0630 we got the managers involved and the patient was FINALLY transferred to the ICU at 0730. FIVE HOURS after all this started. ugh. Have I mentioned that I hate doctors sometimes?
Sunday, October 18, 2009
My feet hurt.
I kinda want to get those step counter thingies that calculate the distance you've walked so I can see how much running around I do at work. Today was ridiculous and it just reminded me of how I strongly dislike doctors sometimes (sorry Egon). It's so frustrating that regardless of how much we know/do and how well we know our patients, nurses cant do shit without the okay from a doctor. Are the doctors the ones providing hands-on care to the patient 24/7? I fully appreciate the knowledge doctors have, but sometimes they don't understand what is going on with patients because they're just not around enough.
We have a 24yo patient on our unit who had 2 small bowel transplants gone bad, he had the 2nd one removed a few weeks ago (yep, he has no small bowel) and just had major heart surgery 3 days ago. He is in awful shape and is not exactly the most stable patient. But, not only is he medically "heavy" but on top of that, he is also obnoxious and super needy. Yesterday he started vomiting liters - LITERS - of blood. The doctors were like, "oh ok, just monitor him and we'll probably give him some blood." FYI docs: if your patient is vomiting liters with a blood pressure that is dropping, he needs constant care - something he cannot get on a regular in-patient unit. Each nurse on our floor has 4-5 patients to take care of, and when you have a patient like Mr. H, your other patients tend to get neglected, which unfortunately happens and you deal with it, but you find ways to remedy that (i.e. transfer him a unit where he can receive 1-to-1 care). We tried to talk to the doctors to get him transferred to the ICU where he could get that, but noooo, the doctors didnt want to. Today I was the lucky one who got to take care of him. Overnight he got 4 units of blood, 2 units of FFP, and his H&H were still only 9 & 23. I came on to my shift and his heart rate was 110 and O2 sat was 82%. (That number should never drop below 92%.) He gets pain medicine every hour, Benadryl every 4, nausea meds every 6, Ativan every 6, labs drawn every 6 hours, vital signs every 4 hours, and IV antibiotics every 8. Of course none of those are scheduled for the same time, so everything is spread out during the day so its not like you can take care of more than one thing with each trip into the room. And that's just what was scheduled, that doesnt include added interventions. For example, halfway through my shift he started having irregular heart rhythms which required interventions and thus more care, and his lab levels were low and needed 4 hours of electrolyte replacements. I was probably in his room every half hour, and I had 3 other patients. He wouldnt be such a handful if he didnt get the pain medicine every hour. Typically patients who require pain meds that frequently get put on a pain button, which I convinced the resident to do, but then the stupid fellow who I absolutely CANNOT stand, said no. I'm sorry, are you going to come in and give this guy meds every hour? Are you going stay in his room for 20 minutes to try to get his pillow positioned just right so he doesnt scream bloody murder? Are you gonna sit there and listen to him when he starts talking about how he doesnt want to live anymore? No. We have to do that. You just write orders of a piece of paper and never go in to see your patients. Yeah, you're a fantastic doctor. (sidenote: why the hell is this patient still a Full Code? Because the doctors are too stubborn and refuse to admit that this kid is dying? oh ok, thats a good reason.)
I really think that med students should be required to do a rotation following a nurse. Even for just a week, just so they can realize exactly what it is we do all day. Siiigh.
We have a 24yo patient on our unit who had 2 small bowel transplants gone bad, he had the 2nd one removed a few weeks ago (yep, he has no small bowel) and just had major heart surgery 3 days ago. He is in awful shape and is not exactly the most stable patient. But, not only is he medically "heavy" but on top of that, he is also obnoxious and super needy. Yesterday he started vomiting liters - LITERS - of blood. The doctors were like, "oh ok, just monitor him and we'll probably give him some blood." FYI docs: if your patient is vomiting liters with a blood pressure that is dropping, he needs constant care - something he cannot get on a regular in-patient unit. Each nurse on our floor has 4-5 patients to take care of, and when you have a patient like Mr. H, your other patients tend to get neglected, which unfortunately happens and you deal with it, but you find ways to remedy that (i.e. transfer him a unit where he can receive 1-to-1 care). We tried to talk to the doctors to get him transferred to the ICU where he could get that, but noooo, the doctors didnt want to. Today I was the lucky one who got to take care of him. Overnight he got 4 units of blood, 2 units of FFP, and his H&H were still only 9 & 23. I came on to my shift and his heart rate was 110 and O2 sat was 82%. (That number should never drop below 92%.) He gets pain medicine every hour, Benadryl every 4, nausea meds every 6, Ativan every 6, labs drawn every 6 hours, vital signs every 4 hours, and IV antibiotics every 8. Of course none of those are scheduled for the same time, so everything is spread out during the day so its not like you can take care of more than one thing with each trip into the room. And that's just what was scheduled, that doesnt include added interventions. For example, halfway through my shift he started having irregular heart rhythms which required interventions and thus more care, and his lab levels were low and needed 4 hours of electrolyte replacements. I was probably in his room every half hour, and I had 3 other patients. He wouldnt be such a handful if he didnt get the pain medicine every hour. Typically patients who require pain meds that frequently get put on a pain button, which I convinced the resident to do, but then the stupid fellow who I absolutely CANNOT stand, said no. I'm sorry, are you going to come in and give this guy meds every hour? Are you going stay in his room for 20 minutes to try to get his pillow positioned just right so he doesnt scream bloody murder? Are you gonna sit there and listen to him when he starts talking about how he doesnt want to live anymore? No. We have to do that. You just write orders of a piece of paper and never go in to see your patients. Yeah, you're a fantastic doctor. (sidenote: why the hell is this patient still a Full Code? Because the doctors are too stubborn and refuse to admit that this kid is dying? oh ok, thats a good reason.)
I really think that med students should be required to do a rotation following a nurse. Even for just a week, just so they can realize exactly what it is we do all day. Siiigh.
Wednesday, October 14, 2009
Crazies always make the day interesting
Liver patients always intrigue me. Its amazing what kind of effect a failing liver has on the body. One of my patients today has End Stage Liver Disease (ESLD) and because of it, is completely jaundiced (to the point where his skin actually looks like its glowing, its so yellow), his abdomen is enormously distended, and he is encephalopathic (confused). Apparently overnight he pulled out his feeding tube that he had inserted thru his nose (a Dobhoff) not once, but twice. He gets his nutrition thru the tube and all of his medications crushed and pushed thru the tube as well. Naturally, he couldnt get any of that. Then when he went down for a procedure, I get a call from the radiologist informing me that my patient had decided to pull out his Quinton catheter, which is essentially a large IV that is inserted into the internal jugular and used for dialysis. Thus, my patient not only lost all IV access and could not get dialysis today, but I'm assuming was also bleeding profusely from the site. Thank goodness the radiologist decided to walk out and check on him, otherwise there's a good chance he could've lost quite a bit of blood laying there on the stretcher. Anyway, he was quite the handful the first 2 hours of my day. But then all of a sudden he did a 180 and was a completely different person in the afternoon. He was totally lucid, cracking jokes, compliant, and so pleasant. I swear, liver disease is one of the most puzzling things.
PS - totally random, but as I was driving out of the hospital parking lot today I saw a guy who I'm assuming is a Georgetown student, undergrad or maybe even med school. He was wearing khaki pants and a blue blazer.....and wearing a bright pink and purple backpack. It was awesome.
PS - totally random, but as I was driving out of the hospital parking lot today I saw a guy who I'm assuming is a Georgetown student, undergrad or maybe even med school. He was wearing khaki pants and a blue blazer.....and wearing a bright pink and purple backpack. It was awesome.
Sunday, October 11, 2009
HC highlights
I was debating whether or not to come back for homecoming this year, but I'm so glad I did! Great weekend! ...Aside from switching back and forth between hungover and drunk all day Saturday. Totally worth it though. :)
- "Um, there's no flight suit involved in that equation. EW."
- Boxer switch (so disappointed there was no documentation of this)
- Egon's awesomely uncomfortable pull-out couch
- "That girl's not wearing any pants!"
- Gin Bucket!
- Man voice
- "Oh hey. Would you like to join me in section FFFFF?"
- "Hi my name is Ricki."
- Drunk Brandi
- Being Katie's wing-woman (which I will gladly do any time) :)
- Angry Egon threatening to kill everyone
- Kreg's awesome moves
- Drunk, late-night heart-to-hearts :) :)
- "I dont need to hook her up. Nikki hooks herself up."
Siiigh, I always get so depressed when its time to leave. I never want to have to say bye. I miss everyone already! ...So, who wants to go back to NC? :)
- "Um, there's no flight suit involved in that equation. EW."
- Boxer switch (so disappointed there was no documentation of this)
- Egon's awesomely uncomfortable pull-out couch
- "That girl's not wearing any pants!"
- Gin Bucket!
- Man voice
- "Oh hey. Would you like to join me in section FFFFF?"
- "Hi my name is Ricki."
- Drunk Brandi
- Being Katie's wing-woman (which I will gladly do any time) :)
- Angry Egon threatening to kill everyone
- Kreg's awesome moves
- Drunk, late-night heart-to-hearts :) :)
- "I dont need to hook her up. Nikki hooks herself up."
Siiigh, I always get so depressed when its time to leave. I never want to have to say bye. I miss everyone already! ...So, who wants to go back to NC? :)
Thursday, October 1, 2009
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