Sunday, January 28, 2007

Day's Off are....Great

Much as I love being a nurse, and plying my skills on the innocent...I love being off so I can recoop from a hard, long and tediously long shift. Working nights, the 1st day, of course, is sleep time, so with the three day weekend, I am in heaven. My last work night was hell on earth, one transfer and TWO admissions. Doesn't sound like much ... but for night shift that is quite a load...especially since there is no pharmacist at night and you are hard put to find medications in the Pyxis, especially since a lot of the drugs need the House Supervisor to overide. Luckily, the House Supv. is on our floor, and her office quite handily was on my pod (yea!!!).

I had one new patient, that I kid you not, had 25 home medications including his daily OTC Vitamins. The kicker??? The doc in ER and the Cardiologist did not choose to continue his medications...until he was seen again the next morning.....after his second EKG....but they didn't bother to tell the patient, who was just convienced that the *evil nurse* was just with-holding his medication...or just too freaking lazy to go and get them. He threatened me "I am going to get chest pain if you don't get my pills NOW!" Well I applied the handi-dandy Nitroglycerin ointment to his chest (it was the only thing ordered), put O2 back on him, and instructed him to breath deeply and slowly (to calm him down), then I carefully explained to him why he could not have his zillion pills at this time. I stressed that the doc was waiting on the 2nd EKG and his ECHO readings...and that also some of the medications would have been held anyway...seeing as he had arrived on the unit "stable" from the ER...with a blood-pressure of 52/30 following the Lasix he had been given ...oh, but they held the NTG paste because his BP was low..... hummmmmmmmm....that was a fancy piece of critical thinking. They did a BNP....thinking possible CHF, but get this....he had a D-Dimer of over 3000 and they didn't do PE protocol or CT of the Chest (oh yes he was admitted with Shortness of breath).

My other patient, a lady, who takes only one med daily, came in short of breath ... Her D-Dimer was NORMAL, but they did PE protocol and a CT of the Chest on her....the me. He arrived on Day shift when all the diagnostic tests were quite easily obtained and she arrived at night...! At night we DON'T have a PHYSICIAN, but a PA, who works his ass off. Remind me to only go to the ER at night...when the smart one is working!!!

Anyway, I have been recooping....drank a boatful of good Margarita's, went dancing with my man and some friends...and just chilled to the max. Now I need to recoop from the recoop. Ha.Ha.


shrimplate said...

I think I understand this now. The PA orders the CT or VQ scan to rule out embolism for the patient that has *no* SOB, but the physician postpones he same scans for the patient who *does* have SOB and all...

Got that.

It's so simple really.


GingerJar said...

Actually she did have shortness of breath...and syncopy...but normal D-dimer and ABG's. Just a weird night altogether.