Last night should have been the easy..breezy, nice and easy. Three patient's and one of those a "medical", non-tele, DNR, no family, NPO, on his way back to the nursing home. Humm...do you think that caring MD...after 4 days NPO and positive for the BIG STOKE...in that...we are surprised he is even alive...will think to drop an NGT and give some nutrient's...or TPN...OR SCHEDULE A FREAKING PEG! Probably not. Poor little guy. Made me think of my Grandpa's last few weeks. Well last night...he got turned every two hours like clockwork...I personally changed him if I couldn't find the aide, I used my stash of baby-powder when we bathed him, I did oral care every time I went into the room...I pretended he was family and that somebody did care. By the end of shift, he wasn't totally comatose anymore...he was saying "water" in Spanish and a little eye opening was happening. His quality of life may not be much...but for the 12 hours I had him it was tolerable (as my grandma used to say).
Had one patient that was on the button all night...knew he was going to be the proverbal pain in the ass when every request was prefaced by "I hate to bother you", "I know you are busy" and "If you can make the time". Yes he was post-op day one, yes he had chest tubes and incisions...but why the hell do I have to fix a "crooked" foot rest (to look at it bothers me", "pull me up exactly 1 inch and I will be comfortable" (no lie..his exact request), 03 am...I want to walk...04 am...I can't sleep and nothings on t.v., 0430 I was sleeping and lab woke me up to stick me, 05 am the ace wrap is too tight. 0530 am the dressing near my neck is bothering me. 06 don't forget my pain med. 0630 Oh, now you're waking me up to take off my dressings (which is what I told him had to be done this morning...last night)...and you are insisting I get back into the chair (you slave driver bitch nurse).
Kodak moment: Unhappy patient, MD throughly pleased that patient is in chair, dressings removed, and he had a "good night"!
TGIF!!!!!!! oH, and what about that 6 am full admit I did....Damn...I rock!
Saturday, June 28, 2008
Thursday, June 5, 2008
"Brain Damaged"
Yesterday, before I got off shift, I got a late admit, you know...the kind where you really have to rush to get everything done. He came at almost 5 am. I still had a bed-bath to help with (aide is 8 months pregnant and the patient bedbound and way over 200 lbs and needed to be weighted in the sling scale). So, I get this patient who supposedly has practically no history of anything...just hypertension, high cholesterol, non-compliant on meds with vague chest pain, ambulatory, cardiac enzymes neg, everything pointing to a quick admission history and assessment, right? WRONG!
I step in the room and the patient is sitting in the chair, jeans on under the gown, muddy shoes on and the guy is literally shaking....so hard his arms are jerking and I think he must have Parkinson's or something. "Sir, are you cold, would you like to lie on the bed and cover up". "Hell no, I'm not cold, I'm scared!" "Well sir why are you scared? Have you ever been in a hospital before?" I ask, trying to assess the reason for his fear. Eyes darting around the patient yells "You Nurses Killed My Daddy, You gave him too much Medicine and you Killed Him Dead!" .....blink...blink...ok, now I know why the ER was in such a rush to get this guy upstairs...why didn't they give me a heads up??? I keep my voice soft and calm and assure the patient that I won't be giving him any medications unless he begins experiencing chest pain again because the only thing ordered from ER was aspirin which he had alread gotten, and nitro...which he would get if he was having chest pain.
Ok, now he is ready to get in the bed. I relieve him of the muddy shoes (wish I had a broom for the floor) and I put his monitor on him, explaining everything as I go...He informs me that his blood pressure is fine and that he quit taking his blood pressure medicine 2 years ago because he didn't need it anymore...his pressure is just fine. I ask him how often he checks his blood pressure....blank look, blink...blink...blink..."well I don't check it, I don't need too...it's just fine." Yup...and that's why it's called the silent killer. I explain the new BP guidelines 120's over 60's yada yada yada. The guy asks me to call his wife and give her the room number, which I do. Now he's calm enough I can start taking his history. I have one eye on the clock...it's almost 6 and I still need to bath the bedbound patient.
"Sir, other than Hypertension and high cholesterol, do you have any other medical conditions that might affect your care?"
"Well........." he drawled..........."I was born Brain Damaged." (ok, now the corners of my mouth were twiching). "You were?" I ask. ""Yup" he says. Well now I'm looking for a clue that this guy is pulling my leg....he looks normal (except for the shaking). He doesn't act like he has anything wrong with him. "My wife was born brain damaged too, that's how we met". (WHAT???) "She died two years ago." He states. Hummmmmmm maybe I'm confused...I just talked to his Wife on the phone. "Your 1st wife died two years ago?" I ask for clarification (as you can tell this history is going to take the rest of shift to complete). "nope, didn't you just talk to her on the phone? They did CPR". Hummmmmm ok, now moving on..............................
Well 1 hour later....yes I agree...the may is definately brain damaged and a little scary as compared to scared.
Wow was I glad to go home. Yes Big guy did get bathed and weighed but...it was a hurry up rush rush deal. I didn't go home until 9:30...gotta love 14 hour shifts....but today...Vacation. :)
I step in the room and the patient is sitting in the chair, jeans on under the gown, muddy shoes on and the guy is literally shaking....so hard his arms are jerking and I think he must have Parkinson's or something. "Sir, are you cold, would you like to lie on the bed and cover up". "Hell no, I'm not cold, I'm scared!" "Well sir why are you scared? Have you ever been in a hospital before?" I ask, trying to assess the reason for his fear. Eyes darting around the patient yells "You Nurses Killed My Daddy, You gave him too much Medicine and you Killed Him Dead!" .....blink...blink...ok, now I know why the ER was in such a rush to get this guy upstairs...why didn't they give me a heads up??? I keep my voice soft and calm and assure the patient that I won't be giving him any medications unless he begins experiencing chest pain again because the only thing ordered from ER was aspirin which he had alread gotten, and nitro...which he would get if he was having chest pain.
Ok, now he is ready to get in the bed. I relieve him of the muddy shoes (wish I had a broom for the floor) and I put his monitor on him, explaining everything as I go...He informs me that his blood pressure is fine and that he quit taking his blood pressure medicine 2 years ago because he didn't need it anymore...his pressure is just fine. I ask him how often he checks his blood pressure....blank look, blink...blink...blink..."well I don't check it, I don't need too...it's just fine." Yup...and that's why it's called the silent killer. I explain the new BP guidelines 120's over 60's yada yada yada. The guy asks me to call his wife and give her the room number, which I do. Now he's calm enough I can start taking his history. I have one eye on the clock...it's almost 6 and I still need to bath the bedbound patient.
"Sir, other than Hypertension and high cholesterol, do you have any other medical conditions that might affect your care?"
"Well........." he drawled..........."I was born Brain Damaged." (ok, now the corners of my mouth were twiching). "You were?" I ask. ""Yup" he says. Well now I'm looking for a clue that this guy is pulling my leg....he looks normal (except for the shaking). He doesn't act like he has anything wrong with him. "My wife was born brain damaged too, that's how we met". (WHAT???) "She died two years ago." He states. Hummmmmmm maybe I'm confused...I just talked to his Wife on the phone. "Your 1st wife died two years ago?" I ask for clarification (as you can tell this history is going to take the rest of shift to complete). "nope, didn't you just talk to her on the phone? They did CPR". Hummmmmm ok, now moving on..............................
Well 1 hour later....yes I agree...the may is definately brain damaged and a little scary as compared to scared.
Wow was I glad to go home. Yes Big guy did get bathed and weighed but...it was a hurry up rush rush deal. I didn't go home until 9:30...gotta love 14 hour shifts....but today...Vacation. :)
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