It's been a Hard Days Night, and I've been working like a dog!
Last night started with a bang. The patient in 26 was confused...as in, I know who I am but who are you and all these other people....and where is my house??? This was not my patient, but became my "task" to "handle" when he got led back to the desk by security...his nurse was hanging a cardiac drip on a pt with a heart rate of 150...sustained...so needless to say she was a bit busy. "CowBoy" (as I dubbed the 70-something gent ... who was trotting around in white pj's with pinstripes and Brown Alligator cowboy boots, was convienced that the *evil* nurses were holding him hostage...but he was more than happy to be hostage...if he could hold my hand...and hug me...and pat me...and it was like he had 15 hands I kept pulling off of various body parts! I finally settled for placing the nursing station counter between us...but I had to let him hold my hand to keep him from taking off for the elevator....as I said...his nurse was busy...and after a snicker...the Nurses Aide...*bless her little heart* disappeared somewhere...leaving me to handle Don Juan "CowBoy" alone....He wanted to know when the "Lobby Party" was starting...since he saw a sign for the lobby. He had to describe in detail...how weird the bones in my hands were (an ex tried to squeeze the hand off and wound up bending it backwards last year) ... but he found the movable bones oh, so, interesting....! I put him back in his room about 5 times...like moving an Octipus with suction cups....and finally found a number for his wife...who lived an hour away! He didn't want to watch TV, but I found some really old Time Mag's and put him and them back in his room...again...well by the time his spouse got there...he was all innocent...asleep. She was PISSED that she got dressed and came all that way...and he was ASLEEP! Well she crawled in bed by him to keep him in the bed...and she proceeded to sleep while he woke up and kept removing his monitor, pushing the call bell (couldn't remember what he wanted) and so on the rest of the night. Remember...not my patient...
Then I had the 450# pt in 1 who was in the big boy bed, that I could barely reach over the rails, who wanted this body part positioned, and that body part positioned and ....ya get the drift. (Nurse Aide disappeared on this one too, as she is 90# and said body parts all out-weighted her!). After about 10 trips in and out of the room, I finally gave in....gave her fluids over her limit...just to make her a happy 450# camper...did peri-care...(all the way to my arm-pitt) while dangling off the side of the hydrolic bed...there was a little 2 inch I-hook that I was able to balance on... for some reason the dang bed would not lower any farther! Anyhow, I have various bumps and bruises from that bed...and a pulled shoulder from helping to bath her two nights ago...when there was just two of us and she was incontinent...again...having to balance on the 2 inch I-hook!
Then my "easy" patient's...the Hypertensive emergency..with 2 hr neuro checks...that had to have a consent signed for a procedure today...and the family wanted written literature on the test (that I had to look up on the system and print out...of course the printer was out of paper...had to get the resource nurse to unlock storage for that)...
Then the patient in 3 who was confused...and the spouse did not stay...a comfort care pt...who decided at 4:45 to get out of bed (door open...direct view of the nurse), except the IV INFILTRATED in 5 and I had to restart...I was standing in the doorway when he went "splat". Hell's bell's...he forgot to use the call bell again...and where was that perky Nurse Aide ??? the one that was watching him while I started an IV....Not in 4...her call light was on for assistance to the BedSide Commode...
Well I picked up 3, checked him out, changed his linens and gown, lotioned him down...no injury..called his wife, paged his doc. Went to 4 put her on the commode, cleaned her bed up, emptied the emesis basin, washed all that up and empty the trash while I wait for her business to be done....Resource Nurse semi-watching the fall patient, because we have another patient (thank God not one of mine) semi-coding in another room. Same room we had a partial code night before (right in the middle) jinxed I guess. Anyway...got all that done, filled out the required paperwork for the fall. Finally got finished after report and left work by 0830! Tired! Wired up to the Max! Two Margaritia's and 2 hours playing Yahoo Bookwork to unwind!
Then about 3 pm my hubby woke me up and gave me a back rub, shoulder rub, foot rub....................well anyway...........I feel much better now!
Monday, March 5, 2007
Monday, February 12, 2007
BAck again for more
Well, I've been off for 3 wonderful nights. Of course *they* asked me to work at least one of my nights off....especially since it is the weekend, and especially since *they* are short. What at *they* gonna do when the new law that is being lobbied gets passed...they we can only work a 12.5 hr day and only so many hours a week, and only 3 /12 hour shifts in a week??? Who are they gonna get to cover then??? And if you work two jobs and work more than the Mandated maximum your nursing license can be suspended...or even taken away!!!! Where will the nursing staff be then??? I bet *THEY* will changing their tunes soon...*THEY* even tried to make all nurses exempt from over-time benifits because we are "supervisory" if we even "change" nurse one time...ever....ever....
Well, the staffing pool is getting empty...all the fish are going to the California waters where they get better pay...and caps on their patient ratio's.
This minnow has swam yet, but it is enticing.
Well, the staffing pool is getting empty...all the fish are going to the California waters where they get better pay...and caps on their patient ratio's.
This minnow has swam yet, but it is enticing.
BAck again for more
Well, I've been off for 3 wonderful nights. Of course *they* asked me to work at least one of my nights off....especially since it is the weekend, and especially since *they* are short. What at *they* gonna do when the new law that is being lobbied gets passed...they we can only work a 12.5 hr day and only so many hours a week, and only 3 /12 hour shifts in a week??? Who are they gonna get to cover then??? And if you work two jobs and work more than the Mandated maximum your nursing license can be suspended...or even taken away!!!! Where will the nursing staff be then??? I bet *THEY* will changing their tunes soon...*THEY* even tried to make all nurses exempt from over-time benifits because we are "supervisory" if we even "change" nurse one time...ever....ever....
Well, the staffing pool is getting empty...all the fish are going to the California waters where they get better pay...and caps on their patient ratio's.
This minnow has swam yet, but it is enticing.
Well, the staffing pool is getting empty...all the fish are going to the California waters where they get better pay...and caps on their patient ratio's.
This minnow has swam yet, but it is enticing.
Wednesday, January 31, 2007
Drug Seeker
She is back in the hospital. For the zillionth time. When she leaves here she will go to the sister facility two blocks North. When she leaves there she will go to the smaller facility in the next town, then to the bigger city. In about 6 weeks when she has exhausted all of those she will be back.
She has no insurance. She has no job. Her hubby goes with her from hospital to hospital, he is also unemployed. They are not elgible for government programs (Think "Rio Grande Valley").
She can't afford her drugs. She is non-compliant with her medical management. The MD's know her well. Her drugs of choice: Lasix, Anti-hypertensives, and Insulin.
I doubt they have a home, maybe visit family or friends for the one or two days a month she is not admitted in acute CHF. December bought her a CABG for Christmas...Thanks to the Taxpayer's....even though the doc's know she is a poor risk, non-compliant, what are they to do?? The sad part....she is 41 and knows she is dying.
Drug Seeker...yes, non-compliant...yes, but as a patient...she never asks for anything except a little water. Never complains of pain, never asks for pain medications and is grateful for any little tiny thing that is done for her. I have patient's with the greatest of Insurance, who have a multiple of pills and plenty of help at home. They have food, clothes, heat and a roof over their heads. They demand bowing and scaping, and yes I'll get that right away...after all....isn't this Hotel Hospital???? Yet, this one simple woman touchs my heart.
She has no insurance. She has no job. Her hubby goes with her from hospital to hospital, he is also unemployed. They are not elgible for government programs (Think "Rio Grande Valley").
She can't afford her drugs. She is non-compliant with her medical management. The MD's know her well. Her drugs of choice: Lasix, Anti-hypertensives, and Insulin.
I doubt they have a home, maybe visit family or friends for the one or two days a month she is not admitted in acute CHF. December bought her a CABG for Christmas...Thanks to the Taxpayer's....even though the doc's know she is a poor risk, non-compliant, what are they to do?? The sad part....she is 41 and knows she is dying.
Drug Seeker...yes, non-compliant...yes, but as a patient...she never asks for anything except a little water. Never complains of pain, never asks for pain medications and is grateful for any little tiny thing that is done for her. I have patient's with the greatest of Insurance, who have a multiple of pills and plenty of help at home. They have food, clothes, heat and a roof over their heads. They demand bowing and scaping, and yes I'll get that right away...after all....isn't this Hotel Hospital???? Yet, this one simple woman touchs my heart.
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 difference...beats 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.
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 difference...beats 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.
Tuesday, January 23, 2007
Here comes the Judge!
She was emancipated, dirty, dehydrated and confused. Why am I here?? When is the helicopter coming to get me??? Call my husband W...., he doesn't know where I am. What are you doing to me. Why am I here....
*She* had been in the bed sick for two weeks. No one knew what was actually wrong with her. She quit eatting and drinking. She didn't take her pills...any of them...although EMS found a shit-load of them sprinkled on the bed covers. Her daughter had been trying to call her for days, without a response. Her Husband *W* , also has Aizheimer's, but not as "bad" as her case. They are Winter Texan's ... who winter by the sea-shore on the Gulf when the weather gets bad. Unfortunately...Texas, like the rest of the nation, is experiencing unseasonably cold weather. As Winter Texan's these people were unprepared for the cold. They hold up in their rolling homes on wheels, bundled up in the covers...developing DVT'S and waiting for the warm to return.
Her monitor is going off. I dash to the room, Sinus Tach 130....She is sitting calmly in the bed with an electrode dangling from her mouth, nursing it like a lollipop....."What is this?" She asks, shaking the offending tasteless electrode at me. She pop's it quickly into her mouth. She has managed to strip off her gown and almost get on her gray sweat-shirt. She looks at me..This sad woman, with perfectly manicure nails...painted peach...with dirt under them. The sad part...Severe Aizheimer's has robbed her memory of almost everything...she knows she has a husband, who *knows* her medical history, and a daughter...who doesn't live here. She doesn't remember that she was a county Judge in West Texas. She doesn't remember where she is or why she is...just that the helicopter is coming to get her. How sad. Aizheimer's has to be the worst.
*She* had been in the bed sick for two weeks. No one knew what was actually wrong with her. She quit eatting and drinking. She didn't take her pills...any of them...although EMS found a shit-load of them sprinkled on the bed covers. Her daughter had been trying to call her for days, without a response. Her Husband *W* , also has Aizheimer's, but not as "bad" as her case. They are Winter Texan's ... who winter by the sea-shore on the Gulf when the weather gets bad. Unfortunately...Texas, like the rest of the nation, is experiencing unseasonably cold weather. As Winter Texan's these people were unprepared for the cold. They hold up in their rolling homes on wheels, bundled up in the covers...developing DVT'S and waiting for the warm to return.
Her monitor is going off. I dash to the room, Sinus Tach 130....She is sitting calmly in the bed with an electrode dangling from her mouth, nursing it like a lollipop....."What is this?" She asks, shaking the offending tasteless electrode at me. She pop's it quickly into her mouth. She has managed to strip off her gown and almost get on her gray sweat-shirt. She looks at me..This sad woman, with perfectly manicure nails...painted peach...with dirt under them. The sad part...Severe Aizheimer's has robbed her memory of almost everything...she knows she has a husband, who *knows* her medical history, and a daughter...who doesn't live here. She doesn't remember that she was a county Judge in West Texas. She doesn't remember where she is or why she is...just that the helicopter is coming to get her. How sad. Aizheimer's has to be the worst.
Monday, January 22, 2007
Wake Up People
To all the stupid people who think that Mom is gonna live forever...even if she has had both feet amputated....multiple times...a piece at a time...Mom, who has been on Dialysis for umpteen trillion years, Mom who is in ICU, comatose, on three or four cardiac drips....TODAY....TODAY...was NOT the day to decide that MOM needed to be changed to a FULL CODE, against her express desires. Then after your OH SO CHALLENGED mental decision...you left after visiting hours, to go home, to peacefully sleep. WHERE WERE YOU...when she coded...and we called you??? DO YOU THINK we call at 3 am in the morning simply to annoy you...to wake you from your beauty sleep??? STUPID PEOPLE who respond to the nurse...I'll be by in the morning....HUH???? PEOPLE...IF A ICU NURSE IS CALLING YOU AT 3 AM IN THE MORNING AND ASKING YOU TO PLEASE RETURN TO THE HOSPITAL AS SOON AS POSSIBLE.....THAT MEANS NOW........MOM IS NOT RISING UP AND WALKING....SHE IS GROWING WINGS AND THE CHOIR IS SINGING!!!!!
We coded her 4 times...bless her heart, when I left this morning she was still breathing, ventilator assisted, the SON finally showed up around the 4th code, but was adament that everything be done...HIS mother is a fighter....poor woman.......all the doctor's could do was just shake their heads......
In Texas....especially the Rio Grande Valley...the patient's live forever...really...at least that is what the general population expect's...if you are a full code...you are not suppose to die.................EVER!
We coded her 4 times...bless her heart, when I left this morning she was still breathing, ventilator assisted, the SON finally showed up around the 4th code, but was adament that everything be done...HIS mother is a fighter....poor woman.......all the doctor's could do was just shake their heads......
In Texas....especially the Rio Grande Valley...the patient's live forever...really...at least that is what the general population expect's...if you are a full code...you are not suppose to die.................EVER!
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