Codes at Work and other stuff

Wow. Yesterday we had a hell of a Code Blue. I was floated to ICU and had a relatively easy night, two tele patient's with no bed to send them to, and one ICU pt. No drips, no real challege...nice and easy...breezy. Then about 6 a.m., bam! (it's the BAM that get's ya every time!) Move the tele pt to another room, then recieve the "tele" pt to ICU to start NTG drip...stat dialysis ... non-rebreather...ect.

I'm right in the middle of stabilizing my new pt (at 6:05...that's how fast I transferred and got my room cleaned and mopped...should get a medal for that one), the patient in Cardiovascular Recovery Codes! She had been up walking around just fine hours before. Started feeling "funny", suddenly like blew a gasket or something. Her chest tube starts pouring blood and she goes asytole! The other ICU nurse runs to the code...and now I have one tele pt, and 4 ICU patients...and still stabilizing my admit. Well if that's not challengening enough....three minutes later they call a Code Orange Haz-mat decon code in the ER (what the heck is going on....what day of the week is it anyhow??). Back to the Code blue...this lady is not doing well (remember asystole!), Everyone's running, nursing students trying to see and stay out of the way...Cardio-thoracic surgeon CRACKS the chest BACK OPEN AT THE BEDSIDE (shades of Gray's Anatomy!). All that...and I missed most of it... (remember the other 5 patient's! Not to count dealing with the family who wanted all 45 members to be in the patient's room at the same time...and wanted to wander around in the hallway while we are running with equipment to the code...."Sir I'm sorry, but could you wait outside of the ICU for a little bit, I'm attempting to stabilize your *mom* *aunt*grandma*cousin* and If I could be in the room rather than running traffic control I could probably do more good for her".) Well eventually it all got done. My patient was doing better, painfree, hemodialysis in progress, NTG titrated up significantly when the actual day shift ICU nurse relieved me (late because everybody coming in also went to help with the codes).

I was glad to leave to go home. Unfortunately...even with the cardiothoracic surgeon at the bedside...the CVR lady didn't make it. Her nurse had tears in her eyes when she left that morning. Sometimes it is just so damned hard to be a nurse.

I'm a Patient now.

Ok, so I know that PVC's cannot kill you. I've been told that over and over by the cardiologist. However, tell me, why do you have the chest pain, palpations, shortness of breath, and feeling of impending doom...if it really isn't anything significant. And for please don't say it's an anxiety attack, when I am able to continue to care for patient's and calmly give my relief nurse a full concise report to continue care for six patient's. An anxiety attack would not start with indigestion and still be continuing 6 hours later...and getting worse. I drank 1/2 bottle of Peptol Bismol because I was convienced I was just having "gas" pain. Interestingly enough I placed myself on teley and had 3 hours on continous bigemity rhythm .... had to mute the monitor because the alarms were ringing constantly. Not just the 33 PVC's per minute...but the underlying sinus brady of 40. Now, to say I just felt like holy hell and did continue to work...chart, formulate care plans, give medications, and admit a new patient during all this...how does that cause a physican who doesn't even know me from Adam to form the opionion I must have been having an ANXIETY attack. Hell, if I was having an Anxiety attack, bring on the Xanax!!!! I would have loved to have slept for a few hours! My fellow nurses on my floor didn't mind taking care of me. I put on my own monitor, did my own I/O's, fetched my own towels....and alarmed for 24 straight hours with cardiac arrhythmia and sinus brady. Enzymes neg, had low KCL and had to drink some of the nasty liquid stuff we love to foist off on unsupecting patient's...and even though Isral is a new grad, he had enough sense to stay in the room to be sure I finished my OJ and Liquid KCL cocktail (blech!). Anyhow, I'm home now with a "event monitor". The thing is I don't notice the PVC's until they get totally symptomatic. When I have bigemity for like an hour or more I get short of breath and have chest pain....but remember that is probably an "anxiety" attack, and PVC's cannot kill you ... just make you feel like your having a heart attack or dying. The worst part is now I have an ER bill, inpatient hospitalization bill, cardiologist bill, and now a bill for this damn monitor...and nothing will be done. They cannot even increase or change the anti-arrhythmia drug I'm on...because my heart rate is so slow I cannot take it most of the time, and the doc doesn't think a pacemaker is a good option because I'm too "young" and might have to have a few battery changes in my lifetime. So, will all this eventually cause me to have heart damage or Sick Sinus Syndrome???? Who knows. I just know that I continue to feel like hell, and I don't think it's an Anxiety Attack!

Cancer Week

I've decided that it must be cancer week on our unit. Got two patient's in ajoining rooms with very simular diagnoses. Keep getting their labs and stuff mixed up (LOL) because almost same diagnoses. Work a cardiac floor, just not used to side by side cancers I guess. One gent came in for a heart cath and finds out he has a lung mass. The other came in knowing he had colon cancer, was actually already scheduled next week for surgery, but had complications...and wound up on the cardiac floor. Neither of these guys are really young...but it just hits you sometimes, you know, there sometimes is no way of knowing just what is sitting there in your gut or lung just waiting like a spider for the "right" time to spring on you.

I remember one patient I had came in with shortness of breath...she was in her mid 30's, she was a smoker...but what had happened was she was letting her dog out and the wind caught the door and hit her in the ribcage with it fracturing the rib. What she didn't expect was that when the x-ray showed the fractured rib....it also showed extensive lung cancer. She lay there is the ICU barely able to breath....not sure if she really wanted to know what lay ahead. She had on perfect makeup, she had "enhanced" perfect breasts, she had met and recently married the "perfect" man. What she did not have was the "perfect" diagnosis.

So, there ya go....Cancer week.....*sigh*

arrrrrrrrrrrgh

If my arms become to short to wipe my butt...please...please just shoot me...put me out of my misery!

The 15th time the bell went off ....for the butt wipe queen I wanted to call it quits...but I pasted that silly smile on my face and did my job....how pleasant is it to do this over and over. How does anybody live??? I get one or two of these type of patients a week. If this is any indicator of the Obesity Crisis in America, I can swear that there really is one.

New Nurse

Hummmmmmmmm. Well we were all new once. I understand why we were told in Nursing School that "nurses eat their young", especially since I have been training a new grad. I have decided this little gal (well actually woman since she is over 40) must have never worked a day in her life. She has zero time management skills and cannot seem to remember from one day to the next how to even flush a saline lock. Now seems to me, that in order for the University to have awarded her a BS degree in nursing she must have exhibited some type of "smarts" along the way. You would think the NCLEX would be designed to weed out total dumb-asses...but apparently not, a few seem to sneak by. Now if I could just figure out how to get her to pull our the information she learned in school and apply it (as in critical thinking skills) to the actual situations maybe we could get a "Real Nurse" out of her. I wonder if my preceptors thought the same thoughts about me (look at that dumb ass!).

Well I can remember some of the "rookie" mistakes I made that made me look pretty ignorant. I remember when we were in a code and the doc wanted 20 mg of something and I misunderstood and ran to get a 20 ml syringe. Of course everybody looked at me like I had lost my mind...then after the code there was some snickering going on (not quite behind my back). Good thing my "friends" kept me in line...can you imagine something that was 20 mg per cc in a 20 ml syringe...well we sure wouldn't need to code them anymore that's for sure.

Ok, so I am praying for patience. I promise to be better. I promise..I promise.

What's up with spell check?

I've written some great posts, but as soon as I do spell check they get locked into drafts...forever...and I cannot post them. Ummmmmmmm need to take time to read how to fix this.

New Grad's BSN Progam

When will the colleges learn...just teaching a person theory and human anatomy and physiology...teaching about disease processes and lab norms and abnormals is not all there is to being a nurse. The new nurses come out so green and wet behind the ear's that they cannot even hook up an IV line to the patient without breaking out in a sweat and having anxiety attacks. A little hands on...hell a lot of hands on....teaching would go a long way to giving these new nurses some confidence!!! Not that I want somebody who thinks they know it all straight out of nursing school....but we all know it just takes a critical patient that you are trying to get off your floor and to the ICU (GOTTA LOVE THE ICU NURSES!!!!)to bring them down a notch! And if you are training somebody and two of the patients are crashing and burning...they learn really quickly that it is not all about knowing the processes and the drugs...it's about quick intervention.

I've been training a new grad...and I think she is gonna be a good one...if she doesn't quit from lack of confidence. She's afraid to do just about anything that involves actually touching the patient. She doesn't trust her own judgement...mainly from lack of CLINICAL PRACTICE. She will come and tell me "Mr. So n so sounds like he may have crackles...can you go listen....maybe I am not hearing right.... You go listen...yup crackles. I think Ms. So n so 's IV is infiltrated...her arm is swelling up a lot. You go look...yup IV is infiltrated...but the IV is still infusing!!! (INTERVENTION GIRL...TURN OFF THE IV, GET A SYRINGE AND SOME NS...CHECK FOR BLOOD RETURN...HOW DOES IT FLUSH..HOW SWOLLEN IS IT?) IV restart...out of the question...at least for now...the new grad turns red, starts sweating and having palpations....:). God , don't we remember those days? At least I was an LVN and could defer anything I didn't know how to do the RN ( who sometimes ranked right up there with God and Jesus at that time). Now that I am an ADN, and I have 7 years experience....I finally feel like a nurse. Of course...when there are two patients crashing and burning simutaneously...I'm like every other nurse...new grad or not....feeling the heat and the feeling that I'm just barely keeping my head above the water.

Sink or swim....all of us have to go through the trail by fire to eventually become a seasoned nurse. I will have to say though, that preceptoring has done a lot for my own self confidence. I realize how far I've come from where I was. I remember being scared to death to make a mistake...I still am...that's why I preach erring on the side of caution. It is better to use your own judgement and intervene for the patient than to just go along and do what ever the doctor's order's say say. Using one's own brain .... and your own assessment skills can save lives .... the doctor is not always there to see the "picture" and most of the time...you call and the doctor backs you up 100%. If not...giving a drug a hour or two late is better than giving something...that you cannot take back if the patient starts crashing and burning!

New grad's...gotta love them...they are tomorrow's preceptor's...and hey, I'm gonna be old someday and need a good seasoned nurse to save my happy butt!