Tuesday, April 22, 2014

Incident my ass

I admitted a pt on my last shift who was ?CVA - for which the orders indicated that the pt was to be screened for dysphagia. I had never done one before but I've heard others talk about it and figured that I could do it just as well. But to be sure I ran the steps by one of my teammates - and I was correct....

so off I went to do the assessment - and the pt passed - so I went back to the computer to document it in meditech.

Somehow it didn't register it. I KNOW I did it - I know that I added the intervention myself and that I documented it. Not entirely sure that I put the intervention on the correct person but I know for sure that I did it.

Well now I'm getting in trouble saying that the documentation wasn't done and an incident report needs to be filled out - it's such BULLSHIT!!!!!!!

I'm seriously starting to hate this unit. Is it a huge deal whether it was done? The important bit was that it WAS done and was communicated to on-coming nurse who then communicated it to the next nurse.... hell if anyone was to actually ASK this pt if someone did this, they're cognitively in tact enough to say so I bet! But of course not, who would ever do anything so easy!

ARGGGGGGGGGGGGGGGGGG!!!!!!!!!!!!

Sunday, April 20, 2014

Hypertensive kind of day

My shift was filled with 3/5 pts requiring interventions for SBP > 150

Go figure their BP's were ok ALL DAY LONG! Now I get onto shift and these BPs are incredibly out of whack.

Several phone calls later and ppl's BPs are semi back to where I wouldn't shit my pants because they're sooooo high.

It was amusing when I took my one guy's BP and found it to be 170/100ish and so I went looking for the on-call doc - turns out he was on the next door unit so I took my  MAR and went to him....

What had happened was that my pt's IV went interstitial last night and family decided they didn't want access anymore and the discussion was to make the pt DNR - but not palliative.... well the IV access was because my pt couldn't control his own BP due to pontine myelinolysis and so required IV hydralazine - but without that access it was changed to G-tube.... well the doc's in all their wisdom decided to leave the dosage the same even though the route was now different..... now it was catching up with my pt! On-call doc was familiar with the guy and said he didn't much care that it was elevated and to just give him his next scheduled dose of hydralazine - which wasn't actually due for another 3 hrs. Ya not happening without an actual order. So since the guy was moaning (he was also nonverbal and non responsive except to pain) off I went to grab him some morphine - hey it's going to lower the BP so it's helpful in two ways! Then I also gave himt he hydralazine when I was supposed to and an hour later it was 149/90 - well at least it was moving in the right direction!

At least it's no longer my problem! Tomorrow is another day though!

Thursday, April 17, 2014

I'm no longer a virgin

I'm shell shocked speechless

I had my virginity taken away from me....

One of my patients died. While I was working. Anytime I've taken care of a dying person, they've always died after I've had them. Or before I come onto shift then I have to do the death rites. But this time it was different.

Sort of anyways.....

Between my first shift and me coming on for the next shift my patient's O2 needs increased ALOT.... as in 2L to requiring 50% O2.

He lasted on 50% for 2 hrs then went up to 60% for an hour then needed 100% via a non rebreather mask in order to simply maintain him at 90% - and I had the vitals machine hooked up to his toe so that if I or any of my colleagues went past his room we would know what his sat was (BTW ALL his other vitals were awesome)

I did my last rounds at 0645hrs - I get off at 0730hrs so that left me enough time in order to complete my documentation.

At 0730 hrs I gave report on 4 of my patients - then was about to go into THAT pt's room when my colleague decided she wanted report on the other patient first - I said alright and we went to the room next door (door ways are not next to each other tho) and gave report.... took about another 5 minutes total.

When we went into Mr. X's room, he was gone. You could tell just by looking at him. Clearly he had just passed because he was still warm. My colleague and I just looked at each other completely shocked. He was NOT expected to pass! At least he was a DNR so we didn't have to do anything to him but man was I shocked. I couldn't believe he had died.

Stats state that people die most often at change of shift - go figure!

I feeel a bit of guilt - maybe had I gone in there another time he wouldn't have died. You coudl tell that he knew he was dying because he took off his oxygen mask. It was sitting in his hand. So maybe if I had gone in there again it would have stayed on his face, helping to keep him breathing.

When I informed his doctor that he had died he was shocked as well. No one expected this guy to die. I mean, 2 days previously he was on the rehab unit!!!! He was on his way to getting better (he was a previous patient on our unit and I had taken care of him when he was with us before - so it was kinda surreal). So because he wasn't expected to die there was no order on his chart that indicated that the nurse could pronounce so we had to wait to pronounce til the doctor made it to us.

I felt bad for his family as well because they didn't get a chance to say their goodbyes. When I called his family I was only able to say that he was doing poorly and that they needed to come now (charge nurse told me not to tell them that he had died). Sucks. His family was shattered that they didn't make it in time to say goodbye. So of course they're going to feel guilty that they didn't get to the hospital faster. UGH. I would seriously be pissed or feel guilty if that sort of thing happened to me let me tell you!

I left my patient's death rites to my colleague but I did all the documentation associated with his death. May he rest in peace!


Monday, April 7, 2014

I passed at least

Unfortunately I missed the top level by 3% - ugh!

Feeling less overwhelmed but at least I have a bit of stuff off my plate. I'm plugging my way through it.

I feel like the little train that could - "I think I can, I think I can, I think I can" - therefore I know I can.



On other news... I've been in talks with the teacher of my next course (clinical that is) about trying to set up placement cause I've had SUCH a hard time getting it arranged myself. I have inquired whether I would be able to do placement in the ER because I work already in a medical unit and if I can't get into a surgical unit then I would love to try out a placement in the ER. We'll see how that goes though, it's doubtful.

Friday, April 4, 2014

Overwhelmed

A feeling I can certainly say I feel at the moment.

Here's what's on my plate...

Sunday previous - MAJOR test - only got 73% on it (boo!)
Tuesday this past - 3 quizzes - not too bad but a TON of reading for it
Tomorrow - MAJOR paper due - still reading resources, got my quotes picked out (mainly) but still have to get it put together

Saturday - working days then coming home and studying immediately BECAUSE....
Sunday - another MAJOR test - can't say I feel prepared for it! Oh and I have to also work days! Plus I have a discussion board post due and my final draft of my paper for my one course (finished that one already at least)

Then Tuesday I have 2 more quizzes - TON of reading for them.
Friday - MAJOR paper due - mostly done - still have to complete the editing though.
Sunday another discussion board - and I work saturday and sunday evenings.

And it just keeps going like that with a few more tests and quizzes thrown in for good measure!

Seriously, I'm only JUST keeping my head above water - it doesn't help that this paper that's due tomorrow is NOT a subject that interests me (so as to try my ADHD!) and the psych course is the bane of my existance (I hate the subject - and hate is a strong word but it so aptly fits!). I just keep telling myself to take one day at a time, it's the only way I'm surviving.

Monday, March 31, 2014

Never thought this would happen

Saw the surgeon today, after my night shift....

And he said that I was healed enough that he cut my fistula string!!!!!! I'm done with it.

I never thought it would happen. It's felt like it's been FOREVER and a day since this all started.

He said I don't need to see him again....

Unless I develop another abcess (good God I sure hope not!!!) or if the fistula doesn't close up properly and I am still getting discharge and pain in a month from now.

He gave me another month of short weeks for work but then I should be back to work regular schedule!

Saturday, March 29, 2014

How did I get myself into this mess?!

I was sleeping away, dreading getting out of bed.... it was after 3:30 when the phone called.... it was my charge nurse asking where I was and why I wasn't working! HOLY SHIT BATMAN, I wasn't SUPPOSED to be working.... Hell I even double checked that since two weeks ago I went into work when I wasn't supposed to be working (OK with that because at least I'm not getting in shit for going in when I'm not supposed to)... so I made for SURE what I working this weekend. So much so that I printed out new schedules last week because I was paranoid about missing a shift or something.

So I told my charge nurse that I didn't have a problem coming in but that I would also bring my schedule to PROVE that the problem wasn't me this time!!!

So I brought my schedule in and even proved myself! What was her response?! Ya, make sure that you go into the scheduling system to ensure that you know your shifts, don't go by the print outs that SHE does!!!!! Grrrrrr...... Lady it's not like I'm available to work many shifts! We also called scheduling people to ask when the shift was accepted... turns out more than a week ago at 10:20 AAAAAAAMMMMMM - let me state this in VERY clear language - I LOVE MY SLEEP!!!! So when I drop my daughter at school, I go straight to bed... I do NOT pass go.... so I sure as hell wasn't answering the phone at that hour to accept a shift more than a week in advance!!!!

Plus, when I accept a shift, I get the scheduling people to send me an email indicating which shift I've accepted on which day so that when this sort of shit happens I can have proof or something.... well I certainly did NOT have an email from them indicating the "supposed" shift I picked up.

So off I went.... late - and it was the shift from HEEEEEEEEEEELLLLLLLLLLLLLLLLLLLL - it was like it was fucking payback for not knowing I was supposed to be working or something.

Pt 1 - CVA, lang barrier - on the call bell ALLLLLLLLLLLLLL the time - which I don't understand half the time what the pt wants... so that was fun - oh and a diabetic so you have all the extra work that goes along with that.... plus she's incontinent.

Pt 2 - non formed but has a security guard - because he's hallucinating - that snakes are crawling all over him - turns out it's actually illusions which still suck majorly but the pt KNOWS that what he's experiencing isn't real but still it traumatized and wants it to end! Plus he's a double amputee who's also a diabetic - and is newly admitted and the chart hasn't been checked yet by a nurse (so that "fun" job lands on my shoulders - which has to be checked BEFORE I can do meds or diabetic stuff) - and he doesn't want to be in his bed (because he thinks that the bedding is snakes (don't blame him for that one) and so he's very anxious and needs a LOT of hand holding and reassurance.... plus psych came and saw him so I got even MORE orders (at least these should stop his illusions - we hope!)

Pt 3 - trached, MORBIDLY obese, basilar stroke (AKA VERY BAD), legally blind and because of the stroke can't talk - but she CAN hear and DOES understand - (man that would suck!) and she's in pain and for some reason thinks she's going to fall out of bed so ANY kind of movement makes her startle and drip the side rails for dear life. She's incontinent so it takes several of us to change her (which causes more work because you have to go FIND the other people to assist). Has a PEG tube which means that you have to crush the meds and dissolve them and THEN administer them.... which means lots of work. Oh the fact that there's a trach insitu means that you have to suction so there's more work for you there - I had to do so 4 times in my shift... and when you suction it has to be sterile so there's more work there. She's on 2 different antibiotics that you have to go into our med room for - so more work for that. And she's diabetic - so more work for that one.... oh and when I came on she was tachycardic at >145 bpm - but BP was JUST FINE - so I had to call the doc about that one - administer that med..... which didn't really bring the pulse down so after about 4 hours I had to call on-call doc and get ANOTHER med ordered.... and that all takes work because you have to transcribe the med, get the med co signed - then go give it..... and an hour later recheck vitals and an hour later recheck again. Good thing was was that she wasn't symptomatic - she wasn't having trouble breathing and her BP was good.... it was just that her heart was racing. The other part of lots of work has to do with her tube feeding - you have to make sure that you only put one can in at a time because this reduces reflux and the risk of aspiration (forget why but as long as it work it's cool with me!) but you have to still take the time to fiddle with the stuff... and when you give meds you have put them through that which can be a pain in the butt..... FYI pantoprazole is NOT a good med for PEGs or G/J tubes - it clogs them regardless of what you do. And I have told our pharmacist to ensure that autosubbing is done for this stupid med but I am ALWAYS the one bringing it to his attention.

Pt 4 - my ONLY independent pt - did NOT know that he had a urostomy until like 2000hrs when the daughter went looking for me because his urostomy was leaking!!! So off I went to find supplies to change it out - which THANKFULLY we actually had on unit! And of course THAT takes more time away that I just don't have.... he had an IV and two antibiotics - quite a bit of work for that one because I had to prime two lines (incompatible with each other) because he's a new patient.... Other than that he was simple! Poor guy got ignored otherwise. Such is the life though!

Ya it was nuts to say the least. I have 2 more night shifts to go for this weekend - I hope they're better than tonites shift! Though I know who'll be working with me tomorrow and when this one gal and I work together it seems like the floor goes crazy - honestly, the last time we worked we had to restrain FOUR patients, and other patient had a grand mal seizure for like 3 minutes! Insanity! So ya, it should be interesting!