Sunday, January 25, 2015

Having the rug pulled out from under you

Could you imagine being in the prime of your life - so between 20-40 yrs old - in the point of time where you're supposed to find the person you LOVE and get married, have children, travel some, finish school and find a job (hopefully a good one!), apply for health insurance through them so it's coming out of THEIR pocket and not yours and live a GLORIOUS life!!!

So you're in the midst of doing so...

THEN.....

BAM

You are hit with a diagnosis of HIV!!!



Thing is, you live a non risky life, you've done EVERYTHING correctly so how the HELL did you get this?! You've never had a blood transfusion, haven't travelled (unless you count going on a cruise 2 yrs ago that the riskiest thing you did was do accupuncture - I wouldn't have but we aren't talking about me!) and don't have risky sexual encounters (have been monogomous their entire life)... so how does this happen?! AND how is that you find out when you're applying for health insurance?! Geeze if THAT doesn't suck, I don't know what does!

And HOW do you, as a nurse respond when your patient just breaks DOWN - and of course you feel like shit for asking about the diagnosis - you try to be empathetic but how the hell am I supposed to relate when I have never experienced this and I can't even try to. But I CAN be sympathetic and try to lend an ear as well as a shoulder. I did that today for my pt. I hope I provided some hope for this pt.



Monday, January 12, 2015

Outbreak

Had to work a dayshift - the BANE of my existance! Of course it was a shift from hell.

Normally we carry four patients on days

#1 - pt with ALS with increased SOB (possibly pneumonia) and has a PEG tube and requires multiple IV things (antibiotics and solu medrol), plus is a total care.

#2 - a nursing home patient who was made palliative - has influenza A - and is doing better. Is a total care plus a total feed and a diabetic.

#3 - pt with GBS who is now a quadrapalegic and thereby a total care and feed, also a diabetic - plus the family is really needy.

#4 - pt is one assist. Had a stroke but seems pretty good other than some memory issues. Needed a follow up head CT and discharge was pending the result. Also a diabetic so several checks and subsequent insulin injections for those who also have diabetes.

So it's a heavier assignment but not ridiculous. The doc comes in a discharges #2 so I have to call the nursing home and let them know that the pt is coming back and asking if they want the MAR faxed or whether a photocopy will do.... package is made up for them and the ambulance is booked.... for 45 minutes later! Well about 30 minutes after that the nursing home calls us back and indicates that they're in an outbreak and the pt cannot come back. I asked what outbreak and am told it's influenza A.... I told my co-worker... "meh, it shouldn't matter, he's already infected"  HAHAHAHA

I told the doc about it and he said that if he came to the hospital during the outbreak and that he could return during the outbreak. And because the Dr decreed it, so shall it went! And off I sent him.

The other doc came in and discharged pt #4 later in the day. So then I had two discharges and two admissions I had to worry about. On top of all the regular things I have to undertake I have these things. Plus try to fit  my break into all this! UGH I hate these kinds of shifts!!!

Saturday, January 3, 2015

The day I threw an epic fit

So I've worked almost 3.5 yrs where I am. So I'm not new. I've had my fair share of assignments. Some good, some really, really crappy. But RARELY do I EVER throw a fit about it. I normally just try to find a team mate and get my shit done.

Yesterday was a different story...

I worked my normal evenings and came in find 5 patients assigned to me...

Bed. 1 - young adult with a new trach (which = a lot of secretions which = lots of suctioning) who already has stage 2 coccyx ulcer (has NO adipose tissue so therefore no cushioning) which = turning every 2 hours and changing at that time as well to try to prevent the ulcer from getting worse. Also has a G tube so that's more work... and is on dilantin which means remembering to hold the feed for 1 hr pre and post administration. And of course lovely family members who are all up in your face about care being done IMMEDIATELY because they're used to one-on-one care like the ICU.

Bed 2 - open but report was already taken and it's a repatriation from another hospital and it's an acute CVA.... so admission and who knows what kind of condition the pt will be in. Although it looks easy to do, it takes at LEAST 1.5 hrs for an admission because of all the charting and such that needs to be done as well as carrying orders and contacting doctors for orders and such.

Bed 3 - CVA who requires little in terms of assistance except for meds and supplies.

Bed 4 - Parkinsons (end-stageish) who is DELERIOUS!!! And absolutely BONKERS!!! Speaks another language and LOVES to climb out of bed! Is a total feed and is incontinent of urine AND stool... also needs to be turned every 2 hrs..... so a LOT of work with this patient.

Bed 5 - a total again who has UBER amounts of dressings that have to be changed multiple times a day. Is obese so it takes several ppl to turn (always takes time trying to find someone to help!) and needs to be done at least q2hrs. Is also a total feed and incontinent of urine and stool. This one makes your back kill by the end of the night.

Now I wasn't going to say a bloody thing until I found out that bed 5 was being discharged back to the nursing home and so I would have all the work of a discharge and then ANOTHER admission....

But to top this all off was that I'm super sick with a head cold and a chest thing (I'm thinking bronchitis - it hurts to breathe but I don't have any wheezing or crackles) and the ONLY reason I went to work was because I knew my friend was working and when I needed help would come to my assistance immediately and would work as my dedicated teammate.

So THAT was where I drew the line....

I knew I couldn't do a total delerious pt, a total trach with many needs, AND two admissions.... if I wasn't sick I probably could but I just knew I couldn't.

So I went to the charge nurse and asked for a change in assignment.... and she went beserk! Talking about how everyone is always complaining about their assignment and how everyone should just put up and shut up. That was where I was like "I NEVER complain about my assignment so you need to stop".... I got another nurse involved (who regularly is charge nurse when I'm working) and even said to her, "when do I EVER complain about my assignment?! I never do" And she agreed which was nice and so the current charge nurse although irritated that she had to change the assignment begrudgingly did so.

So my 5th pt was someone who required IV meds, narcotics several times, a foley that I had to empty but was independent in every other way.... which was just fine by me!

I barely made it through my shift but at least I can say I did. Then I told the next charge nurse that they needed to cancel my shifts for the rest of the weekend cuz I was too sick to work!

Sunday, December 21, 2014

The reason for little girls

Today we had our first ever tea party. Little tykes friends (2 from school) and one we've known for like 4+ yrs came.

It was a TON of fun! We thought about this because when we went north to go have Christmas with my family, my mom's best friend's daughter gave us HER daughter's tea set.... and it's impressive! It's care bear (not that you really notice it in the cups but the saucers have little bears on them - which the girls thought were really cute so it's all good!) and think deep shade of pink which it's ultra feminine but very pretty none the less. Then because I wanted to meet the mommy's I decided to make it a mommy and daughter tea. Of the 5 invites I sent to school two said that they could come. Then of course I invited my pal and her daughter. So because of this I went out and bought a tea set that the adults could use. It was a really simple design, though elegant. IMO the day was a great success. Now if only I could get better at time management for things such as this! I totally needed just another 30 min (I suppose I shouldn't have "snoozed" my alarm twice!)

Little tyke had a TON of fun and so did I. I hope we can strike up some outside school friendships. the mom's seem pretty cool so we'll see.

Saturday, December 13, 2014

This MUST be a joke

My journey through school to get my BSN finally has seriously been a roller coaster.... several ups and a BUNCH of downs.... with many twists and turns.

But I've always hung on, thinking that God has a plan and that with him, all things are possible....

I'm living in a house that I have grown to hate, with people I seriously detest (and I KNOW feel the same way), in a situation that makes me depressed if I think too much about...

I work in an area that I'm undervalued and underappreciated. Where I do the SAME duties as a BSN nurse but get paid at LEAST $5 (minimum!) an hour less. But I think, well this gives me knowledge and skills I need to have as a BSN nurse so it's all good....

Well I've been on this road for 5+ yrs now... and I STILL don't have my BSN.... I'm STILL experiencing roadblocks and difficulties and ignorance/intolerance....

It's hard not to feel deflated to hear "no" YET again. To be told that they won't can't help me.

It seems that when I find an open door it gets slammed in my face.

I talked to the contract person today and told him that we had to change avenues AGAIN.... he gaffaed at the incredulity of the situation.... that he had NEVER experienced the difficulty in ANY student previously before as I have had (should I be surprised, no.... but I was).

Anyone know anyone in Michigan that would want to help a student out with placement???? Let me know! I certainly need it!

Sunday, November 30, 2014

Klebsiella pneumoniae - an interesting fact

Had a pt who has a UTI that has this growing in her urine.... that went in and infected her blood. Then because of this all she went septic and her liver and kidneys shut down....

Now the interesting thing is that this specific strain that the pt was infected with can ONLY be caught by FILIPINOs!!!!

Majorly weird.... even talked to infectious disease doc about it.... don't know how the pt even contracted the infection because they hadn't been to the philippines in years (yes their race was filipino in case you were curious).

Unfortunately, my pt spiked a temp tonight as I was leaving, also complaining of RUQ pain and then also had decreased sats (was 95% on my shift, no SOB at all) - the new nurse couldn't get the sat >90%,.. so off I go paging the on-call to get orders.... portable CXR and a change in antibiotics (still that the bacteria is sensitive to but in a different class).... so hopefully tomorrow we'll see a change for the better!

Friday, November 28, 2014

And I do my job so well

My last shift made me feel like I've mad a difference in a person's life for the legit first time.

I had a pt who needed an IV because of being on IV antibiotics and the doc wouldn't consent to an oral route. So I asked a colleague to help me out - they were a difficult stick and have had plenty of sticks so I figured I would get the best instead of rumagging around in their arms trying to find meself one! Well after break we managed to get a chance to get a go at it.... we both go in the room.... and JUST as she sticks my pt....

OFF GOES THE CODE BLUE ALARM

Now a few months back we were getting sooooo many fake alarms because of the ppl who designed the building and made the code blue buttons look like they could be call buttons..... so they put a shield over them to defer ppl from doing this..... now when they're pushed they're usually legit.

So our unit doesn't actually have our own code blue cart.... we have an AED.... BUT we ARE just down the road from one (we are next to cardiology and they have PLENTY of legit codes so it's only apt that they have their own!)...

Well it just so happens that where my pt's room is is riiiiiight across from where we store the cart (incl suction and oxygen tank in case the wall one doesn't work).... so because I wasn't being used in my own pt's room I went racing out and grabbed said stuff and raced to the room where the code was.

Upon entering the pt was in high fowlers so I immediately dropped the bed flat while a different colleague applied a non-rebreather... as we were getting this all done EVERYONE arrived.... the code team - the ICU team and of course all of my unit colleagues....

The ICU nurse handed over the CPR board.... while someone else applied leads on the pt and yet another went about hooking up the suction in the room....

The ICU nurse yells out "everyone stop we need to see if there's a pulse"

She subsequently checks for a femoral...

Nope, nothing.... "OK, start CPR"

Well my colleague, bless her heart, is vertically inclined and said that she would do CPR - ya I stepped on that one and told her ya right (oh ya, for some god unknown reason someone had put the bed HIIIIIIIIIIGH in the air) so there was NOOOOO way that she was getting to this guy's chest in order to start compressions! I told her to lower the bed and I would start CPR...

And goodness did I.... all that was going through my head was getting the rhythm right and the depth.... and immediately as I pushed down on this guy's chest did I hear (and feel) the "crack" of breaking ribs..... geeze it felt like I broke his damn sternum! And for the next 5-6 compressions I broke more ribs.... the thing that was going through my head at the time was "well if I'm breaking them then I'm doing something right!".... then time seemed to make me realize that I'm supposed to be counting for 60 compressions so that this guy could get some breaths!.... so off I go counting.

About 3/4 of the way there the RT decides that they're going to intubate and so off they go trying to put a tube in this guy..... and boy did they yank on his jaw and neck trying to get him intubated.... hell I could even see down his throat!!! But at least he was able to be intubated!

Then the lead doc decides that I had done CPR for long enough and declares that I need to change places.... so I stop.... and they check for his pulse....

SUCCESS!!!!!!!!!! A steady rhythm with a pretty good BP!

People seem to calm down and we wait a few minutes watching him and waiting to see if his heart will stop again.... and thankfully it didn't.

We got him stabilized and transported him to ICU where he started to come to and actually trying to move.... ALL a fabulous sign!

I can't wait to go back to work and find out what has happened since. It was all very thrilling to be a part of this and to actually be successful! To think that I actually DID something to bring LIFE back to someone! And trust me, you could see the INSTANT that life came back to his body. It was magnificent! THIS is the reason why I love nursing.... why I want to work in critical care.... to make such an astounding difference in someone's life.