Friday, March 22, 2013

Thursday, March 21, 2013

HOLY SHITBALLS of a shift!!!!

So I worked nights on Monday - I enjoy nights.... it's "supposed" to be quieter and calmer. Except that I work on a neurology unit and we have CRAZIES!!!!!!!!!! It was no different, so here's my rendition of what went down....

Go into work and get report at 11:30 - I get the "crazy" ward - ward room (4 bed room) which tends to be filled with the ones who are bed climbers (not intentionally either, just seems to work out that way) and monday was no different... All except the new admit were on exit bed pad alarms which go off when the pt gets out of bed....

Report given was that pt 1 had one of his meds held because his BP was 104/76 - to me that's a good BP for most ppl but this one med his MRP wanted it held if his BP was <140 data-blogger-escaped-.="" data-blogger-escaped-5="" data-blogger-escaped-admitted="" data-blogger-escaped-and="" data-blogger-escaped-awake="" data-blogger-escaped-because="" data-blogger-escaped-br="" data-blogger-escaped-continued="" data-blogger-escaped-delerium.="" data-blogger-escaped-for="" data-blogger-escaped-go="" data-blogger-escaped-got="" data-blogger-escaped-he="" data-blogger-escaped-hello="" data-blogger-escaped-him="" data-blogger-escaped-his="" data-blogger-escaped-i="" data-blogger-escaped-in="" data-blogger-escaped-language="" data-blogger-escaped-my="" data-blogger-escaped-native="" data-blogger-escaped-of="" data-blogger-escaped-other="" data-blogger-escaped-pts.="" data-blogger-escaped-report="" data-blogger-escaped-said="" data-blogger-escaped-sleep="" data-blogger-escaped-so="" data-blogger-escaped-still="" data-blogger-escaped-to="" data-blogger-escaped-told="" data-blogger-escaped-was="" data-blogger-escaped-when="" data-blogger-escaped-with="">
Once I finished report, I sat my ass in front of the closest computer to that room so that if any of the pads went off I could run to the room in time to get the pt before they climb out of bed or fall. So when the pad went off (and I realized what the sound was because it's different than the sound our exit BEDS make) I ran to the room to find the pt standing next to him bed. I silently cursed myself for not realizing the sound faster and thanked the high heavens that he hadn't fallen.

I put him back bed and told him to go to sleep again. Pt rambled something that I didn't understand (in his language that I only speak/understand a little of) and so I made my way back to the station hoping that he would fall asleep. NO such luck! Less than 5 minutes later the alarm goes off again and I go into the room to find the pt at the end of the bed. Internally thanking myself that I got there fast enough to intercede before he fell. The pt muttered something about bathroom so I figured that he needed to void.

I assisted him to the bathroom, semi forcefully assisted him to sit on the toilet he said "no pee", ok I understand that one! Now I figured that if I put him back to bed that he would just keep setting off the alarm so I did what every other nurse does on our unit when we have climbers that won't sleep.... put them in a geriatric chair that tilts and reclines the pt and allows us to put them by our station to keep an eye on them and prevent them from falling. He didn't want to sit in the chair but again I eagerly encouraged him to sit in it. Smart bugger he was too that once I put the seat belt on (upside down to make it more difficult to undo) he still figured it out in record time.

So once in front of the station I left him with my co worker so that i could go find a tray that goes with the wheelchair. Once found I put that sucker on and boy was the pt pissed.... he kept banging the tray saying "no eat, no eat" in his language over and over. Now that I knew he couldn't get the tray off, I put him next to our other resident climber lady parked in front of the station already, figuring they could keep each other company since they speak each other's language. Once beside her he calmed down and they started talking.

Quite pleased with myself I sat back down in my computer spot and started in on my night shift work....

At approx. 0200hrs one of my co workers gets up out her spot to do something and says "Hey Dee, your guy is having a seizure"

Now, this statement is NEVERRRRRRRRRRRRRRRR good!!! And it's certainly not something I expected to be hearing in regards to this pt seeing as he was admitted with delerium, not traumatic brain injury or stroke or a seizure disorder so I got my ass off that chair in a split second and beelined it to my pt (not as far as I'm making it seem) but when I turned around and looked at my pt all I saw was his head back and his arms at the side of his chair. They weren't shaking or anything. When I got beside him I shook him, spoke to him, asked him if he was ok (again in his language) and called for the RN (she was down the hall). I explained to her what happened and had he go get the vitals machine while I stayed with my pt. Although my pt was breathing, he wasn't responsive. When I took his vitals, and the machine finally registered it (it inflated twice and inflated to as high as 227 so I wasn't expecting the results I got) his BP was like 54/30... WTF???!!! I didn't believe it so I did it again with the same machine on the same arm. Again pretty much the same results. Now I was internally freaking out! I had the RN go get a different machine and when we redid his BP on the opposite arm it was a tad bit higher (like 60/35). HOLY SHITBALLS!!!

I immediately paged the on-call Dr, who then told me to call support (silent code blue) which is one nurse with her 5 lead monitor machine and code blue stocked cart. It took her like 10 minutes to get to us which I was surprised with.

She didn't believe me that his BP dropped that much and figured that it was a low reading because our BP cuffs are longer ones which can cause lower readings because of cuff fit. But her machine read the same as mine, and that he was bradycardic. She asked for his chart, MAR and Kardex which took a couple of min since they were spread out in a couple of different places. When I got back to her she still hadn't put the leads on him so I questioned whether she was going to hook him up or whether she wanted an ECG for him. She said she wanted to do the leads first and see his rhythm to decide whether to justify an ECG.

She monitored him for a bit more and again he had a seizure, but it was very brief - maybe 5-10 sec. The support nurse was like "I think that was a seizure" but wasn't totally sure. Another 20 min pass (guestimate) and he has another one... now she indicated that she thought that maybe they were syncope episodes but couldn't rule out a seizure. But she asked me to put him back to his bed.

The RN who helped me with his BP was still around so I asked her to help me get him back to bed. Once we got into the room and beside the bed I untilted and pulled his seat back up to sitting position (before he was completely reclined in order to make sure the ECG monitor strip wouldn't show artifact from movement) he started to have another "seizure" but a min+ later he wasn't stopping and was losing consciousness, his head had dropped forward and I was supporting his upper body as well as his head position so he didn't constrict his airway. Our hospital has a no lift policy but I made a decision that if we didn't get him back to bed that he was going to lost consciousness and probably die from lack of air or his heart stop because his heart wasn't compensating for being upright that's for sure. I told the RN to grab his lower body and I would have his upper body (since I was already supporting it) and we heaved ho him into his bed. Once supine his shaking stopped and I stayed with him while I had the RN go tell the support nurse (who was now talking to the support team physician). Shittiest part of this all is that while doing this I reinjure my lower back - ARGH.

Approx. 5-10 min later the support nurse comes back into the room and hooks him back up to the machine and wait for the Doc to arrive. I go out and check on my other couple of pts since nothing can be done til the Doc arrives and you can totally tell when he does cuz he has this little lost puppy dog face... I point him in the right direction and follow him in.

He checks on the pt, does a sternal rub, somewhat gets the pt to respond and tells me he wants a blood sugar check... I go to find the equipment (just to find out that they're locked and have to do the QC on them, just to find out that I myself am locked out of them because I guess it didn't register the last time I did a QC because I didn't download the machine soon enough after it, grrrrrrrrrr!) and get my ass to the room, do the check and it's 5.9... ok that's not bad IMO but Doc isn't impressed and wants an amp of D50W IV push stat and figures that he's not drinking enough so he also wants a NS bolus, 500mL stat.

I go out to get the D50W from our PIXIS med dispensary machine and come back into the room to find out that the nurse just took it from her machine.... I inform the nurse that it would have been nice that she had told me she was going to do that. She tells me that she'll keep the one I brought and just put it back into her cart so at least I don't have to return it to my machine. Then I go and get the NS and when I get back the nurse tells me that she can't get the D50 to push through. I grab a NS flush and am able to get mine to go through and told the nurse that sometimes you just have to push the shit out of the tube and sure enough it starts to go through.

While she's doing that I put up the IV stuff and get him connected and program the pump for bolus wide open. At first it wouldn't accept it so I had to start out with 100cc then every 1-3sec bump it up by 100cc til I finally got it to except 999cc. I leave that running and head back to the nurses station to find out that the Doc got paged to a lady vomitting frank blood and needed to go. He writes a bunch of orders for blood work and says that if anything is abnormal to page him. GREAT!

Approx. 15 min has gone by and when I go back to the room the support nurse tells me that his BP was come up to 127/60 which is certainly MUCH better! And support nurse indicates that pt's doing much better, is almost alert again and that she has to go to the other page for vomitting blood lady and that if I need anything or if anything changes to page her.

Pt maintained his BP til about 0600hrs when it was 94/50 which all I was thinking was plz keep at least this BP til I leave, then it can be someone else's respomsibility!!!

Long story short, I'm still a death virgin - I haven't had ANY patients die on my shift!!!

Bad news is that I pulled something or pinched something in my back and I'm off work til at least next tuesday.

Sunday, March 17, 2013

Am I awesome or what?!

I FINALLY got my mark from my prof for developmental psychology throughout the lifespan - only took 2 weeks and me constantly haggling her!

I got 94% in that class!!! BOO YA!!! That will certainly jack my GPA up a few notches!!!

So now all I have to conquer is my CPR recert - doing that later this week. And then I have to study to test out on an english course and public speaking - the last which you have to do a speech for that has be 3-5 min long. Now that might not seem long, but if you don't know your topic before hand, that could be tricky!!! Not really looking forward to it let me tell ya!

This online crap is SOOOOOO not for me. It definately stirs up my ADHD and procrastination let me tell ya all! It's super hard to be motivated in the environment that I live in. I wish hubby would have my back and be ok with us moving out of this place and FINALLY having a place to our OWN again. It makes me so sad and depressed and when I'm like this it's hard to be motivated to do school work and studying.

Work is going well, again, just wish that I were in a department that I loved - like paeds! I'm so uber jealous of my coworker for getting a position on their unit. I'll seriously have to keep my eyes peeled.

Wednesday, March 6, 2013

Thinkin of transferring

I think I've come to the end of the road for being on my unit. It's such a friggin heavy pt load wise and the manager won't give us PSW's (personal support worker).

We've lost something like 6 nurses since I've been there - to other units I mean. The newest nurse has left us for paeds. I'm going to miss her, she's one of the good ones. I wish I was leaving for there!

Now I have to watch the boards to see what's available, cuz I'll only leave for paeds or labor & delivery.

Hopefully something will come up soon.... plus, working one of these units will sets me up for when I become an RN.