The new year

Ok, I slacked off on my blog...Facebook has taken over. Sorry. This new year has already brought some laughs...a 90 year old woman with a gi bleed. The doctor says I need to drop an ng..so I'm trying to explain this to the patient who is of course hard of hearing and I say" I need to put a tube in your nose to go down to your stomach and see if there is any blood in there". She says... "oh, up my nose with a rubber hose, I get it". I never laughed so much, all this from a poor little lady who I thought might not make it. She did tolerate the procedure very well, and even thanked me.
Most of my new year at work was spent in the telemetry monitor room where we watch all the telemetry for the 3 tele units in the hospital. It gives you another perspective on that position. It's not easy to watch all the screens and see if something is different from earlier in the day. It's a different kind of stress.
Here's hoping that healthcare gets better in 2010.

New nurses and nurses to be

Just a few thoughts...for all of you nursing students and new nurses. Please use the time at clinicals to learn and do new stuff, not look in your books and hide in our breakroom. You only get so much time to learn, pretty soon you will be expected to do it. Please treat your patients like they were a beloved family member, or just how you would want to be treated. Spend your down time talking with them, walking with them and getting to know them, it will help you to better care for them.
Please stop whining about how much you have to read, how hard your papers are and how long it takes to get your test scores, it's meant to be stressful, because nursing is stressful. Be grateful you can see your test scores online in a matter of hours, we had to wait until the next class (up to a week,OMG)
I would like to remind you that you are lucky. There was a time when the NCLEX was only offered twice a year in major cities across the country. It was an eight hour a day 2 day test.It was a paper and pencil multiple answer exam. You waited up to 3 months for the results. During those waiting periods you could work as a graduate nurse, similar to an externship until you got your results.
It's more than a job, it's a calling.
Non noc nocere.

this weekend

Ya gotta love the full moon. It brings out the interesting people. And the beloved change of shift code....classic Torsades de pointe. The worst part was that he was a relatively young man and his Mom was in the room when he went out. We tried to get her out but, the code cart was blocking the doorway out of the room, not to mention the numerous bodies that filled the room. I think she got to see the first shock...pretty traumatic, but, it was life or death at the time.We got her out to the desk and spiritual care was there to be with her.He was intubated and sent to the ICU and returned to our unit later the next day. Lucky.It just seems I am seeing younger and younger MI and coronary artery disease patients.38 and 40 year olds having triple bypass and more. Most of them preventable with the right lifestyle changes...you can't change what's inherited but you can keep from adding to it.It's a choice. Life is a choice. Your life is your choice.
Non noc nocere

Cardiac stuff

I had a great weekend, went to a cardiac symposium put on by one of the local cardiology groups. It was held at the Arizona Golf Resort..very nice and great food. The speakers were informative and some of them were even funny. No, really, Cardiologists, funny, I swear. The latest stuff...lets see..not 3 nitros for chest pain, if you take one nitro wait 5 minutes if it doesn't help call 911. The newest dose of aspirin is 162mg, 325 after a stent for a month or so then down to 81 or 162 the whole time. Percutaneous valve replacements are being done at certain sites across the country right now but they are a thing of the future. To see all the info...www.tricitycardiology.com.
I had a 75 ya\ear old woman who went into rapid a fib even though she was on a maintinence dose of Cardizem. Her b/p was 100's over 60's...doc ordered 600mg of Rythmol then 150mg bid plus and increase to 240mg Cardizem. I was nervous, he said it would be fine...I warned my coworkers to keep an eye on her heart rate for me. I gave the Cardizem then about an hour later I gave the Rythmol. About an hour later she called and said she felt dizzy, I had the nursing assistant take her b/p but I went in the room as well...good thing, her b/p was 59/30... and she was on her way out. I called for the charge nurse, some saline and oxygen but I stayed with her, then I called the code. She was out not responding, couldn't get a b/p, eyes rolled back. I put the head of her bed down and was doing the "Annie Annie are you ok" thing when she opened her eyes, I was relieved ,somewhat ,but not out of the woods yet. Luckily the doc was still in the hospital and came when the code was called...we gave her fluids, some atropine, cuz her heart rate was 30, then she started to throw up...gave her some Zofran...and another bolus of fluids. The code team left and I was there with her and the doc. I stayed with her and explained a little bit of what happened, I called her family and at her request, asked them to come to the hospital. Her daughter ended up staying the night with her. She made it thru the crisis and went for a cardioversion the next day. To my surprise, when I asked the monitor room, they said she never did lose her heart rhythm, just her blood pressure.
Moral of the story...listen to your gut instinct. I didn't want to give the meds... I just had a feeling. The doc explained that the Cardizem would slow the rate and the Rhythmol would make her heart beat faster and that would hopefully convert her rhythm..it sounded good but I was still uncomfortable, which is why I enlisted my coworkers help to watch the monitor. Ah, the joys of cardiac nursing.
Non Noc Nocere

On the road nursing

So, I got a text message last week that my sister was on vacation and had chest pain. She was sitting in a hospital in Las Vegas and her kids were in Oklahoma City freaking out. I took the short 1hr flight to be by her side and translate the medical system for her and her husband. She is not the easiest person in the world to please, she has very high standards. Since she had gone by cab to the hospital, she ended up at a low standard small facility just off the strip. (no name, at this time) I had never heard of it before, nor had anyone I know heard of it.
The hospital was small, maybe 5 floors, and not modern in anyway. Unfortunately it was not kept very clean either, much to my sisters horror, she thought hospitals were clean places. Funny how most people think that. She had her ekg and her serial cardiac enzymes which were all negative and she was pain free. She was in the middle of her stress test when I arrived. I walked back up to her room with her. The transporter said he would let the nurse know that she was back,my sister had not yet met her nurse. The "nurse" didn't come in to say hello for an hour and a half. And that's all she did was say hello, no stethoscope, no vital signs, nothing about whether she could eat or drink...just, hi I'm your nurse I'll be back with your pills. About 2 hours later she was back with her pills, no beta blocker though, just aspirin and nitro, and of course Protonix.(wish I had bought stock in that drug company). That was it, didn't see her again. Twice in a twelve hour shift, really...are you kidding me? That is acceptible nursing care?
Then we met the doctor with a chip on his little shoulder. Did not want to hear about letting my sister leave and go back to Oklahoma...granted her stress test was positive for reversible ischemia, but, she's pain free and there's no positive enzymes. He ordered a cardiology consult...ok here's my irritation...it is now 6:30 at night on a Friday in Las Vegas...could we not have called doctor attitude when we got the results and told him so he could ask for a cardiology consult earlier? Frustrating. Not to mention that my sister was not offered so much as a washcloth or a towel (not even one left in the room) let alone to be set up to bathe or change her linens. Plus the fact that one of her telemetry leads was off for over an hour, yeah I put it back on after I helped her get a bath...yeah, no one came in when they were all off either. Thank goodness the night shift charge nurse and nurse were excellent. They came in and introduced themselves and did an assessment and told her about her meds and everything a good nurse should do.(thanks Cheryl and Joy)
We saw the cardiologist by 11am on Saturday, he talked about a cath until we told him she was there on vacation, was pain free and wanted to go home to follow up with her cardiologist there. He said fine, as long as she flew home and didn't drive back...Dr attitude said no, he would not sign her discharge, she has to sign out AMA. What a power play. So, we eloped instead...lots of people don't know it but, you can just walk out without signing the paper.
It was a long ride home with an emotional sister, she hates flying, but we made it safely. She had her echo and her cath and no MI or blockage thank goodness. Probably the rare cardiovascular artery spasms...leave it to my sister to be one in a million.
I came away from the experience with a new view and appreciation for my patients and their families and what they have to go through with our messed up medical system. Minutes literally are hours when you are waiting. Keeping people as informed as possible will keep them happy...most people anyway.
Send me an email before you decide to travel to Las Vegas and I'll tell you the name of the hospital to avoid.
Non noc nocere

Nurses Week

Talk about cutting back.... how was your nurses week? Mine was anticlimactic to say the least. On Nurses day we got these info cards on bright green card stock... the info was how we could do better. Things like answer the phone (within 3 rings) with a smile on your face as if you were on video. Before you leave any patient room or visitor encounter ask if there is anything else I can do for you. And if , I'm sorry when (within 1 minute)you answer a call light own it and play it through...yeah it was that kind of Nurses day. Not a thank you or a nice job or any of the positive things we should hear..just work harder. No lame lunch bag, no water bottle, not even so much as a free pen...how about ya'll?
non noc nocere

Depends on the day

The first picture was from our second day at the Grand Canyon...thank goodness we had the first day (second picture) otherwise we wouldn't have seen any of it's beauty. Sounds like work...some days you see the good things you do, others there's just so much in the way you can't see at all. Hope you are having a good day.