Workin and waitin

Yeah it's hard to tell but the walls are painted and the woodwork is being salvaged. I guess we a re restoring and remodeling. Wish I could be there for the transformation more. It's coming down to the wire. I imposed a deadline to try to help speed things up. Hopefully my husband will be out here in Phoenix in the great weather by Halloween. Lots of little things left to do, paint, counter tops, ok some big things left to do too. We still need stairs out the back of the house and all the floors except the kitchen are hardwood and need sanded and stained. Some days I think it's easier to be here working.
Yesterday was not one of those days. I have been complaining about not being on tele, well, you know what they say about paybacks. I had 2 people go to the cath lab one after the other. My first lady came back with no closure device and had to be flat for 7 hours. She was nice enough to go into flash pulmonary edema and had one of those doctors that won't call you back. This poor old lady needs an aortic valve really badly. She had been NPO all night getting IV fluids at 125/hr. So, by the time she got back from the cath lab and I turned them to his prescribed rate of 100 for 3 hours , she got about 45 min of it before she started coughing and her lungs were crackles all the way up...just freaked me out. I called the doc for 45 min then I got the clinical manager. This poor little thing, her sats were in the low 80"s on room air. By the time we got the doc on the phone and the lasix in her her sats were 91 on 4 liters. Then, the jackass is like all worried about her and calls to check on her a couple of times. Then, he shows up at like 6pm and has to borrow my stethoscope to listen to her lungs. The patient tells him what a great nurse I am and he says yeah she is and caring too. What an ass. The poor thing has a long road ahead of her Monday she's having TEE,a pacemaker, an aortic valve replacement, and a MAZE procedure...she is 85. Tell me your thoughts on that...she is alert and oriented still lives alone and her family is very involved in her care. How would she fair in Hillary's world?
While that is happening I got a 32 year old who was admitted the nite before to the ICU for bilateral pyelonephritis and urosepsis. She had dopamine to keep her bp up and it infiltrated..they used the ante dote to save her skin. They sent her to med surg and when she got there her bp was 60/40...so we'll send her to tele for the dopamine this time. Oh, she needs a PICC but they are backed up so, she has IV fluids going at 250/hr and she needs another IV for the dopamine. The PICC nurse is arguing with me on the phone that the doc needs to come and put in a central line if she's that sick, he's really busy and won't get to her today. We get a second line in her but itsonly a 22. She is a pain in the butt rolling all over the bed. By the end of my shift it went bad. I tried to get another line twice and had to leave the next nurse with the same thing I got...one line but dopamine, IV fluids and antibiotics to go in. All this fun on no break and no lunch yet at 2:30 in the afternoon.
I got my second pt back from the cath lab...luckily she is ok and had gotten a closure device. But 2 hours into her 4 hour bedrest she starts crying and getting nauseated because her bladder is full and she can't go. No orders to straight cath her of course, I get the doc who says bladder scan her and if it's greater than 200 straight cath her. Meanwhile her bladder is hard as a rock and she's starting to lose her lunch...yeah I straight cathed her...850cc later( I clamped it off so she won't spasm) she is happy and smiling. Got a total of 1250cc from her. Bladderscan her...what am I stupid? Let's see him sit in a bed flat on his back being pumped with I fluids at 150/hr, after being given medicine with a side effect of urinary retention. And he has to wait for some doctor to call me back (at least a half an hour) only to give a stupid order to bladderscan him. So now I have to go find the machine (which takes at least another 10-15 minutes because every floor doesn't have one)to mash on his bladder (which hurts like heck because it's being stretched to capacity) with a cold hard ultrasound probe that weighs about a pound and a half, only to discover, that he needs his bladder emptied...oh, let me just wipe all the ultrasound gel off then go and get the straight cath kit and hope no one stops me and asks me a question or to do anything else for you while you lay there in agony. Guess they don't think about it because they never have to watch the patient or the family wait for the call back from them.
So, that was my day yesterday..oh plus I had a patient who went to dialysis and came back and wanted to go home but no doc I called would write the orders and I had discharged someone at 10am. Ya gotta love nursing.
Non noc nocere.