Friday, July 24, 2009

Weird ass dream about a patient....

There was a patient on our floor recently for a GI bleed. The docs were giving him Colyte to clear him out for colonoscopy, and every time he had a BM it looked like a murder scene. Soaked through the bedding, dripped on the floor. Really bad.

Yesterday someone finally said "You can give him all the Colyte in the world, it's an active bleed and he's not getting any better" and he was moved to a higher level of care unit.

Because the guy is in his late 80s, the docs are very wary of doing surgery. And this is where my dream begins...

I'm talking with another nurse about the crappy situation this guy is in. "Either they do surgery and he likely dies from anaesthesia, or has to have an ostomy for the rest of his life, or something like that. Or, they do nothing and he bleeds to death. Every bag of blood we put in comes right back out"

I start asking around if anyone knows what eventually happened to this guy, and came across a whiteboard with patient names on it (not unlike the one in our station, but a little different). Next to this patient's name it said "Dead."

I got very freaked out. Oh man, I just took care of this guy, and he's gone already? Craziness! So I go walking around some more and come across the patient's family members.

I ask them what happened, and they start talking about how this has been a difficult time for them, but no, he's not actually dead.

What happened in reality was that after all the bleeding from between his legs, he decided he was supposed to be a woman, and that he was just on his period. And had a sex change operation. The old "him" was dead, but "she" was alive and well.

And thus ends my dream. I wish to god I knew what to make of it.....

I think there's something wrong with my brain.

Thursday, July 16, 2009

It's official. My manager hates me.

She came up to me yesterday and said "Purple, I've volunteered you for a new project. It's about keeping the care boards updated."

Care boards are in each patient's room. They have the date, room number, room phone, MD's name, RN's name and phone number, and the "plan of care" for the patient's stay.

It is to be fully filled out and updated daily.

And she wants me to be in charge of making sure it's done for "maybe 5-8 rooms" every shift I work.

Note that. When I am *working* on the floor with with *patients of my own*, she wants me to go around and check other people's rooms to make sure their boards are filled out.

We *have* people that do this, when they're on committee and don't have anything better to do. I have better things to do, dammit.

And what's this BS about volunteering me? That's not how volunteering works, *especially* when it's something that could adversely affect my patient care.

I don't know what she's trying to pull here, but I don't like it...

Tuesday, July 7, 2009

One last important thing....

Today I received in my work email a very urgent notice from the head of all computery-stuffs.

Apparently we are *not* to be using hospital computers to stream Michael Jackson's memorial service from the interwebs tomorrow, as it ties up bandwidth required for critical patient care applications.

They *really* deemed it necessary to send out an email? Even if I *did* give a crap about the memorial, I don't have time to sit and watch *anything* during my shift.


And sometimes it ends up okay...

At 1900 they switched me to committee, where I had time to write that last entry. I also ate dinner, helped reposition a patient, delivered some lab labels to a new admit, helped reinsert the NG tube, called pharmacy about a missing medication, did a fingerstick, started an IV (one shot! gorgeous forearm vein. probably coulda gotten a 16 in it), and showed some people how to find a certain report on the computer system.

Felt way more useful than when I had patients.

And then, afterward, I went to Denny's with four of the best friends a person could hope to work with. Nothing soothes frazzled nerves like a strawberry milkshake and some bad-for-you food, mixed with an enthusiastic gripe-fest.

Thank god for my coworkers. Sometimes they're the only thing separating me from a 5150 hold :)

Monday, July 6, 2009

Assignment Despite Objection

A Day Shift RN filled out a form that documented her objection to her pt load, because it was unsafe. She encouraged me to do the same.

My load was way too heavy. I cried for the first time in a month or two. Sigh.

One pt was here on suicide watch. No reason for her to be here. Heart is just fine, needs to be in a psych facility. She has a sitter for 1:1 observation. Waste of a sitter. Very tearful, but not very demanding. Not really a problem.

One pt was here for an possible infection in a dialysis port. He's mostly healthy and wants to go home. But he's on a heparin drip, which is a high-alert medication that also requires monitoring thru frequent labs. And he's been bleeding. One of his IVs yesterday, and his dialysis catheter today. And one of his IVs was starting to annoy him, and it had to be DC'd and replaced.

One pt came from ICU th'other day. Part of her intestine ruptured, so she had surgery to clean it out and make a colostomy. She has a colostomy bag, a line of staples (which were removed too early by a med student) and a few drains. She was in ICU for respiratory arrest, and is on high-flo O2. She hasn't been eating, so she's on CPN, food thru the veins. This means fingersticks q6hrs. She also doesn't swallow well, requiring meds to be crushed in applesauce. Her family is concerned about her recent mental fuzziness. She has a PICC line. All labs are RN drawn

One pt was also in ICU in the past for respiratory arrest. He had a PEG tube placed, which he pulled out a few days back. This means there is a hole in his stomach and abdomen. To prevent infection, there is an NG tube to suction to make sure nothing stays in his stomach. He has been pulling his tube out at least once a day every day. He's been on restraints, but his day shift nurse decided he was doing okay enough to have them off. Not the brightest of ideas. He also has CPN, requiring fingersticks. He has a PICC line, and I got orders at the beginning of shift to hang 5 extra bags of medication, which I have to juggle with his ABx and anti-seizure meds. He was doing ok until 1900, when (surprise surprise) he pulled his NG tube. The Dr has now said that *no one* is to take off his restraints for at least 3 days, because repeatedly jamming a tube down his nose is rather bad for the tissue. He's also on contact precautions.

I know on paper it doesn't seem so bad. But it's too much for a person to handle. I only survived because my resource did a bunch of meds and lab draws for me, and because one of the RNs who wasn't even supposed to be doing pt care did meds for me.

I barely had time to assess my patients before having to work on the meds.

I tried not to get overwhelmed but I couldn't stop it.

Hooray for crying in the breakroom. And bathroom. And almost on the floor.

I am so glad I have the next 2 days off. If not I'd probably call in sick.