I'm glad people like Marc Koska exist... Truly brilliant
Tuesday, October 27, 2009
Sunday, October 25, 2009
Man I love children...
At work last week a dad came up to the back station with his two kids (8ish and 12ish?). Their mom was on our unit, and the kids were understandably worried. The dad wanted to help reassure the kids, as well as see how his wife was doing.
He asked if the kids could take a look at the telemetry monitor at the desk. I said sure and brought up the appropriate strip window and turned the screen towards the kids.
It was a picture-perfect sinus rhythm, 60-62. I didn't know the patient, so I don't know if that's on the brady side for her or what, but it looked fine to me. I asked if either of them had seen something like this before, and the older one said it looked like in movies. I said that the heart runs on electricity, like a machine, and the bumps were little jolts of electricity. "When the heart gets shocked, it squeezes up tight, just like when you get a static shock and you feel yourself twitch a little bit" I pointed out the QRS complex: "This point here is what tells the heart to beat. See how everything is very smooth, and the bump (P wave) is nice and round, and the spike (QRS) is thin and pointy? Those are all good signs of a healthy heart."
The kids looked a little relieved, as did the dad, I think. lol I brought up another strip, with had a fairly jagged baseline, the occasional missing P wave, and huge blocky QRSs. I pointed out how different it looked from their mom's. Hers was just plain prettier to look at.
Then I told them about the monitor techs in the cockpit looking after her heart, and the phones we carry calling us automatically if something bad happens "but something bad won't happen" interjected the dad. I hope he's right. The dad thanked me for explaining things to them. I told him it was probably the best thing that happened for me all week.
I really enjoyed the interaction. I miss young people a lot. I miss being able to educate people who have open minds and vivid enough imagination to make sense of what I'm telling them. I need to get the hell out of telemetry.
He asked if the kids could take a look at the telemetry monitor at the desk. I said sure and brought up the appropriate strip window and turned the screen towards the kids.
It was a picture-perfect sinus rhythm, 60-62. I didn't know the patient, so I don't know if that's on the brady side for her or what, but it looked fine to me. I asked if either of them had seen something like this before, and the older one said it looked like in movies. I said that the heart runs on electricity, like a machine, and the bumps were little jolts of electricity. "When the heart gets shocked, it squeezes up tight, just like when you get a static shock and you feel yourself twitch a little bit" I pointed out the QRS complex: "This point here is what tells the heart to beat. See how everything is very smooth, and the bump (P wave) is nice and round, and the spike (QRS) is thin and pointy? Those are all good signs of a healthy heart."
The kids looked a little relieved, as did the dad, I think. lol I brought up another strip, with had a fairly jagged baseline, the occasional missing P wave, and huge blocky QRSs. I pointed out how different it looked from their mom's. Hers was just plain prettier to look at.
Then I told them about the monitor techs in the cockpit looking after her heart, and the phones we carry calling us automatically if something bad happens "but something bad won't happen" interjected the dad. I hope he's right. The dad thanked me for explaining things to them. I told him it was probably the best thing that happened for me all week.
I really enjoyed the interaction. I miss young people a lot. I miss being able to educate people who have open minds and vivid enough imagination to make sense of what I'm telling them. I need to get the hell out of telemetry.
Wednesday, October 21, 2009
Spotted this on Nurse In Australia's blog. Had to share....
Be warned, the injection techniques are somewhat scary. What licensed person would even *think* of doing it like this?
Had an odd, yet very good, shift this evening
When I got my assignment at 1500, I was a little concerned. One of my pts was going to cath, and not coming back. One was to be discharged ASAP, as the family was getting antsy. This would leave me with two spaces for admissions. Wheee!
So I got my two out of there as soon as I could. While I was trying to get ducks in a row for my DC, I get a text from monitor tech saying that one of my pt's leads was off. So I go into the room, and my pt is practically dancing out the door, tele box on the bed. I ask her what's up, and she said "The doctor said I can go home!" "Well that's all well and good, but we prefer if you tell the nurses before you start tearing off equipment." She laughed and apologized, and I went to go see if there was a discharge order. Sure enough, in the space it took me to go see her and get back to the station, there was a new order. Okeydokey, I thought. Why not just let another one go...
Did the DC in record time. I was down to one patient by 1630 or so. And my last patient was a young walky-talky who came in for ACS, and had been chest pain free since the morning. Pretty much just here for Lovenox to thin his blood so they could try to avoid another cath (he'd had one in July).
So I was the best damn nurse I could be to my one patient. I also helped 2 other nurses pass meds. Frankly, I was bored lol. I was told I'd be getting an admission, but by 1830, no one called to give report. The Charge and I did the math, and figured that I could go on committee and give my pt to one of the incoming RNs at 1900.
When on committee, you're supposed to do audits and paperwork. I ended up being more Resource-like (as I always do) because it helps the unit far more than all the paperwork in the world. I got to help orient one of our new traveling RNs, a nurse who'd been on the job since I was in kindergarten. I know it's hard getting used to a new hospital with a new system, but she seemed extra frazzled. I helped her out with the computers, drew some blood for her (she said she wasn't very good at it) and found her brain when it went missing. She gave me a hug and a peppermint candy when I found her brain lol. It was very cute.
When I finally went on dinner around 2015, I decided that today would be the day I EKG myself. I've had a weird arrhythmia for a couple years now. Hard to type out, but it's something like lub-dub, lub-dub, lub-dub, lub......DUBlubdub, lub-dub. Everytime I have one of the weird beats, I imagine it looking like a PVC on an EKG. Not that I think/know that's what it is, but it's what it feels like if that makes any sense.
Alas, plain old normal sinus arrhythmia.
After all that effort to hook myself up (granted I only used 5 leads out of laziness) I hoped at least the mysterious rhythm would be identified. No such luck. Maybe I need to be hooked up for an hour or so, maybe overnight, to give my heart a chance to act up.
I even got the opportunity tonight to make the assignment for the unit at 1900 and 2300. I hope I did it okay, and no one was too mad. I think those assignments are easier than the 0700 one. At 0700, *everyone* leaves and you have to start fresh. At 1900 and 2300, only 2 people left each time, so you just sorta fill in the blanks. It was good experience, though, despite the battle with the copier that followed.
I can only hope for another good night tomorrow, day 5 out of 5 in a row. I can't wait for some days off!!!
So I got my two out of there as soon as I could. While I was trying to get ducks in a row for my DC, I get a text from monitor tech saying that one of my pt's leads was off. So I go into the room, and my pt is practically dancing out the door, tele box on the bed. I ask her what's up, and she said "The doctor said I can go home!" "Well that's all well and good, but we prefer if you tell the nurses before you start tearing off equipment." She laughed and apologized, and I went to go see if there was a discharge order. Sure enough, in the space it took me to go see her and get back to the station, there was a new order. Okeydokey, I thought. Why not just let another one go...
Did the DC in record time. I was down to one patient by 1630 or so. And my last patient was a young walky-talky who came in for ACS, and had been chest pain free since the morning. Pretty much just here for Lovenox to thin his blood so they could try to avoid another cath (he'd had one in July).
So I was the best damn nurse I could be to my one patient. I also helped 2 other nurses pass meds. Frankly, I was bored lol. I was told I'd be getting an admission, but by 1830, no one called to give report. The Charge and I did the math, and figured that I could go on committee and give my pt to one of the incoming RNs at 1900.
When on committee, you're supposed to do audits and paperwork. I ended up being more Resource-like (as I always do) because it helps the unit far more than all the paperwork in the world. I got to help orient one of our new traveling RNs, a nurse who'd been on the job since I was in kindergarten. I know it's hard getting used to a new hospital with a new system, but she seemed extra frazzled. I helped her out with the computers, drew some blood for her (she said she wasn't very good at it) and found her brain when it went missing. She gave me a hug and a peppermint candy when I found her brain lol. It was very cute.
When I finally went on dinner around 2015, I decided that today would be the day I EKG myself. I've had a weird arrhythmia for a couple years now. Hard to type out, but it's something like lub-dub, lub-dub, lub-dub, lub......DUBlubdub, lub-dub. Everytime I have one of the weird beats, I imagine it looking like a PVC on an EKG. Not that I think/know that's what it is, but it's what it feels like if that makes any sense.
Alas, plain old normal sinus arrhythmia.
After all that effort to hook myself up (granted I only used 5 leads out of laziness) I hoped at least the mysterious rhythm would be identified. No such luck. Maybe I need to be hooked up for an hour or so, maybe overnight, to give my heart a chance to act up.
I even got the opportunity tonight to make the assignment for the unit at 1900 and 2300. I hope I did it okay, and no one was too mad. I think those assignments are easier than the 0700 one. At 0700, *everyone* leaves and you have to start fresh. At 1900 and 2300, only 2 people left each time, so you just sorta fill in the blanks. It was good experience, though, despite the battle with the copier that followed.
I can only hope for another good night tomorrow, day 5 out of 5 in a row. I can't wait for some days off!!!
Monday, October 19, 2009
Attention! Just a helpful PSA for all those involved in patient care:
We use "emesis" basins as a spittoon for people brushing their teeth in bed. They make great trash receptacles for used tissue. If new and clean, they are useful for containing snackyfoods on the bedside table.
But when a patient turns into a vomit-breathing dragon s/he is *not* going to be able to aim for that little thing.
We try to make sure everyone has a big basin upon admission, but it seems there is never one in the room when the patient needs it OMGNOW!!!!! If you throw a basin away, pleeeease bring in a replacement one.
And that's it for my barf-related rant. :)
Thanks very much to NursingBirth for letting me use the image. Funniest thing I've seen online today. Guess that says a lot for my sense of humour lol.
Tuesday, October 13, 2009
Handwashing Detectors... interesting
http://www.msnbc.msn.com/id/33297138/ns/health-health_care/
"When health care workers enter a patient's room, they wash up and run their hands beneath a nearby HyGreen sensor. The HyGreen sensor activates a green LED light on workers' badges to signal that their hands are clean.
A proximity monitor by the patient's bed then sends out infrared and acoustic signals to the badges, and when the health care workers approach, the monitor verifies that the green badge light is illuminated. If it isn't, the badges quietly vibrate to alert health care workers to clean up. "
"Whenever the HyGreen bed monitors verify if health care workers have washed their hands, they send that information, along with the time and location, to a wireless database maintained by the hospital's infection prevention team. That way, hospitals can know in real time which workers aren't washing up. And, if a hospital-acquired infection breaks out, they can pinpoint the source more accurately."
I'm all for handwashing. I know how important and essential it is. But this seems creepily Big Brother to me.
At least they're discreet. Though I'm wondering how clunky a vibrating badge would have to be. I'm picturing a restaurant pager hanging from my chest lol. And a vibration that buzzes as loud as my cell phone. That wouldn't be good. The last thing I need is a confused little old lady going "what's that?!"
I know I'm not perfect in my handwashing. Especially when I have my hands full of something as I'm entering the room. I wish we had some sort of clean surface to put things on outside the pts' rooms so we could use the gel, then grab the stuff and go in. Most of the time, I end up going in the room, putting the things down on the garbage can lid (because it's the only available flat space in the room), then using the gel. Not the most hygienic practice.
I look forward to the day when we can just irradiate our whole bodies every time we enter a room lol....
"When health care workers enter a patient's room, they wash up and run their hands beneath a nearby HyGreen sensor. The HyGreen sensor activates a green LED light on workers' badges to signal that their hands are clean.
A proximity monitor by the patient's bed then sends out infrared and acoustic signals to the badges, and when the health care workers approach, the monitor verifies that the green badge light is illuminated. If it isn't, the badges quietly vibrate to alert health care workers to clean up. "
"Whenever the HyGreen bed monitors verify if health care workers have washed their hands, they send that information, along with the time and location, to a wireless database maintained by the hospital's infection prevention team. That way, hospitals can know in real time which workers aren't washing up. And, if a hospital-acquired infection breaks out, they can pinpoint the source more accurately."
I'm all for handwashing. I know how important and essential it is. But this seems creepily Big Brother to me.
At least they're discreet. Though I'm wondering how clunky a vibrating badge would have to be. I'm picturing a restaurant pager hanging from my chest lol. And a vibration that buzzes as loud as my cell phone. That wouldn't be good. The last thing I need is a confused little old lady going "what's that?!"
I know I'm not perfect in my handwashing. Especially when I have my hands full of something as I'm entering the room. I wish we had some sort of clean surface to put things on outside the pts' rooms so we could use the gel, then grab the stuff and go in. Most of the time, I end up going in the room, putting the things down on the garbage can lid (because it's the only available flat space in the room), then using the gel. Not the most hygienic practice.
I look forward to the day when we can just irradiate our whole bodies every time we enter a room lol....
A quickie....
I am in the middle of a scheduling block from hell. 5 on, 1 off, 1 on, 1 off, 5 on. Tomorrow will be my first day off. I don't know if I'm going to survive. This is frickin' ridiculous. I'm thinking I'll call in sick Thursday so I can get 3 days off in a row to recuperate. My back it sore as hell from moving heavy people around, and it feels like I'm walking on shards of glass.
As for the quickie, the other day I was going to pull up insulin. Our B station med room was out of the 50 unit syringes, so I went to A station. They had about 20. So I gave Material Services a call and they said they'd take care of it. I did my 1800 med pass, went to dinner and didn't think about it until 2100 fingersticks.
I checked the med room and we didn't have any more syringes than we started, so I called MS again. This time I was informed that they were out.
Yes, the storeroom of a *major* chain hospital was *out* of 50 unit insulin syringes. "We might get some tomorrow," I was told.
So tomorrow (ie, yesterday) comes and we still don't have them. We have to use the 100U ones, which are a pain in the ass to dose accurately. I asked the ass.man. about it and he said he'd call again. Here's hoping today we'll actually have the supplies we need to do our jobs...
But an even bigger hope is that Staffing calls me off today so I can rest my weary bone. I'm too damn young to feel this old.
As for the quickie, the other day I was going to pull up insulin. Our B station med room was out of the 50 unit syringes, so I went to A station. They had about 20. So I gave Material Services a call and they said they'd take care of it. I did my 1800 med pass, went to dinner and didn't think about it until 2100 fingersticks.
I checked the med room and we didn't have any more syringes than we started, so I called MS again. This time I was informed that they were out.
Yes, the storeroom of a *major* chain hospital was *out* of 50 unit insulin syringes. "We might get some tomorrow," I was told.
So tomorrow (ie, yesterday) comes and we still don't have them. We have to use the 100U ones, which are a pain in the ass to dose accurately. I asked the ass.man. about it and he said he'd call again. Here's hoping today we'll actually have the supplies we need to do our jobs...
But an even bigger hope is that Staffing calls me off today so I can rest my weary bone. I'm too damn young to feel this old.
Wednesday, October 7, 2009
Fun doctors' notes, part II....
Do I sense a series beginning? Anyway, here goes:
"CODE STATUS: DNR/DNI and pressors okay partial code. Son Dr. R (psychologist ) easily reachable and involved in the patient's care. Go to sleep man"
I can only imagine what "go to sleep man" refers to... Is it a reference to the son being involved in pt's care? Or a note to another MD to get some rest? Or to himself?
No one knows....
"CODE STATUS: DNR/DNI and pressors okay partial code. Son Dr. R (psychologist ) easily reachable and involved in the patient's care. Go to sleep man"
I can only imagine what "go to sleep man" refers to... Is it a reference to the son being involved in pt's care? Or a note to another MD to get some rest? Or to himself?
No one knows....
Friday, October 2, 2009
Can't a girl catch a break?
So it's 2253. Just did a final rounding check on my patients. They're all comfy in bed, falling asleep. Came back to the computer to make sure I'd finished all my charting. I notice on the monitor that one of my patients' pacemaker is acting very strangely. He'd been tachy in the 120s all day (each QRS with a pacing spike before it) but this time each QRS had two pacing spikes. Having never seen that before, I decided to call cross-cover and let them know. He'd had the battery replaced recently, and I figured any info on it would be helpful.
Two minutes later I get a text from the monitor techs. "rm 55 leads off. thx"
Immediately I get a sinking feeling. Rm 55 is a 90/f who fell yesterday and broke her hip. She has Alzheimer;s, and is confused easily. When asked, she is oriented to person and place. In an odd way, though, it's like her answers are recited and not understood.
"Do you know where you are right now?"
"Big Shiny New Hospital"
But she does not know what it means to be at the Big Shiny New Hospital and she can't remember why she's here.
So I head on down the hallway with the sneaking suspicion that she pulled all her wires.
Why can't I ever be wrong?
Not only has she pulled her tele, she is naked except for her SCDs and a smile, and her two IVs are sitting on the bedside table, along with some kleenex that was obviously used to stop the resultant bleeding.
At that moment I get a call back from cross-cover, who tells me to do an EKG on Mr CrazyPacer. Standing outside a naked woman's room.
I get off the phone as quickly as humanly possible and attend to Ms Sundowner. Still A&Ox2, and pleasant as can be. As she had all day, she would respond to any statement with "Whassat?" until it was repeated several times. I tried to explain, yet again, that I was her nurse and that I would help her. Happened to see my watch. 2257. There's no way I can clear this up in 3 minutes, so I call my Resource.
She comes in and takes over so I can give report to the poor girl who is taking over for me.
Report is given in record time, with much sighing and eye-rolling (understandably. I love you S! *grin*) from my replacement. Since we've finished quickly enough, I tell her I'll take care of Mr CrazyPacer's EKG.
It's 2315 and I get into the room and start up the machine, and I get a call from the Ass.Man. who is demanding to know why Ms Sundowner is getting a sitter and wondering what medications I could have given her instead and asking why I am not rounding more frequently on a patient that I know will be sundowning because she has a history of dementia and what isn't she getting something around the clock for her dementia and I nearly yelled at him to STFU.
I told him that I went by her room about twice an hour and she was sleeping the whole shift. She had no PRN anti-crazy meds and nothing around the clock. The only thing she was taking for Alzheimer's was Aricept. He then starts badgering me about what the MD said when I called (but I hadn't gotten a chance to call) so then I got questioned on why I didn't call. I told him that I knew nothing of the sitter because I asked the Resource to take over so I could give report, and that anything that happened between then and now was something she initiated. I told him I was trying to do an EKG and got off the phone as quickly as possible.
I apologized to Mr CrazyPacer (who was awesome btw) and did the EKG as best I could. The machine decided to hate me and I forgot which button printed out the kind of strip the MD wanted. Eventually got it and then got the hell outta Dodge.
The last thing I wanted was to run into the Ass.Man. on my way out.
I did the best I could, and all I got was him taking out frustrations on me at end of shift. AAARRRGHHH!
Two minutes later I get a text from the monitor techs. "rm 55 leads off. thx"
Immediately I get a sinking feeling. Rm 55 is a 90/f who fell yesterday and broke her hip. She has Alzheimer;s, and is confused easily. When asked, she is oriented to person and place. In an odd way, though, it's like her answers are recited and not understood.
"Do you know where you are right now?"
"Big Shiny New Hospital"
But she does not know what it means to be at the Big Shiny New Hospital and she can't remember why she's here.
So I head on down the hallway with the sneaking suspicion that she pulled all her wires.
Why can't I ever be wrong?
Not only has she pulled her tele, she is naked except for her SCDs and a smile, and her two IVs are sitting on the bedside table, along with some kleenex that was obviously used to stop the resultant bleeding.
At that moment I get a call back from cross-cover, who tells me to do an EKG on Mr CrazyPacer. Standing outside a naked woman's room.
I get off the phone as quickly as humanly possible and attend to Ms Sundowner. Still A&Ox2, and pleasant as can be. As she had all day, she would respond to any statement with "Whassat?" until it was repeated several times. I tried to explain, yet again, that I was her nurse and that I would help her. Happened to see my watch. 2257. There's no way I can clear this up in 3 minutes, so I call my Resource.
She comes in and takes over so I can give report to the poor girl who is taking over for me.
Report is given in record time, with much sighing and eye-rolling (understandably. I love you S! *grin*) from my replacement. Since we've finished quickly enough, I tell her I'll take care of Mr CrazyPacer's EKG.
It's 2315 and I get into the room and start up the machine, and I get a call from the Ass.Man. who is demanding to know why Ms Sundowner is getting a sitter and wondering what medications I could have given her instead and asking why I am not rounding more frequently on a patient that I know will be sundowning because she has a history of dementia and what isn't she getting something around the clock for her dementia and I nearly yelled at him to STFU.
I told him that I went by her room about twice an hour and she was sleeping the whole shift. She had no PRN anti-crazy meds and nothing around the clock. The only thing she was taking for Alzheimer's was Aricept. He then starts badgering me about what the MD said when I called (but I hadn't gotten a chance to call) so then I got questioned on why I didn't call. I told him that I knew nothing of the sitter because I asked the Resource to take over so I could give report, and that anything that happened between then and now was something she initiated. I told him I was trying to do an EKG and got off the phone as quickly as possible.
I apologized to Mr CrazyPacer (who was awesome btw) and did the EKG as best I could. The machine decided to hate me and I forgot which button printed out the kind of strip the MD wanted. Eventually got it and then got the hell outta Dodge.
The last thing I wanted was to run into the Ass.Man. on my way out.
I did the best I could, and all I got was him taking out frustrations on me at end of shift. AAARRRGHHH!
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