Wednesday, March 23, 2011

A quick story

Was helping out with a procedure on the Mom/Baby Unit that involved the pt getting a little bit of fentanyl beforehand to help chill her out beforehand.

I don't know exactly how it came up, but the other nurse I was working with said something about the doctor having to give it. I dunno, I guess we don't give fentanyl on our unit? *shrug*

So I do the doc a favor and draw it up using a cannula access needle
and put the plastic covering back on to keep sterility while we got everything else together.

The doc comes in and pulls the plastic cap off, exposing the red-hubbed blunt needle and asks (confusedly) "So, um, I just put this into the IV?"

I take the syringe away from her and put the plastic cap on so I can unscrew the access needle. "No, it's a needle-less system. Just screw the syringe into the luer-lock on the IV"

She turns to the patient and tries to figure out how they go together (without even alcohol wiping the IV port!). "Um, I don't usually give medications......"

"How about I give the med and we'll just say you did, okay?"

"Sounds good to me."

I don't think this incident is limited to this one particular doctor. My guess is that most wouldn't know how to give an IV med if you asked them to. Which is why my blood boils when I see doctors doing nursing jobs on shows like House.... If it were realistic, they'd have no clue.

Party Pitfalls....

Beyond, "Can I get a little help in here?!" there is only one other phrase that strikes terror in the hearts of nurses everywhere:

"You should talk to PurpleRN. She's a nurse!"

I was at a party this past weekend and heard the words careen out of a friend's mouth, hitting my good-time-spirit like lead weights. Before I had the chance to avoid eye contact and slip away, I was pulled into the conversation.

Friend: "This guy here is afraid of having surgery."

Me: "Oh? What surgery are you having?"

Guy: "I'm not having surgery."

Me: "Um.... okay..... Then how did this come up?"

Friend: "Tell her about your brother."

Guy: "When my brother was a kid, he had appendicitis and had to have emergency surgery cuz it burst"

Me: "Uh huh....."

G: "So now I'm really worried I'll get appendicitis and have to have surgery."

Me: (Why am I talking to this guy instead of having fun? *sigh*) "I'm guessing he had stomach pains for a few days and your parents didn't take him seriously until it was too late. Generally appendices don't burst without warning.

G: "Yeah, I do remember that happening."

At this point I hoped that our conversation was over, but for the next 20 or so minutes (felt like F O R E V E R) I had to reassure him that no, he was not likely to get appendicitis, that it was even less likely it would burst, educated him about "rebound tenderness" as a classic sign, told him that *if* he had appendicitis and it wasn't an emergency, he could likely request a spinal block rather than general anaesthesia if that was one of his concerns for surgery (at which point I had to explain what a spinal block was...) and I think I'm *finally* done with this guy when he asks again "So you don't think I'll get appendicitis?"

"No. It's not very likely. Judging by your hair color (it was grey) I'd say if you were concerned about something happening to your intestines, I'd get a colon cancer screening."

"People with grey hair are more likely to get colon cancer?"

[facepalm] " You're supposed to get a scope done at age 50 to check for colon cancer."

"Ohhhh.... so you think I'm going to get colon cancer?"

At this point I was interrupted by someone wanting to know if I'd like a drink.

Yes. Yes I did.

Wednesday, March 2, 2011

Back..... to Telemetry!

I was briefly excited when I didn't see my name on the census board. "You're not on my list...." said the Charge. Took a brief look at the list from Staffing, and handwritten off to the side was "PurpleRN - Telemetry."

Good thing I just renewed my ACLS.

As you may recall, my old unit converted to 12hr shifts, so I'd be coming to them a full 4 hours after everyone else started. Apparently I was to take over the patient load of one of my no-longer-new grad comrades. As far as a first assignment after such a long break, I lucked out.

There were two alert CHFers, a new admission (that had just been done by the previous RN) who was super fun and talkative, and only one confused fall risk patient.

It was hard remembering all the stuff I was supposed to do for the shift. Totally forgot about all those stupid skin notes and turning notes. Still good at identifying rhythm strips at least.

They got new Dynamaps, which totally threw me off. You have to take them out of standby mode and respond to prompts on a screen, which is very weird.

The most interesting/annoying new thing is a different style of bed alarm. It looks like and it works by clipping a tether to the patient, and attaching the magnet at the other end to a contact point on the pager-type-thing. And it is only effective if the tether is, say, adjusted short enough so that it rings if the patient sits up. If it is long enough for the patient to get to the edge of the bed without alarming, it's not good....

This pt had been given Zyprexa before bed, with the intention of knocking her out. It did a great job, and I managed not to wake her up until I had to around 0530 for a vital sign check and BP meds. I hadn't noticed how long her tether was, as she was more or less sleeping on it.

The alarm went off around 0600, and two RNs managed to catch her before she slid off the side of the bed. The pt thought she had to go meet her husband. Tried to reorient her (with minimal success) and readjusted the lead. Also set the main bed alarm again.

I forgot how much fun that part was.

All in all, though, it was a pretty good experience going back. And it was hilarious seeing people's surprise when they realized I was working there.