Today I admitted a rapid response patient from the floor. He was struggling for each breath, and decided he wanted to be intubated. He was a cancer patient, age 60, and had previously been a DNI/DNR. When they can't breathe, it's so scary many patients change their mind. As we were preparing to intubate, he told us that he did not want ACLS, compressions, defibrillation, etc if for some reason his heart couldn't take it.
I explained everything in a calm voice while chaos swirled around him. I told him we were going to put him to sleep and he wouldn't feel the breathing tube being put in. That he wouldn't remember it and would wake up later. But he didn't wake up later. Anesthesia intubated, he bradied down, dropped his pressure... we gave fluids, 1 of epi, and 200mcgs of phenyl. He lost his pulsed. We stopped. He was pronounced.
It doesn't usually happen like that in my unit. People usually come to us almost dead, or they slowly slip away throughout their stay with us. They aren't usually talking to us one minute, dead the next.
The daughter almost threw up when she came in, she was crying so hard.
My other patient's daughter said to me later, "I think I saw a dead body being wheeled out of here, oh my god that was horrible." I said, "yes, that was my patient from this morning. He didn't make it." Her jaw dropping, "How do you do this job?!?!?! I'm so glad I'm a teacher!"
Friday, January 27, 2012
Thursday, January 26, 2012
by the way
I just realized that I never mentioned that I passed my CCRN. With a terrible migraine, I might add. Wow, it's a hard exam. About half way through I started making guesses, because my head was pounding. It's a miracle that I passed, but I did. Damn, I must be smart! Heh heh...
I've been making some sweet overtime money, but I'm about to go on a four day stretch, which I haven't done since Thanksgiving, and man that was rough. I just go into it like a soldier going off to war. If I'm lucky, I'll stay at a friend's house near the hospital for optimal sleep time.
Yesterday, I was singled with a patient with a wound vac. The wound vac cannister was filling up hourly, she was weeping from everywhere, and leaking from her Dignicare (rectal tube). So, she was busy. But for some reason known to the charge nurse only, I was given a second patient at 3pm. I guess I didn't look busy enough with the one. The 2nd patient was also very busy. Bleeding out, in fact, with a case of refractory ITP that no one knows what to do with anymore. So JUST because she was a DNR/DNI, did NOT mean that she was comfort care! Which means she was still a lot of work because I was massively transfusing, using pressure bags for the blood products and fluids, just to keep her pressure up. Because of course it bottomed out, and the family started arguing about using pressors, and I had to stop the whole show and get the (still mentating) patient to make her own wishes known. She didn't want pressors. Which is fine, but that's actually MORE work for me, not less, because that meant 6 liters of fluids to pressurize into her lines. All the while delegating everything for my other patient to other very helpful co-workers.
Anyway. She stabilized but I don't know what ended up happening. All I know was that I got out a half hour late. And that annoys me. Also, the honey nut cheerios I finally opened, and had a mouthful of when her pressure tanked, were just a cupful of soggy mush when I finally got out of the room.
Just another example of a day in the life of a nurse like MOI!
Anyway.
I've been making some sweet overtime money, but I'm about to go on a four day stretch, which I haven't done since Thanksgiving, and man that was rough. I just go into it like a soldier going off to war. If I'm lucky, I'll stay at a friend's house near the hospital for optimal sleep time.
Yesterday, I was singled with a patient with a wound vac. The wound vac cannister was filling up hourly, she was weeping from everywhere, and leaking from her Dignicare (rectal tube). So, she was busy. But for some reason known to the charge nurse only, I was given a second patient at 3pm. I guess I didn't look busy enough with the one. The 2nd patient was also very busy. Bleeding out, in fact, with a case of refractory ITP that no one knows what to do with anymore. So JUST because she was a DNR/DNI, did NOT mean that she was comfort care! Which means she was still a lot of work because I was massively transfusing, using pressure bags for the blood products and fluids, just to keep her pressure up. Because of course it bottomed out, and the family started arguing about using pressors, and I had to stop the whole show and get the (still mentating) patient to make her own wishes known. She didn't want pressors. Which is fine, but that's actually MORE work for me, not less, because that meant 6 liters of fluids to pressurize into her lines. All the while delegating everything for my other patient to other very helpful co-workers.
Anyway. She stabilized but I don't know what ended up happening. All I know was that I got out a half hour late. And that annoys me. Also, the honey nut cheerios I finally opened, and had a mouthful of when her pressure tanked, were just a cupful of soggy mush when I finally got out of the room.
Just another example of a day in the life of a nurse like MOI!
Anyway.
Thursday, November 17, 2011
a little bit about me
I have had a fever of viral origin for over a week, continuously. This morning I woke up fever free, but found that I could not blink or close my left eye. I had a dentist appointment, and he found weakness of my cheek, eyelid, and lip muscles on the left side when grimacing, smiling, puckering, and squinting. I had no right-sided weakness on the rest of my body. My eye is very dry from not blinking, and I also discovered that I cannot taste anything on the top or left side of my tongue. What I can taste on the right side has a strong metallic aftertaste.
I'm lucky that it's mild enough that I don't look completely odd, I can still make facial expressions with just a bit of droop or stiffness on the left side. Such a mild case should be totally resolved in two weeks. I'm on an antibiotic in case an infected tooth nerve root led to the inflammation, but it was probably the virus with the high fevers.*update* A family friend just happens to be a facial paralysis specialist. She started me on a steroid burst and antiviral.
From The National Institute of Neurological Disorders and Stroke:
http://www.ninds.nih.gov/disorders/bells/detail_bells.htm
What is Bell's Palsy?
Bell's palsy is a form of temporary facial paralysis resulting from damage or trauma to the facial nerves. Each facial nerve directs the muscles on one side of the face, including those that control eye blinking and closing, and facial expressions such as smiling and frowning. The facial nerve also transmits taste sensations from the tongue.
What Causes Bell's Palsy?
Bell's palsy occurs when the nerve that controls the facial muscles is swollen, inflamed, or compressed, resulting in facial weakness or paralysis. Exactly what causes this damage, however, is unknown. Most scientists believe that a viral infection such as viral meningitis or the common cold sore virus—herpes simplex—causes the disorder. They believe that the facial nerve swells and becomes inflamed in reaction to the infection, causing pressure within the Fallopian canal and leading to ischemia (the restriction of blood and oxygen to the nerve cells). In some mild cases (where recovery is rapid), there is damage only to the myelin sheath of the nerve. The myelin sheath is the fatty covering-which acts as an insulator-on nerve fibers in the brain.
The disorder has also been associated with influenza or a flu-like illness, headaches, chronic middle ear infection, high blood pressure, diabetes, sarcoidosis, tumors, Lyme disease, and trauma such as skull fracture or facial injury.
I'm lucky that it's mild enough that I don't look completely odd, I can still make facial expressions with just a bit of droop or stiffness on the left side. Such a mild case should be totally resolved in two weeks. I'm on an antibiotic in case an infected tooth nerve root led to the inflammation, but it was probably the virus with the high fevers.*update* A family friend just happens to be a facial paralysis specialist. She started me on a steroid burst and antiviral.
From The National Institute of Neurological Disorders and Stroke:
http://www.ninds.nih.gov/disorders/bells/detail_bells.htm
What is Bell's Palsy?
Bell's palsy is a form of temporary facial paralysis resulting from damage or trauma to the facial nerves. Each facial nerve directs the muscles on one side of the face, including those that control eye blinking and closing, and facial expressions such as smiling and frowning. The facial nerve also transmits taste sensations from the tongue.
What Causes Bell's Palsy?
Bell's palsy occurs when the nerve that controls the facial muscles is swollen, inflamed, or compressed, resulting in facial weakness or paralysis. Exactly what causes this damage, however, is unknown. Most scientists believe that a viral infection such as viral meningitis or the common cold sore virus—herpes simplex—causes the disorder. They believe that the facial nerve swells and becomes inflamed in reaction to the infection, causing pressure within the Fallopian canal and leading to ischemia (the restriction of blood and oxygen to the nerve cells). In some mild cases (where recovery is rapid), there is damage only to the myelin sheath of the nerve. The myelin sheath is the fatty covering-which acts as an insulator-on nerve fibers in the brain.
The disorder has also been associated with influenza or a flu-like illness, headaches, chronic middle ear infection, high blood pressure, diabetes, sarcoidosis, tumors, Lyme disease, and trauma such as skull fracture or facial injury.
updates
- My CCRN exam is set for the 28th of November.
- We ratified our nurse's contract. I think our show of numbers and solidarity really made a big difference.
- The virus I had with continuous fevers caused me to miss three days of work and ate up all my PTO. And I feel really, really out of sorts without going to work.
- We ratified our nurse's contract. I think our show of numbers and solidarity really made a big difference.
- The virus I had with continuous fevers caused me to miss three days of work and ate up all my PTO. And I feel really, really out of sorts without going to work.
Sunday, November 13, 2011
they don't make this easy
I've had seasonal influenza for the past six days. I had to call of to work this weekend, that's 24 hours of paid time off. I'm supposed to work Monday as well, which is tomorrow. If I don't go, I will only have 4 hours of PTO left. In our institution, you absolutely CANNOT call off without enough PTO in your bank to cover you. So I'd be ok, but god forbid something else happen this month.
I have been feeling better, and would like to go back to work tomorrow (get me out of this house!!!), but I spiked a fever last night, again. And I know that I shouldn't be returning to work without it having been 24 hours fever-free. Which means if I don't spike a fever all night, I'd be fine. But if I did, it would be too late to call in!
And most importantly, I take care of patients who are severely immunocomprimised. It could kill them. I guess that settles the whole argument.
Isn't it sad that administration can put such fear into their employees for calling in, when it can be a life or death situation?
I have been feeling better, and would like to go back to work tomorrow (get me out of this house!!!), but I spiked a fever last night, again. And I know that I shouldn't be returning to work without it having been 24 hours fever-free. Which means if I don't spike a fever all night, I'd be fine. But if I did, it would be too late to call in!
And most importantly, I take care of patients who are severely immunocomprimised. It could kill them. I guess that settles the whole argument.
Isn't it sad that administration can put such fear into their employees for calling in, when it can be a life or death situation?
Sunday, October 30, 2011
the good fight
Soooo my nurse's union, part of National Nurses United, has been struggling to settle a contract with our administration. We've been picketing (not striking), marching, rallying, and showing up to every meeting and press release we can. The administration wanted to slash raises, double healthcare premiums, limit scheduling flexibility, ramp up disciplinary actions, take away healthcare coverage for those on extended childcare leave and disability leave,raising the age of retirement, and other unmentionable acts. They claimed that the current state of the economy leaves them no choice but to slash the nursing budget. And yet our health system has been making money and increasing bonuses and salaries to those at the top for the past three years.
Our bargaining team has announced that a tentative agreement has finally been reached. The administrative seems to have backed off of some of their demands... in response to nurses showing up in the THOUSANDS to protest! YAY nursing power! Yay to the little people! Yay to patients who have happy nurses who are proud of the work they do and the people they work for!
Will I vote yes on the ratified tentative contract? That remains to be seen.
Friday, September 30, 2011
raising the bar
I'm going to take the CCRN... I paid the money, I've been studying (sort of), and I got my authorization to test in the mail. And then I lost it. So I am now trying to get a new one, even though the card said "DO NOT LOSE THIS NUMBER". Hopefully the receipt for the huge fee I paid to take it will be good enough to get another card.
By the way, I'm just a sucker for certifications. And tests. It makes me feel better about myself. It's just a test, doesn't make me a better nurse! But does provide a great learning opportunity. Oh, and I don't get paid more.
By the way, I'm just a sucker for certifications. And tests. It makes me feel better about myself. It's just a test, doesn't make me a better nurse! But does provide a great learning opportunity. Oh, and I don't get paid more.
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