A woman had been on our floor for what seems like weeks. She had a history of bipolar disorder, I believe, and she required a 24-hour sitter because she was very confused and would pull at lines and things like that. She often called people nasty names. Sitters are an annoyance, even though they ultimately protect a patient's safety, because they're not provided by the hospital. You have to take someone out of your own staffing to fill the need. That means that you're usually short-staffed when there's a sitter case on the floor. Anyway, as I recall, this patient had had a hip replacement, but the site got infected so they removed the hardware. She was being treated with antibiotics and laid around with no hip joint. On the night shift, while helping to reposition the patient, one of our techs discovered a large pool of blood at her hip site. We ended up calling a code because she was quickly bleeding out. All of a sudden, she became remarkably lucid and was screaming, asking who was going to intubate her, where anesthesia was, etc. A doctor in the room tried to distract her and calm her down, at which point the patient started demanding who that doctor was. When the nurses tried to distract her from that, she started yelling, "No! Who is she? Black glasses, blonde hair. Black glasses, blonde hair!" No one could help but chuckle at the change in the patient's mental status despite the emergent situation.
One of the scarier things that's ever happened to me was when I was taking care of a man with Parkinson's disease. We'd had a very calm morning when I received orders to basically quadruple the amount of the drug he was getting to treat the Parkinson's. I suspected that this was an error, so I paged the doctor to clarify the order. Even though it took a while to receive a response, I confirmed that the new order was correct. Clearly I wasn't the only one to think the order was strange because the pharmacy didn't approve the order for hours. The lack of their approval prevented me from taking the pills out of the medication dispensing machine, so I was stuck. I called the pharmacy to find out why they didn't approve the drug. They said they were waiting to hear back from the ordering physician because the order seemed to strange. I told them that I had spoken to the physician and it was correct. I gave them the physician's pager number to try them again. The order ended up getting approved, and I gave the next dose. About two hours later, the patient went completely unresponsive. His vitals remained fine, but because no one could figure out what was going on, we sent him to the ICU (where, by the way, they continued to give him the drug according to the same order). He ended up getting discharged the following day after waking up and having no problems. He said he remembered the commotion, but wasn't able to respond (I can't imagine anything scarier...). I spent the whole day in agony, thinking I had made the wrong decision to give him the drug despite all my efforts to verify the correctness of the order, but I'm just glad he ended up being fine.
Tuesday, May 19, 2009
Bodily fluids
Last week I was asked to speak on a panel of nurses who had 1-2 years of experience for the nurse residency program at my hospital. Here are a few past events that I thought of as a result of our discussion.
Grossest things I've ever seen:
One time, I took care of a woman who had breast cancer that had metastasized to her brain. I'll always remember her for two reasons. One was this horrendous day she put me through once that all had to do with her taking a shower. The other was a time on a different admission when her health was rapidly declining. Another nurse was taking care of her when she started seizing and was having a lot of difficulty breathing. We called a code and the usual chaos ensued. I noticed that a pool of liquid diarrhea was pouring out of the back of her diaper and collecting below her, so I warned everyone involved so they didn't get covered in the mess. A general surgeon was attempting to insert a central line in her groin. He had tried a few times without success, so he moved to the other side to try there. With his sterile gloves, he pushed aside her diaper and the diarrhea came pouring out there too. He wiped it away with the gloves and successfully put the line in that site. Luckily, he told the ICU nurse that came to transfer the patient, "That line needs to be changed ASAP. It's far from sterile."
More recently, I took care of a woman with colon cancer who has recurrent bowel obstructions, which means that she vomits all the time. This means that her potassium is always low, because she keeps losing it by throwing it up. I received an order to give her some oral potassium pills to replace her losses. I asked if the doctor would be willing to change it to IV form, because I imagined the likelihood of the pill ever getting absorbed was pretty slim. They wanted to try the oral form first, so I brought it in to her. She took the med cup from me, and as she moved it toward her mouth, she slowly said, "I'm feeling a little nauseous..." before projectile vomiting. I had to jump out of the way to avoid being hit by the stream of vomit. It went so far that it actually hit the opposite wall! I've never seen anything like that. And as if that wasn't enough, she did end up getting over a liter of it into a bucket. When I poured it out into the toilet, I saw some whole pills in it. One was bright red, which I didn't recognize. I asked her what it was, and she identified it as one she hadn't taken in over three weeks. Yikes!
Grossest things I've ever seen:
One time, I took care of a woman who had breast cancer that had metastasized to her brain. I'll always remember her for two reasons. One was this horrendous day she put me through once that all had to do with her taking a shower. The other was a time on a different admission when her health was rapidly declining. Another nurse was taking care of her when she started seizing and was having a lot of difficulty breathing. We called a code and the usual chaos ensued. I noticed that a pool of liquid diarrhea was pouring out of the back of her diaper and collecting below her, so I warned everyone involved so they didn't get covered in the mess. A general surgeon was attempting to insert a central line in her groin. He had tried a few times without success, so he moved to the other side to try there. With his sterile gloves, he pushed aside her diaper and the diarrhea came pouring out there too. He wiped it away with the gloves and successfully put the line in that site. Luckily, he told the ICU nurse that came to transfer the patient, "That line needs to be changed ASAP. It's far from sterile."
More recently, I took care of a woman with colon cancer who has recurrent bowel obstructions, which means that she vomits all the time. This means that her potassium is always low, because she keeps losing it by throwing it up. I received an order to give her some oral potassium pills to replace her losses. I asked if the doctor would be willing to change it to IV form, because I imagined the likelihood of the pill ever getting absorbed was pretty slim. They wanted to try the oral form first, so I brought it in to her. She took the med cup from me, and as she moved it toward her mouth, she slowly said, "I'm feeling a little nauseous..." before projectile vomiting. I had to jump out of the way to avoid being hit by the stream of vomit. It went so far that it actually hit the opposite wall! I've never seen anything like that. And as if that wasn't enough, she did end up getting over a liter of it into a bucket. When I poured it out into the toilet, I saw some whole pills in it. One was bright red, which I didn't recognize. I asked her what it was, and she identified it as one she hadn't taken in over three weeks. Yikes!
Monday, May 18, 2009
Julie, Flight Nurse
I had some excitement on my flight back from Boston this morning. As I'm sitting calmly in my seat about midway through the flight, I see a flight attendant get what looked like an AED out of the overhead bin in the front of the plane and head to the rear of the plane. I didn't hear any commotion or call for help, so eventually I figured it must not have been an AED. About 5 minutes later, they did overhead a call for nurses and doctors, so I jumped up and headed to the back of the plane where there was a man leaning over the back of one of the seats. A flight attendant told me he was really nauseous and sweaty. I asked if he was diabetic, and he said yes. I promptly asked the flight attendant for some orange juice, and tried to figure out where this man's baggage was so we could get his glucometer. This was not an easy process, so I called out to the other passengers to see if anyone had one. No response. By this time, a doctor had come to help. Eventually, the man was able to tell us where his bag was, so we got out his glucometer and other meds. My hands were shaking badly as I desperately got his accucheck. It turns out that his blood sugar was actually really high, so he felt much better after giving himself some insulin. Throughout this ordeal, the flight attendant was asking the doctor and me to tell her if we needed to land the plane due to medical emergency. The guy didn't have any chest pain or other symptoms of a heart attack, so he seemed to be in the clear. When we landed in Chicago, there was an ambulance waiting for us and EMTs got the guy off first. As I deplaned, I heard them trying to convince him to go to the hospital to get ruled out for an MI, but who knows what happened after that.
Saturday, May 9, 2009
New leaf
Putting aside the fact that I haven't blogged since 2006, I'm going to try to write a nursing blog. You know, just the weird and crazy and funny stuff. I love the fact that the title of the blog, which I had created while working at the SIC in college, remains humorously appropriate.
I work on a medicine and oncology unit at a large, teaching, university-based medical center. We have 37 beds on the floor, and for at least a year now, we've been solidly full. This is both a good and bad thing. It means we keep our jobs in a shitty economy, but it also means that morale is slightly down, energy reserves are becoming diminished, and we're seeking sicker and sicker people. This, of course, creates more and more work. Were it not for my fantastic colleagues, I'd have been out of there months ago.
Today I worked an 8-hour shift, which is pretty abnormal for me--I usually work 3 12-hour shifts per week. I took care of four patients--two of whom I had taken care of yesterday. One of those patients is a man who has lung cancer that has spread to his liver. He came in with a high calcium level, which is common in cancer patients. Yesterday, he said a few things that didn't make much sense, but overall, was fine. Today, though, he told me we were in an oil tank that was about to explode and thought it was 1925. He'd already pulled out two IVs overnight and got up from bed by himself about 4 times in 30 minutes, even with the bed alarm on. This left me with only one choice--to restrain him. I strapped him down in a vest restraint that attaches to the bed to keep someone from getting up alone. Within 10 minutes, he was begging me to take it off. Not because he knew that I had tied him up, but because "I need to be able to get out of here if this place blows up!!"
The other patient is severely demented woman who spent a month of the geriatric psych unit for a month before coming to my floor to be ruled out for a stroke. The woman spends a few hours a day babbling on to herself. She doesn't make any sense, can't answer questions, and can't follow commands. She doesn't move herself at all, which means that part of my job is to turn her in bed every 2 hours to prevent the development of bed sores. In any case, with any type of care like this that involves touching her, she claws, swats, hits, and grabs at me while screaming obscenities. As long as you can avoid taking this kind of abuse personally and avoid injury, it becomes quite amusing.
Also on the floor were two other jewels. One is a very young man, in his early twenties, in the hospital with a sickle cell crisis. He keeps peeing in the bed and calling for the nurse to change it even though he is able to pee in a urinal, or in the plain old toilet. Now what kind of cognitively intact young man wets the bed?! Of course, his nurses are quite frustrated with him and have spoken pretty harshly to him in an attempt to change this behavior. Yesterday, a few of the techs went in to speak to him after we learned that this guy has a girlfriend. "Do you piss in the bed when you're sleeping with your girlfriend?!" No bed-wetting since.
Another man has threatened violence to the nurses a number of times since his admission. He's also told the nurses about a number of people he's going to "get" upon discharge. We've called security a few times, but this morning the nurse was ready to get the police involved. The patient told her he had a gun under his pillow. After a search by security though, no gun was found. At that point, he told her he would strangle her with some ace wraps.
Just another day at work...
I work on a medicine and oncology unit at a large, teaching, university-based medical center. We have 37 beds on the floor, and for at least a year now, we've been solidly full. This is both a good and bad thing. It means we keep our jobs in a shitty economy, but it also means that morale is slightly down, energy reserves are becoming diminished, and we're seeking sicker and sicker people. This, of course, creates more and more work. Were it not for my fantastic colleagues, I'd have been out of there months ago.
Today I worked an 8-hour shift, which is pretty abnormal for me--I usually work 3 12-hour shifts per week. I took care of four patients--two of whom I had taken care of yesterday. One of those patients is a man who has lung cancer that has spread to his liver. He came in with a high calcium level, which is common in cancer patients. Yesterday, he said a few things that didn't make much sense, but overall, was fine. Today, though, he told me we were in an oil tank that was about to explode and thought it was 1925. He'd already pulled out two IVs overnight and got up from bed by himself about 4 times in 30 minutes, even with the bed alarm on. This left me with only one choice--to restrain him. I strapped him down in a vest restraint that attaches to the bed to keep someone from getting up alone. Within 10 minutes, he was begging me to take it off. Not because he knew that I had tied him up, but because "I need to be able to get out of here if this place blows up!!"
The other patient is severely demented woman who spent a month of the geriatric psych unit for a month before coming to my floor to be ruled out for a stroke. The woman spends a few hours a day babbling on to herself. She doesn't make any sense, can't answer questions, and can't follow commands. She doesn't move herself at all, which means that part of my job is to turn her in bed every 2 hours to prevent the development of bed sores. In any case, with any type of care like this that involves touching her, she claws, swats, hits, and grabs at me while screaming obscenities. As long as you can avoid taking this kind of abuse personally and avoid injury, it becomes quite amusing.
Also on the floor were two other jewels. One is a very young man, in his early twenties, in the hospital with a sickle cell crisis. He keeps peeing in the bed and calling for the nurse to change it even though he is able to pee in a urinal, or in the plain old toilet. Now what kind of cognitively intact young man wets the bed?! Of course, his nurses are quite frustrated with him and have spoken pretty harshly to him in an attempt to change this behavior. Yesterday, a few of the techs went in to speak to him after we learned that this guy has a girlfriend. "Do you piss in the bed when you're sleeping with your girlfriend?!" No bed-wetting since.
Another man has threatened violence to the nurses a number of times since his admission. He's also told the nurses about a number of people he's going to "get" upon discharge. We've called security a few times, but this morning the nurse was ready to get the police involved. The patient told her he had a gun under his pillow. After a search by security though, no gun was found. At that point, he told her he would strangle her with some ace wraps.
Just another day at work...
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