this'll be a sizeable paycheck, but i'd rather have a life

Soooo last night. First night officially back on 5 patients. I started with 4 with a pending admission. Keisha let me have the last admit, and I still thought I was going to drown. It was one of those nights where 2 could have kept me running, much less 5. So here's the rundown of said patients:

1. young female, hx of HTN, had a stroke and now has rt side paralysis, garbled incomprehensible speech, but still has enough cognitive function to try to ask you things and look at you sadly when you have no effing clue what she needs/wants. she was on 2 L O2, Iv antibiotics, peg tube for meds and cans of Jevity, eye drops for a goopy droopy eye, and a demanding family who is trying to file a compliant as I am getting report.

2. mildly confused lady who came in with a GI bleed who is getting her second unit of blood. she is incontinent, keeps having overflow issues with her diapers (onto the bed and floor), and proceeds to pull all her linens off her bed, take off her night gown, then yell for the nurse down the hallway. Her bed lacked a bed alarm.

3. highly confused patient who has a history of pulling out equipment. currently has a catheter as well as a femoral line. her bed alarm worked, but she was at the end of the hallway, and you almost had to sprint when you heard it going off. she kept trying to get up to go to the bathroom and pulled off the foley statlock and the dressing on her line, which was already under strain because it was hooked up to fluids.

4. sweet lady with high blood pressure and sugar. and knotty jumpy deep veins that i couldn't start an IV in.

5. my new admit that came in at 3 am- nice little lady with a hx of a bilateral lung transplant and end stage renal failure. She needed blood, premedication, and labs.

I did not get a break. I ate a granola bar at the desk while looking at orders for my new admit. I left at 9:30am. I did have some crackers and juice to help me finish my charting. i gave out PRN medications like they were going out of style. Patient 1 got klonopin, ambien, ativan, and 5 mg dilaudid (3 doses- 1mg, 2 mg, 2 mg) over the course of the evening. i am pretty sure that combo would have just flat out killed me. But not her, she didn't even seem to sleep. Patient 2 got lasix after her second unit of blood... and then she peed on the floor again and complained that there weren't more linens in her cabinet (um sorry, you have soiled the whole stock. twice.) Patient 3 got lasix, ultram, and maybe hydralazine I think and Xanax that did very little to help her settle down. and I think she was supposed to get clonidine but i ran out of time. Patient 4 got insulin, ambien, lasix, and hydralazine. Patient 5 got benedryl and tylenol.

Also, I had 4 incontinent, or only semi-continent patients. And the slowest PCT on the planet. I swear she just would like amble down the hallway and mumble to herself. And she never had her phone, the patients were always getting out of bed, or coming off the monitor, or needed labs, or new sheets, and she was no where to be found. We emptied Patient 2's catheter around 2 am and it had 2700 cc output in it. Um. there is no way all that was produced in the two hours since the last vitals were checked. I don't know what the hell she was doing all night, but next time i work with her, I am definitely going to put my foot down about her being reached by phone. especially when we have such high fall risk patients. who are ALL the way at the end of the hallway. Gah.

I essentially ran around like a crazy person from 7pm-2am, then had an hour to chart my initial assessments and sign off for the next days MARs before my admission got to the floor. I was pissed because they faxed the report, then didn't push the patient for like 15 minutes, and when they did, they pushed the wrong one in the computer, so I had to call the ED, and they brought the patient to the floor before I actually had a chance to look at the orders. From 3-5 I tried to admit Patient 5, and keep Patient 3 from falling, ripping out her foley or femoral line, and figure out how to hang a blood transfusion. Between 5 and 7, I started the blood (rather bumpily), got help with my nutso patient, got a couple people to draw my labs and give that last doese of dilaudid, I gave Patient 1 another can o Jevity and prayed I hadn't overlooked anything too major. Giving report was a pain because I felt like both nurses had the "well why didn't you do this and that??" attitude. In fact, I had to hang antibiotics, start a patient profile that should have been done 3 days ago, and retime some labs and get them to run it on some tubes they already had- AFTER i gave report.

And THEN I sat down to chart, do the admission, do my reassessments, chart checks, DARPs, pain assessments and I/Os. And that was my night. Long and tiring. like this entry. Now the summary, things I learned, new experiences, gold stars, etc:

1. I didn't cry much. I only teared up a little talking to coworkers, and only cried a little getting water from the pantry

2. hung blood, not very successfully, but whatever

3. more PEG tube experience

4. another IV attempt (not successful)

5. transplant patient

6. I kinda yelled at my patients, which actually felt like i was just taking charge, not like i was being mean, so i see it as progress.

THE END.

I mean, all my shifts CAN'T be that bad, right? like this has got to start being the exception at some point. Geez.