1. Young guy with a hx of multiple gunshot wounds to the chest, currently here for some clots in his lungs. I literally saw he and his gf about 7 times over the course of two days. He needed morphine once, and his fluids changed once. Other than that I told them let me know if you need anything, if not I'll let you rest. I chatted with them a little bit, which is always nice to have some interaction with peers as opposed to old confused and hard of hearing people.
2. Little lady in her 50s who had two valves in her heart replaced a couple months ago and was here for pneumonia I think... Anyway her BP was up and the dr ordered lasix. Which was all well and good except for the fact that she like... lost her ability to pee. Which is more than a little inconvenient since the lasix pretty much makes you pee your life away. I think that she reacted to a muscle relaxant and painkiller combo she took, resulting in a full bladder and no way to empty it. Once the dr showed up at midnight I got an order to straight cath her, so that practice was good for me. Also we got 900 cc out of her bladder, so yeah she really needed to pee. Unfortunately, by the time I left after shift 1, she was in serious pain again and they ultimately put a foley in, so night two she was able to sleep really well, and was suddenly much more agreeable haha. As a side note, she had the toughest skin! It was weird, like i had to really press to get the heparin in her stomach.
3. Sweet large older lady with diabetes and high blood pressure. Who also was struggling with some constipation issues. actually, almost all my patients got whiney about that over the two days. Which I never understand. I get these people who will call me up at 3 am, concerned with their lack of poop. I'm like, really? is there nothing more important on your mind right now? Why the hell didn't you mention this during the day? Don't you want to sleep? I digress. So this lady had a foley, which came apart at one point. I had never seen THAT happen. There is like the part of the wide tube that connects to the rubbery part and its wrapped with red plastic. Well, it is possible to put them back together, FYI. As long as neither connection touches the ground. So that is what I did. I gave this patient to Uclin halfway through the second night so I could take an admission and she wouldn't have to take 3.
4. My 40-something year old narcotics addict. When I got there the first night, he was on 8 mg of DILAUDID. Every 3 hours. And he wasn't passed out or dead. He was WALKING around. Taking himself to the bathroom. Wandering in the hallway. Carrying on conversation. Moving with ease. And then he'd go back to his room, lay on his bed, moan, groan, and yell for me down the hallway. I swear he was just bored, because he knew he only got the pain meds every few hours and would have me come in there and give him some ice, or bring him a pillow, or get the IV to stop beeping even though I'd fully explained that it was only beeping because he'd unplugged it. At one point the monitor tech called to tell me he was off the monitor. I walked in and the tele box is on the bed, the wires are next to it. With the snaps still attached. not the whole foam electrode. just the snaps because he'd gotten tired of it being in the way and ripped the whole thing off. So when i went to reattach it, he had all these like foam doughnuts of electrodes missing the middle on his abdomen. So i just left them there. At one point he decided he should go to Emory to their orthopedic center so he could have better pain management. Never mind the fact that he was getting enough narcotics to kill me probably three times over. every 3 hours. So I, out of the goodness of my heart, told him i'd call the doctor. Who changed his pain meds to demerol 25 mg Q4 and dilaudid 2 mg Q4. So essentially by whining he screwed himself over. Then in the middle of the night he started acting confused. and i still don't know if he was actually confused or if he was just trying to get me to give him more meds. which would be a stupid plan anyway. Night two though, he was back on the Dilaudid 8 mg Q4. Which was a little better but he was still a pain in the ass. The first night it was funny only because my other patients were all asleep. But the second night I had a little more going on so it pissed me off.
5. Tall old white guy who couldn't hear worth crap. He was funny though, some of the stuff he said, and his mannerisms and how when i gave him his cup of meds he took it like a shot, like he was just throwing the meds towards his mouth. He had COPD and was struggling to breathe, which always makes me a little nervous. Plus he was a DNR and I just didn't want him to die on my shift. Between his breathing issues and his blood sugar of 48 on night two, I couldn't justify giving him a sleeping pill, concerned it would put him into The Long Sleep.
6. My admission: young guy with pneumonia, o2 sats in the 70's on room air, 80s on a nasal cannula, and low 90s on a nonrebreather. Apparently though, he might have actually had swine flu, not pneumonia... i spent a good deal of time in his room... oops. Anyway he was pretty nice, you could just tell he was really not feeling good though. Also, respiratory left me with the nonrebreather to figure out how it works. For the record, no humidifier, and you can turn the O2 up to 15 L. Since he was young, the pt profile was easy, but respiratory issues always make me nervous. So it balanced out a little bit as far as admissions go.
So my list of whatever:
1. straight cath practice
2. nonrebreather masks
3. figured out you could put a catheter back together
4. assessed a wound on pt 2
5. practice with the hypoglycemia protocol
6. gave a flu shot
7. practice standing up to techs... see below
Yeah. My techs sucked this week and got real bold and mouthy with me. On the first night, Faheemah didn't have her phone with her or even ON, regardless of the fact that I HANDED it to her at the beginning of the shift. The second night she gave me NO vitals. no printouts, no phone calls. And i had people with really high B/Ps that needed to get covered. I totally snapped at her for it around 5 am. I told her that when vitals are out of range, i need to know about it so i can treat it. and she told me they were all in the computer, and i said if i don't have time to sit down and look through everyone's vitals then i need to know that i'm going to be made aware of the ones that need addressing. Apparently I also said something to the effect of, "you've been working here long enough to know when vitals are out of range." She also let one of our patients sit in crap for hours. here are a couple of our conversations:
8 pm-
Me: oh 24 needs to be cleaned up
Her: well i can't do it right now
Me: thats fine
11 pm-
Me: has 24 been cleaned up yet?
her: no
Me: well do you have a plan as to how thats going to get done?
her: no i can't do anything til this pain pill kicks in. i'm on light duty.
When like 1:45 am rolled around, I ended up having to do it, as my admission was coming up to the floor. I was more than pissed. If you are on light duty, these are still your patients. She could have traded some tasks with Onenitha, or had me help her. Either would have been fine. Not doing anything and not letting me know was not a way to get on my good side. Not only that, she was looking up like sex toys AT WORK during all this. Now Onenitha also pissed me off. at like 5 am, when i'm trying to get some charting done and my admission somewhat complete, patient 2 asked me for some new bed linens, so i told Onenitha, who said, "well the clean linens are in that closet." I said, "Um I know where they are. I am in the middle of things, I don't have time for that. If I had time, I would do it myself."
On a more positive note, I am starting to feel a little more like, one of the gang on nights. Slowly. And really only on nights I don't cry. But anyway, I was really able to joke around with my favorite Keisha, both about my drug addict patient, and the fact that i ask a million questions every night. And then at the staff meeting she was laughing at how i'd put the techs in their place a little bit. Maybe I can have like decent nights 40% of the time. I would like that a lot.
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