sweepthefloor
see jane nurse
- Joined
- May 25, 2010
- Posts
- 11,836
I hope everything is alright. I feel like I left a mess.
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I hope everything is alright. I feel like I left a mess.
Liver failure from ETOH. I think he might get better, but I am not sure now. I lost count of the vent days. He failed wean trials again-- It's the pneumonia and the big belly.Ouch. He won't live long. Have they considered a TIPS procedure? Is he just cirrhosis/liver failure or is he liver or pancreatic CA?
I realized something yesterday. All nurses are pretty damned amazing, regardless of their specialty. Children are resilient and so are nurses. That's the only reason we keep going back to work day after day.
That depends on the doctor and the questions.Doctors questions are never questions, learn that and survive.
It is an awful feeling, and I didn't even chart right. Oh well there is twenty four hours. I have to let go. It was 7:40 and I was still in the room hoyer lifting the patient back to bed when the surgical wound decided to start bleeding. My friends popped in the room and said: Let's go!I hate that feeling. I end up a bit out of sorts until I go back again.
How are his ammonia levels?Liver failure from ETOH. I think he might get better, but I am not sure now. I lost count of the vent days. He failed wean trials again-- It's the pneumonia and the big belly.
We do keep going back.
The ammonia levels are in the high 70s. The INR is high, the platelets are low. The bilirubin is up. There is also new acute renal failure and pneumonia. Palliative care is now on consult to assist with family dynamics.How are his ammonia levels?
Make sure you get the PM care before bedtime.Nurse fantasies, sweet dreams.
My victory rolls.
I am still perfecting my technique. They don't always come out right, but it looks cute when it does.That sounds interestting.
Oh geez. I can hear the tele RN already. An 0730 ICU transfer. I guarantee she appreciated you holding the transfer for a bit.The ammonia levels are in the high 70s. The INR is high, the platelets are low. The bilirubin is up. There is also new acute renal failure and pneumonia. Palliative care is now on consult to assist with family dynamics.
The patient is doing better mentally-- eyes open, following simple commands but there is multi-organ failure going on. It is hard to see the jaundice in a black person but the eyes are yellow.
I wish I was the nurse today because the family likes me. I wasn't the nurse yesterday either but I still gave the patient a bath because the primary nurse was busy.
--
I sent a patient to telemetry this morning. The bed was paged out at 0730. I love how they do that bullshit. I got in trouble because I didn't transfer the patient till 0930. I said to my manager: I have to give this person morning medications and feed breakfast first.
When I was ready, I brought the patient down and finished my charting there because I knew my room would be occupied by the time I got back--- and it was with a post-operative.
Treat the patient. Not the monitor.
I hope everything turns out alright-- it is crazy.Thanks. It was a harrowing day. I don't know HOW 12 hours can be so packed. To be honest, it all started around 2-3 pm. Everything I mentioned happened in the space of around 4 hours. I hope to find out how my friend's daughter is when I go back to work Sunday. I can't help but worry about her - both of them really.
I can't stand it when people around me start freaking out. I always say: It's not a panic situation, let's figure it out. When panic gets involved it becomes hard to think clearly. She should know better as advanced practice that we don't nurse numbers and monitors.Oh geez. I can hear the tele RN already. An 0730 ICU transfer. I guarantee she appreciated you holding the transfer for a bit.
Yesterday was interesting. I got a direct admit chest pain. She was SB-SR in the 50s & 60s. I put her on tele and did my assessment. VSS, heart and lungs sounded fine. My boss came in the patient's room, freaking ALL the hell out. The monitor showed the patient in the 20s. I told the boss that I'd just listened to her heart, and it was not in the 20s. Listened again, with the boss right there, and repeated, that's not 20s. 50s maybe, but not 20s. Boss wouldn't hear it. "Call the doctor."
So I called. *eyeroll* Doc gave me orders for a dopamine gtt, so I was working on setting that up when the transferring nurse called about something else. I asked her about the pt's rate. It had never dropped lower than 50 for her, but with all the PVCs, she wondered if the monitor was picking up all the beats. Light bulb moment. Called tele, had them adjust the monitor, and sure enough, everything looked fine. Had to call the MD back, but he was just happy it was a false alarm.
I'm still a relatively new nurse. I have an excuse. My boss is an ARNP. She doesn't have an excuse. She shouldn't be running a cardiac floor. I came that damn close to starting a dopamine gtt on a hypertensive pt in NSR c PVCs.
Yanno how ya sometimes get that sense that something just isn't right? You can't put your finger on it, but you just know something is wrong? Yeah, well, I had that feeling in reverse. The boss and charge nurse were both freaking out. Patient asymptomatic. Monitor showing severe brady. It just didn't add up. Heart sounded fine, rate in the 50s/60s. I had the feeling that everything was ok, but I figured that was my inexperience showing. Gut instinct kept saying that it wasn't right, but I couldn't explain why.
Teaching reinforced. Treat the patient. Not the monitor. Rule 1 of nursing. And I let myself be talked out of following that rule. Rule 2 - trust your instincts. They don't fail me very often.