As The Hospital Pervs

I hope everything is alright. I feel like I left a mess.

sweepthefloor said:

I hope everything is alright. I feel like I left a mess.

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I hate that feeling. I end up a bit out of sorts until I go back again.

BeachMomma said:

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.

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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.

Loring2 said:

Doctors questions are never questions, learn that and survive.

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That depends on the doctor and the questions.

You know what the doctor did to me yesterday? I said: I need this and this for this patient.

He said: Ok, I will take care of that for you.

Later on... he came and got the chart from me. I said: Don't forget I need this and this for this patient.

He said: Get the Resident to write it. I just wanted you to get me the chart, you didn't get me the chart. I had to come and get it.

I said: grrrrrrr

LongDrySpell said:

I hate that feeling. I end up a bit out of sorts until I go back again.

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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 met them at the elevator.

Nurse fantasies, sweet dreams.

sweepthefloor said:

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.

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How are his ammonia levels?

BeachMomma said:

How are his ammonia levels?

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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.
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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.

tactful said:

Nurse fantasies, sweet dreams.

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Make sure you get the PM care before bedtime.

sweepthefloor said:

My victory rolls.

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That sounds interestting.

Balladeer08 said:

That sounds interestting.

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I am still perfecting my technique. They don't always come out right, but it looks cute when it does.

sweepthefloor said:

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.

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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.

BeachMomma said:

Treat the patient. Not the monitor.

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Brought back a military memory: The map is not the terrain. 8)

I wonder if there are other variations on this.

Oh God, yesterday whipped my ass. We had:

A rapid response that tied up almost every staff member. At the same time, one of the nurses got word that her 21 year old daughter had gone into complete heart block.

A patient assaulted one of the PCTs - a sweet, little older lady that we all love dearly. Yeah, that got results. Maybe not what the pt intended, but he definitely got attention. Four nurses wrestled him to the ground, while a bunch of us cared for the PCT. The rest went to pull drugs, get restraints, call security, and get the doctor on the phone. He was trussed and hog-tied before he even knew what the hell was going on.

The boss had a death in her family, but she couldn't go anywhere because she took over for the nurse who left to be with her daughter. I found myself in the unenviable position of having to re-orient my boss in the fine art of nursing - and taking over a few of the extra patients.

Then, right at shift change, I hear a code blue being called - for one of my own patients. Turns out, she'd just vagaled down and had a syncopal episode, but it was a crazy half-hour that resulted in another half-hour's worth of phone calls and incident reports.

The PCT who'd been assaulted is fine. No apparent injuries. We haven't had word yet on our friend's daughter. She'd been having heart problems, and they were planning to install a pacemaker. As of right now, I don't know the status of her outcome.

If any of you are praying folks, I'd sure appreciate your prayers for my friend and her daughter - and I know they'll appreciate them too.

Personally, I'm physically and emotionally spent today. I'm sure everyone else is too. If I wanted that damned much excitement, I'd work in the ER. I want my calm, boring operating room back, dammit.

good gravy! That is one rough night. Hoping that all will be well.

Time is supposed to be nature's way of keeping everything from happening at once.

Doesn't seem to have worked so well for you then.

My thoughts are with everyone you mentioned, as well as you, yourself.

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.

BeachMomma said:

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.

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I hope everything turns out alright-- it is crazy.

I am glad you made it through the shift. I don't know how we manage. I signed out giving the worse charge nurse floor report ever. I couldn't keep up with the admits and outs, the door, no secretary, the telephone. They say they like me in charge because I am mean in the sweetest ways.

The supervisor only hung up on me once. I closed my eyes and imagined doing that wicked witch laugh from Oz. I successfully hid an agency nurse with us for four hours. He gave most of the staff coverage for lunch breaks. Hahahahahhahaahaha.

She hung up screaming: I am never helping you again!

BeachMomma said:

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.

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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.

I am glad you figured it out, why didn't she check the lead sensitivity? All dysrhythmias should be checked out in more than one lead, and even EKG before treating. Did your boss offer to get an EKG before demanding you call the doctor?

This is part of the collective experience. You can say it was your gut, but this was your assessment skills so you can take credit for that. I do accept that instincts play a huge role but it is also: I have seen stable before, this patient is alright; I have seen unstable before and this patient doesn't look right. Even if we do not know why right away.

You assessed the patient in a way that a monitor can not, in a way that the boss did not, because you are a rational and critical thinking nurse. As opposed to some crazed lunatic with a long white lab coat running around like a poorly trained monkey, disguised as a floor manager with extra letters after her name.

There is a reason that all those NCLEX questions end with: What will the nurse do first? Call the doctor, is never the right first action.

You did great and I am glad that the patient didn't get on the gtt gtt gtt. I am glad you kept your cool too. Don't let them fill you with telemetry anxiety-- just keep calm, assess, intervene, and follow up for the outcome. Come to ICU!

Haha, even these ICU nurses like to freak out. It's just personality I guess.

I had a patient running a fast sinus tachycardia. The patient had a high fever over 103F. This nurse kept saying: I don't like the rate. It's too fast for too long. Aren't they doing anything for the patient?

It wasn't her patient, she was freaking out over the monitor. I told her when the fever breaks the rate will go down. You don't treat sinus tachycardia, you treat the cause. All the beta blockers in the world can't fix fevers.

Then I got her to help me get the patient on a cooling blanket, ice packed, fluid bolus, and extra ativan because the man started having seizures--- waiting for that tylenol and motrin to start working. The heart rate was a distraction-- the real problem was the temperature.

Also, a young heart can handle a fast rate if it is sinus. I wanted to joke around with her and say: he's exercising in the bed. I didn't have time though.

And there is a formula for heart rate and temperature but I don't remember what it is-- for every degree up in temp the heart rate goes up a certain average.

It is not easy pleasing everyone, but I never give up.

Just when I thought I'd heard everything...

A friend of mine is in her 4th year of med school, currently doing a rotation in colorectal surg. She saw a female patient with a gonococcal infection of her colostomy.





(Also, the people seated at the table next to us at the sushi restaurant asked the waitress to re-seat them. I'm going to start keeping track of how often that happens.)

maybe it migrated there!

Guess who is back? The main polish drinker in DTs. The raging bull, the same man. Transfered up from telemetry in full blown tremors with delirium.

The CCT said: Welcome back!
The RN said: You're getting the tube again, and a week long nap.

I left him maxed on Ativan at 10mg/hour and Propofol maxed at 50mcgs/kg/hour

And he was still opening his eyes to speech. After all this time I still can't believe the amount of sedatives required to calm this person. He's got a great personality-- we know because when he gets out he visits his other friends that frequent us often. It is hard to believe.