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Grandma's healed!! Her INR is down to normal levels and she's didn't need the ICU. Yet another success story for nursing :) Unfortunately, that's just about the only thing that went right tonight. Tonight was one of those shifts where everything falls to pieces. My poor patient who came in with a severe UTI starts wheezing really badly at the same time as my 83 year old dementia patient drops his pressure to 88/44 at the same time as my post-op gallbladder's heart rate shoots up to 130 and I realize he has inadequate urine output for my shift. Now I'm a good nurse, but I still am only ONE PERSON and I can only handle ONE CRISIS at a time. So I'm way way behind (typical). Then to top it off, an ICU RN followed me on the night shift, and starts talking about how our patient's lungs sound horrible and he can't perfuse his kidneys with such a low blood pressure and maybe he has aspiration pneumonia and on and on. And there I am. I thought his lungs sounded better than yesterday. I told the doctor about his blood pressure, but he wasn't symptomatic so I honestly wasn't very concerned. The ICU nurse had just stepped onto the floor, and already she's calling the doctor and getting a chest x-ray and talking about labs. Watching her effortlessly do the job that, for me, requires A LOT of work was not easy for me. Working in such a big hospital with so many knowledgeable people, I sometimes have days where I feel very very small. Today was one of them.

2200 and beyond

Things have a way of going badly right about the time that shift change rolls around. That's when I always start realizing that my patient's haven't peed, or that my meds aren't in the right place, and there's always just ONE more thing that I have to do before I can finish (ok, start) my charting. Tonight, I was just going to help put a catheter in. I procrastinated, finished up a note, then moseyed down to the room. So I walk in, and this little old lady is white as a sheet with her left leg soaked in blood. Turns out that somebody gave Grandma too much coumadin and her INR was 10. Seeing as how that's TEN TIMES the normal level, she bumped her leg and the next thing we know she's leaking like a sieve. Not to mention the fact that she collapsed and went unresponsive in the ER. So clearly, the doctors think that she's stable enough for the floor. NOT. With a heart rate of 130 and an H+H of 5.8 and 18 (bad. very bad), Grandma needs some blood and oh here's a thought AN ICU BED. Unfortunately, since this all happened at the end of the shift, I have no idea how she's doing. Usually I try to con the night nurses into calling me on my cell and feeding me lab results so I can rest easy, but this isn't even really my patient. Guess this one's just a cliffhanger.

A+O x ...

The days where I could go into a patient's room and have a normal conversation feel like a distant memory. Seems like everyone around here lately is disoriented, or has dementia, or my personal favorite: psychosis. In fact, of my 4 patients this week, 3 have "altered mental status" or more succinctly, a case of the crazies. I have spent this week explaining to my 80+ patient that he doesn't have to crawl out of bed to go to a wedding. There are no weddings on Monday. The rest of our time together I have to convince him that I'm not torturing him, he is not a prisoner, and that there really is someone "running this damn Mickey Mouse show". My next gem is an alcoholic with a history of seizures who we're doing every 4 hour CIWA checks on. We're usually good until I get to the questions about hallucinations, at which point he tells me that he sees other people's faces on my body. Familiar faces, like the ones from tv. So really, he says, I don't know what you look like. Seemed logical to me at this point to describe my face. He got mad. Apparently "I don't understand". The latest is a paranoid schizophrenic who lives over at the mental health complex. I got him as a transfer out of the medical ICU. The first thing he said to me was "I'm going to need 5 mg of Haldol PO. I'm feeling paranoid. There was a doctor upstairs who's stethoscope touched my foot. She was very pretty. It felt very sexual". Oh good. There is a reason that I'm not a mental health nurse, and this is because I don't have a whole lot of patience for crazy. And because I find it much easier to go along with people's delusions than to reorient them. So yeah, I'm telling the sundowning elderly lady that her plane doesn't leave until tomorrow, so she can spend the night here. What of it? Somedays, that's the only way I can keep MYSELF sane :)

disclaimer

I'm starting a blog!! I love blogs. However I also love not getting fired. I have lots of crazy stories to share, but I won't talk specifically about the hospital where I work, or use patient names, or violate hipaa laws. That means if you know more info about the things I talk about, keep it to yourselves, k? That being said, the basics are: I've been a nurse for 2 years in a level one trauma center in the midwest. I work on a floor that specializes in trauma, but sees just about everything you could imagine. Since I've been a nurse, I've held intestines in people's bodies, seen patients arrested, and watched people die. There have been so many times that I say to myself "did that just happen?". Well it did. And now I'm going to tell you about it!!