great teamwork as always on 6 east

example: last night, one of my patients began complaining of new onset chest pain. which, if you’ve ever been in an acute hospital setting, is a big deal. usually new orders for cardiac markers, aspirin prophylaxis, morphine, oxygen, chest x-ray, frequent vital signs, 12 lead EKG, and possible transfer to a higher level of care are expected. so, i leave my patient’s room and grab a vital signs machine in the hallway and someone asks me what’s wrong. i say my patient is having chest pain and, without me asking, three of them grab materials and go back to the patient’s room with me.

they start doing my vitals and assessing and placing the patient on oxygen and the works. it’s so great to have all this support without even having to ask for it. and, it really touched me at that moment to know that i’m never alone on this unit - there will always be someone (or, in most cases, multiple someones) to help out when i need it.

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my coworker admitted a patient with a history of trichotillomania and diagnosed with trichobezoar

in non-medical terms:

Trichotillomania is hair loss from repeated urges to pull or twist the hair until it breaks off.

bezoar is a ball of swallowed foreign material (usually hair or fiber) that collects in the stomach and fails to pass through the intestines.

A HAIR BALL THAT NEEDED TO BE SURGICALLY REMOVED.

I can’t even.

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not my night last night

so it began bad with five patients already at the start of shift and progressively got worse as i had:

  • a hepatic encephalopathy pt who kept trying to get out of bed and was also a diabetic whose blood sugars stayed in the 400s all night even after multiple doses of insulin 
  • my first rapid response because my other pt desaturated to 77% on 4 liters oxygen and only went up to 84% on 15 liters non-rebreather. the pt was fluid overloaded and even after two doses of lasix, lungs were still fluid filled. the pt ended up needing BiPAP and transfer to the step down ICU (in retrospect, the restlessness and anxiety had to do with the hypoxemia and not just the pt’s psych history). (and note to self, a rapid response/code blue is not the time to get emotional)
  • an admission right after my transfer
  • three lost kardexs 10 minutes before shift change which i had to redo as i was giving report

my co-worker asked me yesterday to switch and work her wednesday while she worked tonight for me and i am so glad it got approved because i did not want to be back at that place tonight. 

i’m going to have a nice quiet night in watching tv and eating junk food and try to forget this is what i do for a living.

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another busy night but good learning experience:

one. new transfer from IMU with a PCA and TPN/Lipids with an abdominal wet to dry dressing and two JP drains.

two. another PPN/Lipids pt with sepsis getting IV pain meds Q4H. i needed three different IVs - one for PPN/Lipids, one for Zosyn, and one for Vanco. One IV blew so a new one had to be started. 

three. Herpes Zoster pt who was really bratty with a raising blood pressure. 

four. diabetic with osteomyelitis receiving Vanco and Zosyn. 

five. trauma pt requiring pain medicine.

and try doing all of this without a CNA to help with ADLs and vital signs. such a long long night. again, couldn’t have done it without my amazing co-workers. i’m very lucky to have them.

now, time to sleep because i’m back on tonight for another long one. and then! four days off (yay!).

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i definitely need the next couple days off to recover from the night i had:

- new admit with blood transfusion and dropping blood pressure

- post-procedure patient with Q15 min VS for 1 hr, Q30 min for 2nd hr. super anxious and angry at the world and did not want me in the room at all.

- total feeder, Q2H turn

- schizoaffective diabetic who kept wanting to be unhooked from antibiotics to go smoke (which were scheduled at the same time, with only one IV and refused to have another placed) and kept wanting orange juice and graham crackers

- one who requested an enema at 4 am

my call lights were going off so often everyone just assumed it was for me. on the bright side, i had really great support from my fellow nurses. and in the downtime, we were able to feast because i brought food and so did my coworker in celebration of my birthday. 

could not even imagine getting through this night (or the past and future nights for that matter) without them. 

and now, a little bit of sleep…

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