Here's another installment of the popular section on what not to do as a nurse. Listen up, new grads. This is NOT the way to get your 15 minutes of fame.
If you think it is, just remember, NCLEX is getting harder. Here in RehabLand, the pass rate went down, but luckily, the licensing folks are thrilled we are still above the national average pass rate.
Here are a few things that got nurses in RehabLand in trouble lately. Just remember, don't try these at home (or work, either) if you plan on keeping that bright, shiny license.
1. If you're supposed to monitor someone in the ICU, monitor them.
Don't paint your nails, don't go on Facebook, don't blow off the newer nurse you're working with who points out the fact that your patient now has a heart rate of 160 and maybe you should call the doc for orders. Also, when said heart rate goes to 200, don't tell everyone that "I had no idea."
Doesn't work. End of story.
2. If you plead guilty to felony theft, you may lose your license.
Another pretty simple example.
3. Falling in love with a felon could get you in trouble.
No, it's not related to #2, but it could be. Jailhouse Nurse falls for an inmate she's caring for. She goes out and gets him a handcuff key and a gun. To add to the fun, she smokes some marijuana (a friend brought it in from a legal state) and gets caught doing that while with said inmate/felon. Boundary violations are not a good thing.
4. Oxygen saturation is important for everything.
Remember your ABCs: Airway Breathing Circulation. Yes, those are important. Failing to notice low oxygen sats and to do something about it, can get you into licensure trouble.
5. When you are a private duty nurse, you have to be there (both physically and mentally).
Two examples: one nurse decided to run "personal errands" for almost two hours while caring for her private duty patient, who had hourly vital signs. She also "forgot" to chart that "errand."
Another private duty nurse decided to huff some Dust-Off while her patient's mother fell asleep. The mom found the nurse passed out in the living room on the couch, and when aroused he/she was in no state to work.
6. Why you don't want to become Walgreens/CVS/insert favorite drug store here.
This was pretty interesting. Two nurses were cited related to "collecting medications to give to poor/uninsured patients" Surprisingly, my license does not say MD or registered pharmacist, either.
Some medications just should not be shared (one RN took unused vials to reuse).
7. Don't bring medical records home.
Ever. No matter how behind you are at work. Can you say HIPAA? This RN took home records that affected a patient's care. Very ugly.
And finally...
8. Don't spank your patients.
Even if they are kids who wriggle around and smack you on the nose while doing their dressing.
That is all. Stay tuned for more in our next installment.
Showing posts with label dressings. Show all posts
Showing posts with label dressings. Show all posts
Thursday, May 14, 2015
Tuesday, February 11, 2014
Things not to do at work
Oh, my coworkers just come up with new fun things to do every single day. Today's installment revolves around computer issues.
Our boss, a lovely physician who is an expert in her field, has a love/hate relationship with her computer. As usual, as soon as our support person leaves for the other side of campus, she has an emergency.
Today's emergency: typing caused the lock screen to come up in the middle of entering the password. I watched as it happened, and noticed something. A large crumb. We repeated the error, so I told our lovely doc, to hold off the attempts to log in until I came back. I brought a can of air and our Saniwipes. To no one's surprise, enough crumbs to feed a small family came flying out of the keyboard.
Moral of the story: don't eat lunch over your desk. Those crumbs are out to get you (especially if they pile up under the keys on your keyboard). A few sprays of the air and cleaning...voila! No more weirdness.
The other problem: some things just shouldn't be used as mouse pads. Here's an explanation from one of the staff: Someone has decided to use Covaderm (yes the dressing) as a mouse pads on a few of the computers causing an abundance of adhesive madness when trying to maneuver the mouse.
Remember, friends don't let friends use adhesive dressings on computers. Stick to the duct tape.
More later...
Our boss, a lovely physician who is an expert in her field, has a love/hate relationship with her computer. As usual, as soon as our support person leaves for the other side of campus, she has an emergency.
Today's emergency: typing caused the lock screen to come up in the middle of entering the password. I watched as it happened, and noticed something. A large crumb. We repeated the error, so I told our lovely doc, to hold off the attempts to log in until I came back. I brought a can of air and our Saniwipes. To no one's surprise, enough crumbs to feed a small family came flying out of the keyboard.
Moral of the story: don't eat lunch over your desk. Those crumbs are out to get you (especially if they pile up under the keys on your keyboard). A few sprays of the air and cleaning...voila! No more weirdness.
The other problem: some things just shouldn't be used as mouse pads. Here's an explanation from one of the staff: Someone has decided to use Covaderm (yes the dressing) as a mouse pads on a few of the computers causing an abundance of adhesive madness when trying to maneuver the mouse.
Remember, friends don't let friends use adhesive dressings on computers. Stick to the duct tape.
More later...
Monday, August 8, 2011
You know it's Monday when...
"It's a cruel, crazy, beautiful world./Every day you wake up/I hope it's a blue, blue sky." --Johnny Clegg
1. Your patient is the heaviest one on the floor.
2. The first thing you have to do when you walk into the room and say hi, is suction said patient.
3. After that, you have to change the patient's external catheter, since the last shift somehow managed to pull it off. Said patient has a wet pad beneath him.
4. Clean up patient and change pad.
5. Wait for docs to round. Hold bowel routine, 'cause heaven forbid a doctor see a patient who poops whilst they're in the room!
6. Once Dr. HarvardMedSchool gives you crazy orders (like attach dressings without attaching them and you're not using one of these), start bowel routine.
7. Bowel routine over, so bathe patient. Suction again, and again, and again, before shave, after shave, after turning, etc.
8. Feed patient lunch. Suction patient.
9. Be so happy you follow the rules re: isolation gowns in rooms because as you dress patient, patient has a lot of gas, which is accompanied by a moderate amount of loose stool, which sprays bed rail, bed, and some gets on you.
10. Take off gown, wash hands, put on new isolation gown and other assorted PPE, then suction patient again.
11. Get patient dressed, into wheelchair and adjusted. (This takes 30 minutes including cleanup after explosion).
12. Get patient out door.
13. Patient returns in two minutes frothing. Suction again.
14. This time it works, get patient to therapy for evaluation for new wheelchair.
15. Patient is gone for not quite an hour. Lo and behold, the PT inadvertently pulls off external catheter during transfer. Put patient back to bed and clean up.
16. Suction patient again once in bed. Finish cleanup.
17. Dress patient in new clothes. Get patient adjusted then resupply room for next nurse.
18. Give report.
19. Wash wet cushion cover.
20. Go home.
And in between all that, I had 1) other patients and 2) lots of documentation to do.
So glad I eat fast and early! And I'm thrilled my work Monday is over, over, over!
Stay tuned...
1. Your patient is the heaviest one on the floor.
2. The first thing you have to do when you walk into the room and say hi, is suction said patient.
3. After that, you have to change the patient's external catheter, since the last shift somehow managed to pull it off. Said patient has a wet pad beneath him.
4. Clean up patient and change pad.
5. Wait for docs to round. Hold bowel routine, 'cause heaven forbid a doctor see a patient who poops whilst they're in the room!
6. Once Dr. HarvardMedSchool gives you crazy orders (like attach dressings without attaching them and you're not using one of these), start bowel routine.
7. Bowel routine over, so bathe patient. Suction again, and again, and again, before shave, after shave, after turning, etc.
8. Feed patient lunch. Suction patient.
9. Be so happy you follow the rules re: isolation gowns in rooms because as you dress patient, patient has a lot of gas, which is accompanied by a moderate amount of loose stool, which sprays bed rail, bed, and some gets on you.
10. Take off gown, wash hands, put on new isolation gown and other assorted PPE, then suction patient again.
11. Get patient dressed, into wheelchair and adjusted. (This takes 30 minutes including cleanup after explosion).
12. Get patient out door.
13. Patient returns in two minutes frothing. Suction again.
14. This time it works, get patient to therapy for evaluation for new wheelchair.
15. Patient is gone for not quite an hour. Lo and behold, the PT inadvertently pulls off external catheter during transfer. Put patient back to bed and clean up.
16. Suction patient again once in bed. Finish cleanup.
17. Dress patient in new clothes. Get patient adjusted then resupply room for next nurse.
18. Give report.
19. Wash wet cushion cover.
20. Go home.
And in between all that, I had 1) other patients and 2) lots of documentation to do.
So glad I eat fast and early! And I'm thrilled my work Monday is over, over, over!
Stay tuned...
Saturday, September 18, 2010
Thoughts on escape
The World is a book, and those who do not travel read only a page. ~St. Augustine
Despite my best intentions, I may have to go back to the Hotel Rehab to get some stuff before I leave for the conference with my travelling partner. Yes, I plan on being in the parking lot early AM for us to carpool, but I really didn't want to touch a computer or go inside. Nevertheless....I'll do what needs to be done. Manager asked if I could lose the Boss. Trust me...I'll try...when we're done! He/she will drive me nuts if I'm stuck with him/her for the whole thing!
This week has not been too bad. The mix of things in a day keeps me occupied. As one of my coworkers mentioned, I had an easy assignment. We also had the luxury of being fully staffed. Sometimes I think the boss does this so I can float around and help others. Many of my coworkers, when given a similar assignment, will not. They go hide in the break room or wherever they can to dodge work. In fact, I was chastised by the Slug when I dodged cleaning out the unit refrigerator when the maintenance crew came through to take care of our current one. He/she likes to comment that "I missed the real work."
Hmm...makes me wonder about his/her prioritization skills. In the same amount of time that the Slug sat glued to the table in the break room with not one, but two other nurses, I got my orientee access to the computer and we went to do a complex dressing change at the request of our charge nurse. I blew off the Slug's comment, because, yes, he/she can do some manual labor once in a while that is not nursing, even if dodging work is his/her game. I'd rather be too busy to notice.
And off I go...more updates to come. Feel free to cross your fingers, toes, light candles or invoke your religious figure of choice. Karma, good thoughts, prayers, etc., are all welcome. Gotta go ask Sr. Mary Martha if there's a patron saint for conference presenters (love the tagline of that blog, "Life is tough. But nuns are tougher."). I have never been so nervous in my life...presenting at a national conference IS a really big deal.
Stay tuned, all you readers...updates will be here first! Have a great weekend!
Despite my best intentions, I may have to go back to the Hotel Rehab to get some stuff before I leave for the conference with my travelling partner. Yes, I plan on being in the parking lot early AM for us to carpool, but I really didn't want to touch a computer or go inside. Nevertheless....I'll do what needs to be done. Manager asked if I could lose the Boss. Trust me...I'll try...when we're done! He/she will drive me nuts if I'm stuck with him/her for the whole thing!
This week has not been too bad. The mix of things in a day keeps me occupied. As one of my coworkers mentioned, I had an easy assignment. We also had the luxury of being fully staffed. Sometimes I think the boss does this so I can float around and help others. Many of my coworkers, when given a similar assignment, will not. They go hide in the break room or wherever they can to dodge work. In fact, I was chastised by the Slug when I dodged cleaning out the unit refrigerator when the maintenance crew came through to take care of our current one. He/she likes to comment that "I missed the real work."
Hmm...makes me wonder about his/her prioritization skills. In the same amount of time that the Slug sat glued to the table in the break room with not one, but two other nurses, I got my orientee access to the computer and we went to do a complex dressing change at the request of our charge nurse. I blew off the Slug's comment, because, yes, he/she can do some manual labor once in a while that is not nursing, even if dodging work is his/her game. I'd rather be too busy to notice.
And off I go...more updates to come. Feel free to cross your fingers, toes, light candles or invoke your religious figure of choice. Karma, good thoughts, prayers, etc., are all welcome. Gotta go ask Sr. Mary Martha if there's a patron saint for conference presenters (love the tagline of that blog, "Life is tough. But nuns are tougher."). I have never been so nervous in my life...presenting at a national conference IS a really big deal.
Stay tuned, all you readers...updates will be here first! Have a great weekend!
Monday, March 29, 2010
Feeling artsy....
Well, it's a full moon in honor of Dahey's natal day, and it's full of excitement, just like the weekend was.
First, I got to get artsy figuring out how to lay the Tegaderm dressings I had to put on a couple of my patients with PICC lines. Sometimes it gets crazy when the best place for the PICC is not the best place for the dressing, like on the inside of an arm of a patient who's very contracted.
Next, since it was time to bake the annual hubby natal day cake, I got to work early. Thankfully, no one snuck in and ate all the icing like they did last year. Between kid and dog, I'm not sure who's worse...and yes, I know cake and icing is not good for dogs. Tell the WildDog that for me, would you? Maybe I'll just get him his own, like this dog....
After that, I tried Photoshopping, cropping and beautifying some of our vacation photos. Another artsy thing I like to do even though I'm not the greatest. When in doubt: grayscale hides a lot!
Finally, I got the note from grad school saying my poem was accepted into the Medical Campus student journal. I have never been published in any capacity as a nurse.
Should prove to be an interesting week...stay tuned!
First, I got to get artsy figuring out how to lay the Tegaderm dressings I had to put on a couple of my patients with PICC lines. Sometimes it gets crazy when the best place for the PICC is not the best place for the dressing, like on the inside of an arm of a patient who's very contracted.
Next, since it was time to bake the annual hubby natal day cake, I got to work early. Thankfully, no one snuck in and ate all the icing like they did last year. Between kid and dog, I'm not sure who's worse...and yes, I know cake and icing is not good for dogs. Tell the WildDog that for me, would you? Maybe I'll just get him his own, like this dog....
After that, I tried Photoshopping, cropping and beautifying some of our vacation photos. Another artsy thing I like to do even though I'm not the greatest. When in doubt: grayscale hides a lot!
Finally, I got the note from grad school saying my poem was accepted into the Medical Campus student journal. I have never been published in any capacity as a nurse.
Should prove to be an interesting week...stay tuned!
Monday, January 4, 2010
Another fun evening
Yes, today's the first business day of the new year, and we're looking forward to the booking agents filling up all the empty rooms in the Hotel again. Our census has been low, low, low, so now we have to start combing the hospitals, homes and clinics hither and yon, to fill up the place. Should make things exciting this week.
Happily, I've been enjoying having less people, because I've been able to spend more time with my patients. One is confused. He's getting better, but why is it that all the confused people, who sometimes can't remember where they are, can remember down to the minute, when they get their next pain pill (and badger me until they get it)?
I'm praying the prosthetic people bring one of our amputee patients his stump shrinkers. He sure needs them. I can't properly wrap his stumps with ACE wraps, and it's driving him (and me) crazy. He finally believed me when the charge nurse told him we weren't really wrapping his stumps according to the book protocol (with ACE going around the waist).
Outside of that, I finally got my grades sent off and am awaiting next semester's bill to submit. Let's hope the education people don't run out of money!
Stay tuned...more to come from the exciting land of Hotel Rehab.
Happily, I've been enjoying having less people, because I've been able to spend more time with my patients. One is confused. He's getting better, but why is it that all the confused people, who sometimes can't remember where they are, can remember down to the minute, when they get their next pain pill (and badger me until they get it)?
I'm praying the prosthetic people bring one of our amputee patients his stump shrinkers. He sure needs them. I can't properly wrap his stumps with ACE wraps, and it's driving him (and me) crazy. He finally believed me when the charge nurse told him we weren't really wrapping his stumps according to the book protocol (with ACE going around the waist).
Outside of that, I finally got my grades sent off and am awaiting next semester's bill to submit. Let's hope the education people don't run out of money!
Stay tuned...more to come from the exciting land of Hotel Rehab.
Wednesday, January 28, 2009
Good cop, bad cop
That was my day yesterday. Instead of playing good cop like I usually do, I had to play bad cop. One of our folks violated one of the rules he agreed to and I had to go to the big man (our director) to have him play the heavy. (It was helpful that he was strolling around on the floor...I didn't feel so bad about it...and he wrote up the note, too.) Nothing is more annoying than a patient who gets mad at you in the middle of the shift.
Since the weather was crappy here again, the usual evening shift folks called in yet again, so the call was out for volunteers. I stayed with our charge over an extra few hours to get the main work of evenings done. I had to deliver pills twice on this round and since we're full, it was busy. Everyone wanted pain pills, besides their regularly scheduled one. One particular pain pill character had a fit because his doc decided to schedule his pain meds instead of letting him call us for the PRNs. Someone was not happy with 75mg of morphine (SR) daily (divvied up BID at optimum times) and his q 4 hour Vicodin 7.5s, along with his assorted adjuvants. What did this win him? More drug education from me. The docs changed his med routine a) so he can show up with less pain and actually do the rehab he's supposed to do and b) give him enough at night so he sleeps well. After about five minutes on that sales pitch, he finally believed me, and then it was on to his demented neighbor.
One of the 12 hour folks picked up my assignment, and since she'll usually do it, I told her about what I had left to do, which was minimal. Many of our 7P to 7A people will not do dressings if they think the evening people (4-8) could have done it, but this nurse is good about it. Thankfully, I only had to leave one dressing, and that was because the patient would not turn until I left (at 2000).
I figured the rest of the folks leaving at 2000 were gone because I couldn't find them. I went outside to more big, fluffy flakes of snow, so I cleaned my car. I saw one of the nurses, but not the other, so she must have been trapped in one of the rooms (she had one of our more persnickety characters tonight). I pulled my car up to hers and the two of us got hers cleaned off, and I was on my way.
Bubba is off school today...so we'll be playing and working in the snow. More later!
Since the weather was crappy here again, the usual evening shift folks called in yet again, so the call was out for volunteers. I stayed with our charge over an extra few hours to get the main work of evenings done. I had to deliver pills twice on this round and since we're full, it was busy. Everyone wanted pain pills, besides their regularly scheduled one. One particular pain pill character had a fit because his doc decided to schedule his pain meds instead of letting him call us for the PRNs. Someone was not happy with 75mg of morphine (SR) daily (divvied up BID at optimum times) and his q 4 hour Vicodin 7.5s, along with his assorted adjuvants. What did this win him? More drug education from me. The docs changed his med routine a) so he can show up with less pain and actually do the rehab he's supposed to do and b) give him enough at night so he sleeps well. After about five minutes on that sales pitch, he finally believed me, and then it was on to his demented neighbor.
One of the 12 hour folks picked up my assignment, and since she'll usually do it, I told her about what I had left to do, which was minimal. Many of our 7P to 7A people will not do dressings if they think the evening people (4-8) could have done it, but this nurse is good about it. Thankfully, I only had to leave one dressing, and that was because the patient would not turn until I left (at 2000).
I figured the rest of the folks leaving at 2000 were gone because I couldn't find them. I went outside to more big, fluffy flakes of snow, so I cleaned my car. I saw one of the nurses, but not the other, so she must have been trapped in one of the rooms (she had one of our more persnickety characters tonight). I pulled my car up to hers and the two of us got hers cleaned off, and I was on my way.
Bubba is off school today...so we'll be playing and working in the snow. More later!
Friday, January 2, 2009
The evenings of 2009
Last night wasn't terrible, but when you have a whole lot of demented people on your unit, it can get interesting! I had one of the hootin' and hollerin' characters (I say this since mine looks like a skinny, white-haired version of Yosemite Sam) who threatened to hit me if I did his bowel routine. Happy New Year to you, too, Buddy!
Sammy did let me do his dressings and turn him and by the end of the night, he was nice, sweet and replying "yes, ma'am" to everything I asked.
The rest of the cast of characters:
1. The man who wanted President-elect Obama to be his power of attorney, and then, he wanted screenshots of his TV as "proof" of neglect. It's starting to look like the Baclofen is messing him up, since his order just got changed. Thanks, docs, we need a little more excitement on evenings and nights.
2. His roommate wasn't seeing anything last night, but he wasn't believing much, either, especially when I politely asked him to check his med cup before he tossed it. He had pills in it that I did not want to go get again from the Pyxis when he could just take them as they are.
3. The nice, sweet man down the hall with the massive dressing changes is now refusing them. Not sure if he's PO'd at the staff, or if they told him he may have to leave. Sometimes, people like to take it out on the nurses when the docs aren't available. We're just handy targets.
Thankfully, the staffing was great. We had a lot of people on evenings who I don't normally get to work with and that was nice. Everyone was helping each other out a lot, which makes the load lighter.
I'm not sure how tonight will turn out, but the first evening of the year went pretty well. One down and four to go!
Sammy did let me do his dressings and turn him and by the end of the night, he was nice, sweet and replying "yes, ma'am" to everything I asked.
The rest of the cast of characters:
1. The man who wanted President-elect Obama to be his power of attorney, and then, he wanted screenshots of his TV as "proof" of neglect. It's starting to look like the Baclofen is messing him up, since his order just got changed. Thanks, docs, we need a little more excitement on evenings and nights.
2. His roommate wasn't seeing anything last night, but he wasn't believing much, either, especially when I politely asked him to check his med cup before he tossed it. He had pills in it that I did not want to go get again from the Pyxis when he could just take them as they are.
3. The nice, sweet man down the hall with the massive dressing changes is now refusing them. Not sure if he's PO'd at the staff, or if they told him he may have to leave. Sometimes, people like to take it out on the nurses when the docs aren't available. We're just handy targets.
Thankfully, the staffing was great. We had a lot of people on evenings who I don't normally get to work with and that was nice. Everyone was helping each other out a lot, which makes the load lighter.
I'm not sure how tonight will turn out, but the first evening of the year went pretty well. One down and four to go!
Friday, December 26, 2008
Happy Boxing Day
Believe it or not, it's a holiday here in the US if you work for the VA. It's not really Boxing Day per se, but W declared it a federal holiday, so most federal workers could get an extra day off. I was at work, but I'll get holiday pay...hooray!
Today was not too terrible. I had the assignment I've had the last three days, so it's been manageable. Get the one guy who gets up up and at 'em right away, so he's happy, then take care of the other two.
For the most part, the other two are very nice, although, the quad is very demanding. He's on the phone constantly, but doesn't want an ECU (no private calls that way). He really needs a Bluetooth with a soft touch button he could use with his one working arm, but that's way beyond what we have at Madison. Sometimes he won't even use the soft touch, much to my chagrin (and it's pretty darned unsafe, too!)
Nevertheless, Oscar and Felix (they really are odd but get along) are doing reasonably well. Felix is in pain a lot, but we medicate him before dressing changes and with his new low-airloss bed with the slick sheet, he can turn a lot easier without him screaming out in pain every time we turn him. He had more pain and problems with his "good" leg today, so hopefully, that is better this weekend. He is a trainwreck in terms of dressings, and he's got grounds for a lawsuit against the place he came from in another state. Thankfully, he is not mean to us (he is upset) but he is thrilled he's at Madison, since we should get him healed up well, barring no other issues.
Oscar has been with us many times. He likes to leave AMA when it suits him. He was here when I started, but left before summer. He's back again, with another suspected caregiver-inflicted wound. It's a doozy and the other hospital tried treating it with a WoundVAC. If only they'd read the instructions about using one with necrotic tissue....arrgh! The docs were aghast when they saw that and away it went as soon as he arrived. We're treating it with the old reliable Santyl moist/dry dressings BID until Dr. Plastic has a look at it after the holidays. Thankfully, it's starting to look better.
'Tis the season for game playing...and I don't just mean with the new games sets that a few families dropped off on the unit yesterday for Christmas, but with the patients, too. We've been having a lot of different varieties.
One is the "Oh, I can't get up to go to therapy" game. This is one of our active rehabbers who's playing this one. He is such a pervert (wiggles his tongue around suggestively when he's getting his intermittent cath) and I really, really wanted to kill him the other night, because he was being such a jerk.
The other game said jerk was playing was "Divide and conquer". Some of our patients try to do this by using the old standby of "no one of this race (color, uniform, you name it) will take care of me right because I'm white/black/Marine/Army/Navy/etc., etc." Said jerk had one of our nurses in tears on my last stretch of evenings. I was really pissed off.
What did he win for that? A smackdown from the neuropsychiatrists. If I would have had one on call, I'd have had them smack him at 2200 while he was up to all his shenaningans, but he had to wait until the next day. They're all off on vacation right now, so they won't harass him until next week. If he were in private rehab, his derriere would be kissing the curb right now since most of them have the "no therapy, no stay" rule. If you decline to go to therapy, you get to leave. Not us, we serve the veterans, and the RPIAs (royal pains in the a*&) really push it sometimes.
Nevertheless, I am happy I survived my holidays at Madison. Now, I'm going to get ready for a holiday party...more to come.
Today was not too terrible. I had the assignment I've had the last three days, so it's been manageable. Get the one guy who gets up up and at 'em right away, so he's happy, then take care of the other two.
For the most part, the other two are very nice, although, the quad is very demanding. He's on the phone constantly, but doesn't want an ECU (no private calls that way). He really needs a Bluetooth with a soft touch button he could use with his one working arm, but that's way beyond what we have at Madison. Sometimes he won't even use the soft touch, much to my chagrin (and it's pretty darned unsafe, too!)
Nevertheless, Oscar and Felix (they really are odd but get along) are doing reasonably well. Felix is in pain a lot, but we medicate him before dressing changes and with his new low-airloss bed with the slick sheet, he can turn a lot easier without him screaming out in pain every time we turn him. He had more pain and problems with his "good" leg today, so hopefully, that is better this weekend. He is a trainwreck in terms of dressings, and he's got grounds for a lawsuit against the place he came from in another state. Thankfully, he is not mean to us (he is upset) but he is thrilled he's at Madison, since we should get him healed up well, barring no other issues.
Oscar has been with us many times. He likes to leave AMA when it suits him. He was here when I started, but left before summer. He's back again, with another suspected caregiver-inflicted wound. It's a doozy and the other hospital tried treating it with a WoundVAC. If only they'd read the instructions about using one with necrotic tissue....arrgh! The docs were aghast when they saw that and away it went as soon as he arrived. We're treating it with the old reliable Santyl moist/dry dressings BID until Dr. Plastic has a look at it after the holidays. Thankfully, it's starting to look better.
'Tis the season for game playing...and I don't just mean with the new games sets that a few families dropped off on the unit yesterday for Christmas, but with the patients, too. We've been having a lot of different varieties.
One is the "Oh, I can't get up to go to therapy" game. This is one of our active rehabbers who's playing this one. He is such a pervert (wiggles his tongue around suggestively when he's getting his intermittent cath) and I really, really wanted to kill him the other night, because he was being such a jerk.
The other game said jerk was playing was "Divide and conquer". Some of our patients try to do this by using the old standby of "no one of this race (color, uniform, you name it) will take care of me right because I'm white/black/Marine/Army/Navy/etc., etc." Said jerk had one of our nurses in tears on my last stretch of evenings. I was really pissed off.
What did he win for that? A smackdown from the neuropsychiatrists. If I would have had one on call, I'd have had them smack him at 2200 while he was up to all his shenaningans, but he had to wait until the next day. They're all off on vacation right now, so they won't harass him until next week. If he were in private rehab, his derriere would be kissing the curb right now since most of them have the "no therapy, no stay" rule. If you decline to go to therapy, you get to leave. Not us, we serve the veterans, and the RPIAs (royal pains in the a*&) really push it sometimes.
Nevertheless, I am happy I survived my holidays at Madison. Now, I'm going to get ready for a holiday party...more to come.
Monday, October 20, 2008
And then there was one...
I started the day with two patients and I ended up with just one, and I'm not even in ICU! Woo hoo!
First, I had to send Mr. R. to a nursing home in a nearby state. It's probably the last time any of us will ever see him. I got his big dressing done and was very careful with it. It was really messy because it was leaking all over the pad he was on when I got to him. Just before that, I had to do a dig stim on him, too, since he didn't get his bowel routine (daily suppository) today. I did this in an attempt to get him cleaned out a little before he left. I cleaned him up, put his theraboots on and a clean gown so he'd be ready to go.
He's not doing well. He was stable, but we don't know how long that will last. He didn't tell us today, but I know he knows he's going home to die. I think it was bittersweet for him and A. was upset that she forgot to say goodbye since she was busy with another patient. I packed all his stuff carefully, put his AM snack in with his lunch and made sure the paramedics knew where everything was. He should see his family today, or so he told me. I hope it all works out for them. We know we did a decent job because he told us he'll miss us. I pray for my patients and he'll be one of the ones on my list. I'll never forget him.
Once I got all Mr. R's paperwork done, Mr. HIJ #1 was my patient for the rest of the day. He was needy as usual, but I got his bath done, his dressing and then I hooked up his IV. He wanted a soda, since none of the volunteers came around today with any, so I went downstairs and bought him one. I even caved in and bought myself one while I was at the machine.
Our boss was gone today, so most of the staff scattered from the nurses' station for most of the day. The slackers, including the Slug, never came near the nurses' station, because you might end up doing some work if you hang out there. I don't care. I'd rather do work than spend my whole day hiding just so I can do nothing. Our charge, P., was busy ordering blood and going with the docs on wound rounds this morning. Thankfully, we don't have tons of people to be inspected, so this went quickly.
I ate my lunch in peace around 1130 before the trays came and I set Mr. HIJ up when his lunch arrived. A the NP and I planned our itinerary for our conference in November. It should be fun. We're on the same flight and we plan on getting some sightseeing done near our hotel before the conference starts. We'll have to start out from here really, really, early, but I think it will work out well.
By the afternoon, I even remembered the other stuff I had forgotten earlier, so Mr. HIJ was happy. He was feeling hot (but afebrile) by the end of the day, so I got him all situated with his fan and everything in his room and he got very comfortable and fell asleep. After that, I finished off as many orders in the computer as possible and then I went on my way home.
Back tomorrow...we'll see how many admissions we really get (supposed to be five!).
First, I had to send Mr. R. to a nursing home in a nearby state. It's probably the last time any of us will ever see him. I got his big dressing done and was very careful with it. It was really messy because it was leaking all over the pad he was on when I got to him. Just before that, I had to do a dig stim on him, too, since he didn't get his bowel routine (daily suppository) today. I did this in an attempt to get him cleaned out a little before he left. I cleaned him up, put his theraboots on and a clean gown so he'd be ready to go.
He's not doing well. He was stable, but we don't know how long that will last. He didn't tell us today, but I know he knows he's going home to die. I think it was bittersweet for him and A. was upset that she forgot to say goodbye since she was busy with another patient. I packed all his stuff carefully, put his AM snack in with his lunch and made sure the paramedics knew where everything was. He should see his family today, or so he told me. I hope it all works out for them. We know we did a decent job because he told us he'll miss us. I pray for my patients and he'll be one of the ones on my list. I'll never forget him.
Once I got all Mr. R's paperwork done, Mr. HIJ #1 was my patient for the rest of the day. He was needy as usual, but I got his bath done, his dressing and then I hooked up his IV. He wanted a soda, since none of the volunteers came around today with any, so I went downstairs and bought him one. I even caved in and bought myself one while I was at the machine.
Our boss was gone today, so most of the staff scattered from the nurses' station for most of the day. The slackers, including the Slug, never came near the nurses' station, because you might end up doing some work if you hang out there. I don't care. I'd rather do work than spend my whole day hiding just so I can do nothing. Our charge, P., was busy ordering blood and going with the docs on wound rounds this morning. Thankfully, we don't have tons of people to be inspected, so this went quickly.
I ate my lunch in peace around 1130 before the trays came and I set Mr. HIJ up when his lunch arrived. A the NP and I planned our itinerary for our conference in November. It should be fun. We're on the same flight and we plan on getting some sightseeing done near our hotel before the conference starts. We'll have to start out from here really, really, early, but I think it will work out well.
By the afternoon, I even remembered the other stuff I had forgotten earlier, so Mr. HIJ was happy. He was feeling hot (but afebrile) by the end of the day, so I got him all situated with his fan and everything in his room and he got very comfortable and fell asleep. After that, I finished off as many orders in the computer as possible and then I went on my way home.
Back tomorrow...we'll see how many admissions we really get (supposed to be five!).
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