Happy St. Nicholas Day to all! It's been a busy week at Hotel Madison, but it's been fun.
Evenings is always a blast of a shift to come back to if only for the havoc we sometimes have with staff. (One was a no-call no-show last night.) Patients are generally good, unless of course, they're busy sundowning. Last night was decent enough, so I am happy for little things. Our shift missed the annual holiday party that our manager has, so said manager sent pizza.
In addition to all of the early in the shift hubbub, we had a TV crew show up to talk to one of our patients. Nothing like having hospital PR staff, the nursing staff and TV people on your floor roaming around just before the craziness of dinner time.
Here are a few of the interesting topics I've encountered recently.
One of my patients I noticed was taking Demeclocycline. I thought it was an odd antibiotic to use until I read this article about SIADH.
Last night, our charge nurse and I were talking about one of our patients who has a tenodesis splint and one who needs one. Another option for this problem: one of our docs talked to a patient this week about getting tenodesis surgery to improve his pincer grip.
Finally, I saw a drug I haven't seen in a long time at our place...good old hydralyzine show up for one of our new patients on the floor. This patient was a character. He looked exactly like a famous criminal and when I checked him to give him the hydralyzine and told him what it was, he denied hypertension. (Surprise, surprise.) He's with us only for a short visit, so he'll easily be home by Christmas.
More later...
Saturday, December 6, 2008
Tuesday, December 2, 2008
Out of order
Everything functioned pretty well today, but the order of our day was a little off with all the excitement.
One of our patients went off on his day pass. He got a big honor and got the full VIP treatment. We don't know if we'll see him on TV, but we're all proud. I just would have felt better if I had not found his meds that I ran to the pharmacy for yesterday at noon today locked in our med room. The night charge forgot to pack them...arrgh! (We got that problem solved, though.)
I had the same two patients as yesterday, minus one, since I inherited the med cart...again. I got lucky and got the slow hall, where no bed bingo was going on and there were no IVs or oddball meds. Everyone was relatively pleasant, so it was a good time passing all the pills down there.
At lunchtime, I got to discharge one of my patients. He was nervous about leaving, which is not surprising, since we have some people who love to visit us. He was "sick" and despite all his vitals being good and the MD's offer to stay, he decided to leave once his ride showed up to get him.
My other patient got a trip to one of his consults, a shower and had lunch and was doing well, when he came up to me in the hall and said, "I need to have a bowel movement." He's an MS patient so I know he knows when he's got to go. I got him to the bathroom, but the strain to transfer him on the commode was too much and he had a little accident. I got him undressed carefully, and got him squared on the commode. He sat there for a while and I finished his bowel program with the famous mini-enema.
He sat some more and when he had transferred to his wheelchair, he said, "I gotta go back." I got him back to the commode for more sitting. While he was sitting, I folded another patient's t-shirts, which were in the dryer, and got his clothes (he already had a bunch) in the washing machine. All was over for him, so I got him some of our famous PJ pants and got him back to the chair. We got his clothes into the dryer and he was on his merry way.
One of my coworkers was surprised. "Why is he going in the middle of the day?" I told her I figured it was because we have him on all sorts of bowel meds (Colace, psyllium, MOM, etc.) and I think that the MOM at lunch is sending him over the edge early. Many of our patients need 4-6 hours for it to work, but some patients go pretty quickly after you give it. Bowel programs in the middle of the day are definitely out of order on our unit!
Finally, we're dealing with loss on our unit again. We're losing a nurse who has to leave due to health concerns. It's scary because this nurse is not near retirement age. Folks are hoping this nurse can use his/her nursing skills to work a desk job in some capacity.
One of our patients, who was a cute little old guy who everyone grew to love during his time with us, died this past weekend. He was friendly and rehabbed himself from being a feeder who stayed in bed, to getting up in his electric wheelchair racing around the unit and even feeding himself with his equipment.
I was happy when I left with J. at the end of the shift. I plan on enjoying my day off! More to come...
One of our patients went off on his day pass. He got a big honor and got the full VIP treatment. We don't know if we'll see him on TV, but we're all proud. I just would have felt better if I had not found his meds that I ran to the pharmacy for yesterday at noon today locked in our med room. The night charge forgot to pack them...arrgh! (We got that problem solved, though.)
I had the same two patients as yesterday, minus one, since I inherited the med cart...again. I got lucky and got the slow hall, where no bed bingo was going on and there were no IVs or oddball meds. Everyone was relatively pleasant, so it was a good time passing all the pills down there.
At lunchtime, I got to discharge one of my patients. He was nervous about leaving, which is not surprising, since we have some people who love to visit us. He was "sick" and despite all his vitals being good and the MD's offer to stay, he decided to leave once his ride showed up to get him.
My other patient got a trip to one of his consults, a shower and had lunch and was doing well, when he came up to me in the hall and said, "I need to have a bowel movement." He's an MS patient so I know he knows when he's got to go. I got him to the bathroom, but the strain to transfer him on the commode was too much and he had a little accident. I got him undressed carefully, and got him squared on the commode. He sat there for a while and I finished his bowel program with the famous mini-enema.
He sat some more and when he had transferred to his wheelchair, he said, "I gotta go back." I got him back to the commode for more sitting. While he was sitting, I folded another patient's t-shirts, which were in the dryer, and got his clothes (he already had a bunch) in the washing machine. All was over for him, so I got him some of our famous PJ pants and got him back to the chair. We got his clothes into the dryer and he was on his merry way.
One of my coworkers was surprised. "Why is he going in the middle of the day?" I told her I figured it was because we have him on all sorts of bowel meds (Colace, psyllium, MOM, etc.) and I think that the MOM at lunch is sending him over the edge early. Many of our patients need 4-6 hours for it to work, but some patients go pretty quickly after you give it. Bowel programs in the middle of the day are definitely out of order on our unit!
Finally, we're dealing with loss on our unit again. We're losing a nurse who has to leave due to health concerns. It's scary because this nurse is not near retirement age. Folks are hoping this nurse can use his/her nursing skills to work a desk job in some capacity.
One of our patients, who was a cute little old guy who everyone grew to love during his time with us, died this past weekend. He was friendly and rehabbed himself from being a feeder who stayed in bed, to getting up in his electric wheelchair racing around the unit and even feeding himself with his equipment.
I was happy when I left with J. at the end of the shift. I plan on enjoying my day off! More to come...
Nuggets for December 2
Here are a few things that have been topics of conversation on our unit and the things I've discovered about them on the internet. Enjoy!
Can you smell cancer?
This was one of the questions recently that folks were talking about since one of our nurses (actually a couple) has worked in oncology.
"So and so (fill in patient name here) is a real pain"
This patient-focused article from the University of Washington talks about the different types of pain in spinal cord injury (SCI) patients.
Stress and the holidays (an oldie but goodie)
It's not just the patients, but the nurses, too, get a little stressed out this time of year.
Can you smell cancer?
This was one of the questions recently that folks were talking about since one of our nurses (actually a couple) has worked in oncology.
"So and so (fill in patient name here) is a real pain"
This patient-focused article from the University of Washington talks about the different types of pain in spinal cord injury (SCI) patients.
Stress and the holidays (an oldie but goodie)
It's not just the patients, but the nurses, too, get a little stressed out this time of year.
Monday, December 1, 2008
Ice and snow are back again
In these parts, the folks have to be reoriented to driving in winter weather. Ahh, there's nothing like the first snow fender benders to slow up your morning.
Today was a typical Monday, where somebody, everybody and nobody worked. Somebody was supposed to gather supplies for the patient going on pass out-of-town tomorrow, everybody knew about it, but nobody did it. An astute nurse who always helps out got the ball rolling and two other nurses (including me) got the job done...by quitting time. What a miracle!
I got assigned the only admission for today. Our doc comes down to assess the patient, and then decides to take said patient up to the clinic where it's more private for her assessment. A little later, we get a call that said patient will be discharged. Huh? Patient just arrived...about an hour ago and ate lunch. This patient had some issues that didn't really require being an in-patient so said doc discharged patient. Said patient will be back tomorrow to work with specialist, which was really the only reason why patient visited us. I'm so glad I didn't start the really long, eye-crossing paperwork!
The icy winds were blowing when I left, but I escaped intact, and only a few minutes late. Another day done...hooray! More to come...
Today was a typical Monday, where somebody, everybody and nobody worked. Somebody was supposed to gather supplies for the patient going on pass out-of-town tomorrow, everybody knew about it, but nobody did it. An astute nurse who always helps out got the ball rolling and two other nurses (including me) got the job done...by quitting time. What a miracle!
I got assigned the only admission for today. Our doc comes down to assess the patient, and then decides to take said patient up to the clinic where it's more private for her assessment. A little later, we get a call that said patient will be discharged. Huh? Patient just arrived...about an hour ago and ate lunch. This patient had some issues that didn't really require being an in-patient so said doc discharged patient. Said patient will be back tomorrow to work with specialist, which was really the only reason why patient visited us. I'm so glad I didn't start the really long, eye-crossing paperwork!
The icy winds were blowing when I left, but I escaped intact, and only a few minutes late. Another day done...hooray! More to come...
The long and winding road
Do you ever wonder how in the world you ended up where you are now? I do all the time.
I know there are a lot of folks out there in this worsening economy who say, "I need a job that lasts like a healthcare one." For them, I'd like to pass along a few things about my experience.
First of all, yes, healthcare is indeed a necessity. Unlike sales or marketing or computers, everyone needs to have access to a doctor and/or hospital. With that access comes access to a variety of other assorted healthcare professionals, namely nurses.
Nurses are in a lot of places from schools to hospitals to local, state and federal health agencies. Nurses do lots and lots of paperwork in addition to doing patient assessment, administering drugs, general patient care and patient education.
Second, before you go jumping into the nursing school pool, be prepared to wait. Some nursing schools have waiting lists of two or more years. Do your homework!
One of the best books I've encountered that discusses many of the nursing specialties out there is Opportunities to Care: The Pfizer Guide to Careers in Nursing. It has a general overview of issues in nursing and a general overview of the role of nurse in the healthcare setting, as well as career planning and words of wisdom. The most valuable part is that it has lots of little vignettes that describe different specialties. (Shameless plug: you can find the rehabilitation nursing story on page 132 in Chapter 27.)
Third, I'd be remiss if I didn't mention something that LaTonia Denise Wright is always talking about in her blog, My 2 cents. Please, please, please consult a lawyer if you have any legal issues in your past. You might go out and get a degree in nursing, but no school on earth will guarantee that your state will license you if you have certain convictions, which is why you need to get an attorney who knows what will and will not work in your state before you start. Your state Board of Nursing is out to protect the public, not your investment in nursing school.
Finally, if visiting hospitals, talking to people and checking out the nursing program of your choice and its statistics and everything else I've mentioned above hasn't scared you away, and you've got all your prereqs in order, dive in. It's an experience you'll never forget.
I know there are a lot of folks out there in this worsening economy who say, "I need a job that lasts like a healthcare one." For them, I'd like to pass along a few things about my experience.
First of all, yes, healthcare is indeed a necessity. Unlike sales or marketing or computers, everyone needs to have access to a doctor and/or hospital. With that access comes access to a variety of other assorted healthcare professionals, namely nurses.
Nurses are in a lot of places from schools to hospitals to local, state and federal health agencies. Nurses do lots and lots of paperwork in addition to doing patient assessment, administering drugs, general patient care and patient education.
Second, before you go jumping into the nursing school pool, be prepared to wait. Some nursing schools have waiting lists of two or more years. Do your homework!
One of the best books I've encountered that discusses many of the nursing specialties out there is Opportunities to Care: The Pfizer Guide to Careers in Nursing. It has a general overview of issues in nursing and a general overview of the role of nurse in the healthcare setting, as well as career planning and words of wisdom. The most valuable part is that it has lots of little vignettes that describe different specialties. (Shameless plug: you can find the rehabilitation nursing story on page 132 in Chapter 27.)
Third, I'd be remiss if I didn't mention something that LaTonia Denise Wright is always talking about in her blog, My 2 cents. Please, please, please consult a lawyer if you have any legal issues in your past. You might go out and get a degree in nursing, but no school on earth will guarantee that your state will license you if you have certain convictions, which is why you need to get an attorney who knows what will and will not work in your state before you start. Your state Board of Nursing is out to protect the public, not your investment in nursing school.
Finally, if visiting hospitals, talking to people and checking out the nursing program of your choice and its statistics and everything else I've mentioned above hasn't scared you away, and you've got all your prereqs in order, dive in. It's an experience you'll never forget.
Sunday, November 30, 2008
The welcome mat's always out...
Many thanks to all of the Change of Shift folks stopping by lately. I really appreciate your visits.
Come over anytime and visit some of the other folks noted on the sidebar to the right. DisappearingJohn and Dr. Wes have sent me a whole bunch of folks in the last couple of days, so if you haven't visited them already, go click on their links and visit.
More goodies later...gotta run!
Come over anytime and visit some of the other folks noted on the sidebar to the right. DisappearingJohn and Dr. Wes have sent me a whole bunch of folks in the last couple of days, so if you haven't visited them already, go click on their links and visit.
More goodies later...gotta run!
Friday, November 28, 2008
Rest after Thanksgiving...or TGIF
After a day and a half where I got to play the roles of wife, mother, cook and galley slave, I was happy, happy, happy to go back to work where the only dishes I saw belonged to patients and I did not have to wash them. Hooray!
I got one of the same patients (a/k/a Mr. Easy--he gave himself that name) and one I haven't taken care of in a while, Mr. I'm Going Home in a Week (if my family actually comes for training). He's a sweet old man and as usual, he's getting anxious about leaving the hotel. Who wants to leave after a year plus of 24/7 staffing to scratch your nose when you'll have to go with your family who won't like it when you ring for them 20 times in two hours? No one really does.
Overall, Mr. IGHIW was in a reasonably good mood with only a couple of bouts of anxiety. I got him in his chair and out of his room for about two hours, so that worked for him. He was tired when he got back.
Mr. Easy ate too much yesterday so he vegged all day in bed, even when his wife came. He ate a little lunch and just slept all day. No fuss, no muss.
I got to do some paperwork and talk to our big boss about getting my certifications next year. I'm still working out the details, but I know for sure I will get at least one, depending on what the official regulations are. Both are attractive, since we get a bonus and pay grade advancements for getting them, but if there are technicalities, I want to know about those ahead of time.
Now, the weekend is here, so now I get to pay the bills and go on about my other fun weekend duties.
More later. Enjoy your weekend, wherever you are!
I got one of the same patients (a/k/a Mr. Easy--he gave himself that name) and one I haven't taken care of in a while, Mr. I'm Going Home in a Week (if my family actually comes for training). He's a sweet old man and as usual, he's getting anxious about leaving the hotel. Who wants to leave after a year plus of 24/7 staffing to scratch your nose when you'll have to go with your family who won't like it when you ring for them 20 times in two hours? No one really does.
Overall, Mr. IGHIW was in a reasonably good mood with only a couple of bouts of anxiety. I got him in his chair and out of his room for about two hours, so that worked for him. He was tired when he got back.
Mr. Easy ate too much yesterday so he vegged all day in bed, even when his wife came. He ate a little lunch and just slept all day. No fuss, no muss.
I got to do some paperwork and talk to our big boss about getting my certifications next year. I'm still working out the details, but I know for sure I will get at least one, depending on what the official regulations are. Both are attractive, since we get a bonus and pay grade advancements for getting them, but if there are technicalities, I want to know about those ahead of time.
Now, the weekend is here, so now I get to pay the bills and go on about my other fun weekend duties.
More later. Enjoy your weekend, wherever you are!
Thursday, November 27, 2008
Change of Shift: November 27, 2008 Volume Three - Number Eleven
Welcome to the November 27, 2008 edition of Change of Shift. Many, many thanks to Kim from Emergiblog for letting me host this edition. Look around and if you like what you see, feel free to come on back!
Happy Thanksgiving to all of our US readers. As you're working on your unit or basting the turkey like me, have a look at all the submissions for this edition. You won't be disappointed by our cornucopia of submissions.
General
Nancy Miller presents Here’s to a Long and Healthy Life! posted at Photography Colleges.
Alvaro Fernandez presents Brain Fitness 2: Sight & Sound, at PBS posted at SharpBrains, saying, "PBS just announced the second installment of their popular Brain Fitness Program show: "Join host Peter Coyote in "Brain Fitness 2: Sight & Sound," the follow-up to "The Brain Fitness Program," as he explores the brain's ability to change and grow, even as we age, helping us maintain and improve our vision and hearing.""
Erika Collin presents 50 Awesome Video Games for Physical Therapy and Rehab posted at U.S. PharmD. Since I'm a rehab Wii-kind of gal, check it out! There's nothing like getting that problem patient boxing away to warm up those muscles!
While muscle strains and pulled ligaments are not very serious injuries, they can be extremely painful. With this in mind, Dean Moyer of The Back Pain Blog shares some thoughts on Neck Pain Relief That's Quick and Easy. Dean, we need you on my unit!
Nurses
Hueina Su presents Best of Both Worlds posted at Intensive Care for the Nurturer's Soul.
and Rx for Balance: Keynote at Northeast Regional Oncology Nursing (NERON) Conference posted at Intensive Care for the Nurturer's Soul.
Kathy Quan presents The Nursing Site Blog: Share Your Ideas with Nurses in Congress posted at The Nursing Site Blog, saying, "Health care and the nursing shortage are on the top hot topics for the next administration and Congress to discuss. Nurses can begin to get comfortable "talking" to legislators who speak the same language. There are 3 nurses in Congress this term. Let's start sharing ideas."
DisappearingJohn presents Dealing with a decision made... posted at DisappearingJohn RN, saying, "A new and exciting job awaits me" Good luck John!
Jeff Long presents Travel nursing pay day. How important is it for you? posted at Travel Nursing Blog.
Nurse Laura, Oncology RN from NurseConnect.com blogs about Rapid Response Team to the Rescue! Nurse Kathy, Clinical Manager, RN from NurseConnect.com blogs about "Self Talk."
MojitoGirl at Sunburned Paradise gives us a close up view of Key West roosters in a post you have to read to believe. Ay carumba, mi amiga! Oy!
NurseExec has some great insight for all of the nursing students out there who want an RN to tell them how it is. Check out her On Nursing post for her first-person account.
Strong One presents Act the Part and You Will Become the Part posted at My Strong Medicine.
Nursing students
Sarah Scrafford presents Forget Facebook: 50 Social Sites for the Serious Student and Job Seeker posted at Career Overview.
MachoNurse describes his first week in clinical in Week One post.
That concludes this edition. Thanks for stopping by RehabRN. Come back anytime!
Submit your blog article to the next edition of change of shift using our carnival submission form or check out Nurses Notes, the next host site.
Past posts and future hosts can be found on our blog carnival index page.
Wednesday, November 26, 2008
Thankful
Although my co-workers and I kvetch, whine and moan about the least little things, today, I have put aside the slights of some of them and I am thankful. We stopped b(^t$%ing about the people we can't change.
I am most thankful that I work at the Hotel Madison. Many of my classmates this holiday season have to take low census (from their vacation if they want to get paid) or get docked because their hospitals need to save a buck. Thank you Uncle Sam for that no low census thing! I can use my vacation for what it was intended...actual vacation...when I want it!
I am thankful I woke up today. It sure beats pushing up daisies as I told K., one of my coworkers. It's been a little depressing seeing some of my old patients in the obituary section of the newspaper lately, but I'm getting used to it, not numb necessarily, but more aware.
Today was a pleasant day. One patient went home to see his family for the weekend and the other was very laid-back and relaxed. No admissions and no time stress today.
I'm off tomorrow, so check out Change of Shift. Back to prepping for Thanksgiving dinner! Stay tuned...
I am most thankful that I work at the Hotel Madison. Many of my classmates this holiday season have to take low census (from their vacation if they want to get paid) or get docked because their hospitals need to save a buck. Thank you Uncle Sam for that no low census thing! I can use my vacation for what it was intended...actual vacation...when I want it!
I am thankful I woke up today. It sure beats pushing up daisies as I told K., one of my coworkers. It's been a little depressing seeing some of my old patients in the obituary section of the newspaper lately, but I'm getting used to it, not numb necessarily, but more aware.
Today was a pleasant day. One patient went home to see his family for the weekend and the other was very laid-back and relaxed. No admissions and no time stress today.
I'm off tomorrow, so check out Change of Shift. Back to prepping for Thanksgiving dinner! Stay tuned...
Tuesday, November 25, 2008
What happened?
I wonder this often when I work and when I see things such as....
...the urine bags that are always full.
On our unit, everyone is assigned patients, including the nursing assistants. In many places in our grand state, those assistants could be delegated to by folks such as the LPNs and RNs. Our assistants regularly refuse delegation, and often neglect their own tasks, such as this, that seem too "demeaning" or "boring". Or my personal favorite...they'll only do the task for you if they "like" the patient.
One of my patients was assigned to the escapist assistant I mentioned before in this blog. Again, his Foley bag was getting ready to explode. If only the boss paid attention...maybe I can ask Santa for that for Christmas.
...a new patient assessment that is not done at 2345.
This patient arrived around 1130AM and said nurse supposedly did all his documentation. It's not unusual for some of the paperwork to be floating around on people who arrive at 1500 or later, because our daytime people leave not long after that, so we on evenings, finish up whatever they don't do. This nurse didn't do much. We had two lowly notes for the patient: one the H & P from the admitting doc and the generic "patient arrived at xx time" one for the admitting nurse. Not a nice surprise!
...that someone who refused a shot got one.
This is what one of our elderly patients told C. tonight that the med nurse (same as the admitting one mentioned above) gave him a vaccination that he did not want. I guess she missed that class on assault and battery in nursing school.
My trainwreck came back from dialysis in a happy mood. He barely rung his call light all night.
Off I go for off-day errands...back later!
...the urine bags that are always full.
On our unit, everyone is assigned patients, including the nursing assistants. In many places in our grand state, those assistants could be delegated to by folks such as the LPNs and RNs. Our assistants regularly refuse delegation, and often neglect their own tasks, such as this, that seem too "demeaning" or "boring". Or my personal favorite...they'll only do the task for you if they "like" the patient.
One of my patients was assigned to the escapist assistant I mentioned before in this blog. Again, his Foley bag was getting ready to explode. If only the boss paid attention...maybe I can ask Santa for that for Christmas.
...a new patient assessment that is not done at 2345.
This patient arrived around 1130AM and said nurse supposedly did all his documentation. It's not unusual for some of the paperwork to be floating around on people who arrive at 1500 or later, because our daytime people leave not long after that, so we on evenings, finish up whatever they don't do. This nurse didn't do much. We had two lowly notes for the patient: one the H & P from the admitting doc and the generic "patient arrived at xx time" one for the admitting nurse. Not a nice surprise!
...that someone who refused a shot got one.
This is what one of our elderly patients told C. tonight that the med nurse (same as the admitting one mentioned above) gave him a vaccination that he did not want. I guess she missed that class on assault and battery in nursing school.
My trainwreck came back from dialysis in a happy mood. He barely rung his call light all night.
Off I go for off-day errands...back later!
Monday, November 24, 2008
Happy Monday!
Reasons I'm happy:
1. It's my last evening shift this week...today! Hopefully, when I get back later in the week, I'll get some new people. I've had a doozy this week, but it's not his fault. When you're a trainwreck, you're gonna have issues.
Thank goodness for therapeutic communication (and some very understanding coworkers) or I'd have jumped out the lunch room window by now.
2. My turkey is thawing. I'll be cooking for my family Thursday, which means Wednesday night will be a late one prepping, chopping and baking some stuff.
3. I am feeling good. So many people I work with are getting colds, etc., and feeling crappy. I went back to sleep this morning and I feel much better. It's amazing how sleeping works!
4. I'll be hosting CoS (Change of Shift) also on Thanksgiving. Another reason to stay up late on Wednesday.
5. Finally, if you're feeling ambushed, check out Jo's latest post at Head Nurse. It made me laugh so hard. My, how people infer things from these blogs!
More later, stay tuned and stay well!
1. It's my last evening shift this week...today! Hopefully, when I get back later in the week, I'll get some new people. I've had a doozy this week, but it's not his fault. When you're a trainwreck, you're gonna have issues.
Thank goodness for therapeutic communication (and some very understanding coworkers) or I'd have jumped out the lunch room window by now.
2. My turkey is thawing. I'll be cooking for my family Thursday, which means Wednesday night will be a late one prepping, chopping and baking some stuff.
3. I am feeling good. So many people I work with are getting colds, etc., and feeling crappy. I went back to sleep this morning and I feel much better. It's amazing how sleeping works!
4. I'll be hosting CoS (Change of Shift) also on Thanksgiving. Another reason to stay up late on Wednesday.
5. Finally, if you're feeling ambushed, check out Jo's latest post at Head Nurse. It made me laugh so hard. My, how people infer things from these blogs!
More later, stay tuned and stay well!
Saturday, November 22, 2008
Nuggets for November 22
I should be thankful that things are not worse, but it's been busy at work lately. Fall is turning to winter and that means we're heading into pneumonia season. We've got a couple of cases all ready. Lots and lots of coughing going on! Chest PT for everyone!
Now for something completely different....here are a few tidbits of interest I've run across in the blogs this week.
This penis reconstruction story makes me think of Fournier's gangrene again. (from Highly Trained Monkey)
What's wrong with nursing (from My 2 Cents)
One of these days...
Sometimes the best therapy is a long-drawn out rant (from Spook RN)
An ingenious Christmas gift you gotta see (I found this thanks to ER RN)
Thinking of going back to school? Some of those professors will be talking about YOU if you aren't very nice...I really loved the "who's the geekiest" post recently.
Now for something completely different....here are a few tidbits of interest I've run across in the blogs this week.
This penis reconstruction story makes me think of Fournier's gangrene again. (from Highly Trained Monkey)
What's wrong with nursing (from My 2 Cents)
One of these days...
Sometimes the best therapy is a long-drawn out rant (from Spook RN)
An ingenious Christmas gift you gotta see (I found this thanks to ER RN)
Thinking of going back to school? Some of those professors will be talking about YOU if you aren't very nice...I really loved the "who's the geekiest" post recently.
Friday, November 21, 2008
Field trip!
Bubba is on one today at school, and if I had time to hang out, I'd take this to my nearest Wal-Mart just for fun. Many thanks to mylife1060 at Hell on White Clogs for this little gem. Enjoy!
Thursday, November 20, 2008
The holidays are coming...
And, as usual, I never feel like I'm ready! I've been busy shopping for Thanksgiving dinner and cleaning out cabinets and freezers. After that, I'll get to clean some more in between working.
On top of it this year, I'll be fluffing and buffing around here as I get ready to host the Thanksgiving edition of Change of Shift. The submissions are trickling in, so if you're so inclined, get going on yours and send it in!
You know it's the holidays on our unit because food is appearing everywhere. It's tough to be a nurse or hospital employee when wherever you look (in only JCAHO-approved places, of course) there's food--candy, cookies, you name it. A few people have dropped hints to families that no nurse can deny a good piece of chocolate. I'll second that, thank you. Bring it on! I'll just have to do a few more laps around the Hotel to burn off that candy!
More later! Send those posts in...I'll be waiting!
On top of it this year, I'll be fluffing and buffing around here as I get ready to host the Thanksgiving edition of Change of Shift. The submissions are trickling in, so if you're so inclined, get going on yours and send it in!
You know it's the holidays on our unit because food is appearing everywhere. It's tough to be a nurse or hospital employee when wherever you look (in only JCAHO-approved places, of course) there's food--candy, cookies, you name it. A few people have dropped hints to families that no nurse can deny a good piece of chocolate. I'll second that, thank you. Bring it on! I'll just have to do a few more laps around the Hotel to burn off that candy!
More later! Send those posts in...I'll be waiting!
Friday, November 14, 2008
It's that time again...
for Change of Shift, and crzegrl and Zippy are hosting there, so head on over.
As I mentioned before, RehabRN (that's me...pinching self) will be hosting the Thanksgiving version of CoS, so submit away!
Happy Friday all! More goodies to come...
As I mentioned before, RehabRN (that's me...pinching self) will be hosting the Thanksgiving version of CoS, so submit away!
Happy Friday all! More goodies to come...
Wednesday, November 12, 2008
New favorite on the floor?
I've been shopping and I found these new comfy shoes...heaven! Guess I need more socks!
Nuggets for November 12
Here are a few of the latest posts of interest I've encountered from the blogosphere.
Nurse William enlightens the masses on the duties of the triage nurse in the ER. Don't miss it!
http://nursewilliam.blogspot.com/2008/11/er-stuff-you-need-to-know-part-1-triage.html
The MERCI project helps recycle medical supplies that might be thrown away to help developing countries.
http://nurseattorney.blogspot.com/2008/10/merci-project.html
Dust in the wind tells us what it's like to go from nurse to triage patient
http://dustitwind.blogspot.com/2008/10/waiting-room-watching.html
Being on call from donorcycle
http://donorcycle.blogspot.com/2008/10/its-still-exciting-to-be-on-call.html
In case you missed it like I did, Nurse Ratched was featured last week in Colin Son's Medscape article in the Pre-Rounds section. Even though, the election is over, go read it.
Nurse William enlightens the masses on the duties of the triage nurse in the ER. Don't miss it!
http://nursewilliam.blogspot.com/2008/11/er-stuff-you-need-to-know-part-1-triage.html
The MERCI project helps recycle medical supplies that might be thrown away to help developing countries.
http://nurseattorney.blogspot.com/2008/10/merci-project.html
Dust in the wind tells us what it's like to go from nurse to triage patient
http://dustitwind.blogspot.com/2008/10/waiting-room-watching.html
Being on call from donorcycle
http://donorcycle.blogspot.com/2008/10/its-still-exciting-to-be-on-call.html
In case you missed it like I did, Nurse Ratched was featured last week in Colin Son's Medscape article in the Pre-Rounds section. Even though, the election is over, go read it.
Move it continued...
Since I'm cleaning the house for the move, I've also decided to get some work done on this blog. There are some amazing people out there who help bloggers out there and I've sought them out (you know who you are!). I've got a lot of ideas and I'm pretty excited.
Please pardon the mess while you're here, but everything will look pretty when it's all done!
Please pardon the mess while you're here, but everything will look pretty when it's all done!
Tuesday, November 11, 2008
I like to move it, move it...
And we'll be doing a bunch more of that at our house soon, both literally and figuratively.
There's always plusses and minuses to moving, but I'll be glad to do it, since Dahey's heading to a new assignment. I love the current Hotel Madison, but they all understand. My shopping buddy, A., will miss me, but now she says, she'll have another place out of town to hang out. My boss and other folks were sad, too, but understanding.
As a result, I'm going to have to figure out which way RehabRN the blog will go. I'm working on some stuff for that, too. I met a lot of neat people at the conference. It was such fun.
More later...
There's always plusses and minuses to moving, but I'll be glad to do it, since Dahey's heading to a new assignment. I love the current Hotel Madison, but they all understand. My shopping buddy, A., will miss me, but now she says, she'll have another place out of town to hang out. My boss and other folks were sad, too, but understanding.
As a result, I'm going to have to figure out which way RehabRN the blog will go. I'm working on some stuff for that, too. I met a lot of neat people at the conference. It was such fun.
More later...
For the soldier...
...the sailor, the airman,
the officer,
the XO,
the COB,
the submariner,
the SEAL,
the parachutist,
the Green Beret,
the lowly KP potato peeler,
today we honor you all.
For the young men and women in the prime of life,
for the husbands, fathers, brothers,
wives, sisters and friends.
And the aunts, the uncles, the cousins.
For the combat nurses, the docs and the corpsmen in the field.
For the young and the old,
Injured and healthy,
Strong and frail.
For the wounded,
I am proud to be your nurse,
To just listen,
Or tell your story.
For the fallen,
Who left everything to fight--
Families, fortunes and friends,
And never returned.
You, truly, gave all.
May we remember, not just today, but every day.
That freedom has a price;
Paid in blood, sweat and tears,
In toil and tribulation,
On battlefields of the past, present and future.
Thank you veterans, one and all.
the officer,
the XO,
the COB,
the submariner,
the SEAL,
the parachutist,
the Green Beret,
the lowly KP potato peeler,
today we honor you all.
For the young men and women in the prime of life,
for the husbands, fathers, brothers,
wives, sisters and friends.
And the aunts, the uncles, the cousins.
For the combat nurses, the docs and the corpsmen in the field.
For the young and the old,
Injured and healthy,
Strong and frail.
For the wounded,
I am proud to be your nurse,
To just listen,
Or tell your story.
For the fallen,
Who left everything to fight--
Families, fortunes and friends,
And never returned.
You, truly, gave all.
May we remember, not just today, but every day.
That freedom has a price;
Paid in blood, sweat and tears,
In toil and tribulation,
On battlefields of the past, present and future.
Thank you veterans, one and all.
Monday, November 10, 2008
Wild and fun
The wild part:
In the middle of the day, I let our dog out on the front porch. He likes to bark at everything, but I noticed he had an unusual bark at something today. I looked out and a very large red fox was running around in the yard across the street. In our neck of the woods, it's not an uncommon site in the early morning hours, but at mid-morning, it was strange. WildDog decided to come inside, since I would not let him run over and chase the red fox across our street.
The fun part:
Work has actually been pretty pleasant. We are experiencing low census right now and most of the folks are in good moods. Things are getting along swimmingly. I somehow (holding breath) am not working Thanksgiving Day.
I can't wait to get up and bake away. I really love the cooking part of Thanksgiving. This year, I'm also very, very honored to be hosting Change of Shift right here at RehabRN on November 27.
For more information, check out Kim's page on CoS at http://www.emergiblog.com/.
Finally, a major Happy Birthday shout-out to my bro-in-law the major and professor. I hope you enjoy your blast from the past we sent!
In the middle of the day, I let our dog out on the front porch. He likes to bark at everything, but I noticed he had an unusual bark at something today. I looked out and a very large red fox was running around in the yard across the street. In our neck of the woods, it's not an uncommon site in the early morning hours, but at mid-morning, it was strange. WildDog decided to come inside, since I would not let him run over and chase the red fox across our street.
The fun part:
Work has actually been pretty pleasant. We are experiencing low census right now and most of the folks are in good moods. Things are getting along swimmingly. I somehow (holding breath) am not working Thanksgiving Day.
I can't wait to get up and bake away. I really love the cooking part of Thanksgiving. This year, I'm also very, very honored to be hosting Change of Shift right here at RehabRN on November 27.
For more information, check out Kim's page on CoS at http://www.emergiblog.com/.
Finally, a major Happy Birthday shout-out to my bro-in-law the major and professor. I hope you enjoy your blast from the past we sent!
Friday, November 7, 2008
The roles of the rehab nurse
This is a series of occasional articles geared toward new nurses entering rehab. If you've been around the nursing world for ages and you have some comments, feel free to throw them out there.
Recently, I attended a conference about multiple sclerosis and one of the presenters talked about how important the roles of a rehab nurse is to patients and the vaunted interdisciplinary team. Here are a few roles you play that may not have been so obvious.
1. Scheduler
Rehab nurses get schedules thrown at them by PT, OT and whomever else can think of something for them to do. We get to coordinate how people get from A to B and sometimes, we even get to say, "No way. You're not taking my people." Knowing how to work the schedule is a very important thing, for your sanity and the sanity of your patients and the rest of the rehab team.
2. Cheerleader
Rehab nurses cheer on patients, to be adherent to medication regimes ("That sounds nicer that 'compliant' "--actual quote by a presenter), to get out of bed and do therapy, and also to look at the sunnier side of life. Yes, some days suck, but you just have to deal with whatever gets in your way and motivate your people. I do not use pompoms, although, I have been known to use Diet Pepsi (or patient's drink of choice) as a motivator. Sometimes, as they say, you gotta fake it 'til you make it.
3. Marketer
Yes, this plays into the previous role of cheerleader. I have to "sell the program" as I always tell people. The program is, you will get out of bed, you will get your life going and you will have a routine. You can be sick and tired, but you have to at least try. Sometimes the best sales pitch is the one where the patient derives it from himself.
4. Therapist
Sometimes, all you may do is to listen therapeutically. You don't get the alphabet soup after your name like those therapists, but you get an earful. Think about how you can use that rant, rave or entreaty to help that patient. If you need help, ask for it, from your charge nurse, manager or your psychology staff. I couldn't live without ours.
Recently, I attended a conference about multiple sclerosis and one of the presenters talked about how important the roles of a rehab nurse is to patients and the vaunted interdisciplinary team. Here are a few roles you play that may not have been so obvious.
1. Scheduler
Rehab nurses get schedules thrown at them by PT, OT and whomever else can think of something for them to do. We get to coordinate how people get from A to B and sometimes, we even get to say, "No way. You're not taking my people." Knowing how to work the schedule is a very important thing, for your sanity and the sanity of your patients and the rest of the rehab team.
2. Cheerleader
Rehab nurses cheer on patients, to be adherent to medication regimes ("That sounds nicer that 'compliant' "--actual quote by a presenter), to get out of bed and do therapy, and also to look at the sunnier side of life. Yes, some days suck, but you just have to deal with whatever gets in your way and motivate your people. I do not use pompoms, although, I have been known to use Diet Pepsi (or patient's drink of choice) as a motivator. Sometimes, as they say, you gotta fake it 'til you make it.
3. Marketer
Yes, this plays into the previous role of cheerleader. I have to "sell the program" as I always tell people. The program is, you will get out of bed, you will get your life going and you will have a routine. You can be sick and tired, but you have to at least try. Sometimes the best sales pitch is the one where the patient derives it from himself.
4. Therapist
Sometimes, all you may do is to listen therapeutically. You don't get the alphabet soup after your name like those therapists, but you get an earful. Think about how you can use that rant, rave or entreaty to help that patient. If you need help, ask for it, from your charge nurse, manager or your psychology staff. I couldn't live without ours.
Whirlwind trip is over
After way too much fun and excitement on United Airlines last night, I finally made it home. Since there was no coffee on the plane, I drank some Coke and was awake enough to get home in one piece without falling asleep. It was tempting but I just don't sleep well on planes.
I enjoyed the seminar with my partner-in-crime, A. We got a lot of shopping and walking done in between sessions and it was fun. I met a lot of interesting people and the organizers plan on keeping in touch with us, to see how we're doing. Since we all work for the same place, I'm not surprised that they're doing this....it'll probably end up as a research project or something!
Today so far has been busy, and tomorrow I'll be back to work after a week away. I'm as ready as I'm going to get right now. Back to housework...stay tuned.
I enjoyed the seminar with my partner-in-crime, A. We got a lot of shopping and walking done in between sessions and it was fun. I met a lot of interesting people and the organizers plan on keeping in touch with us, to see how we're doing. Since we all work for the same place, I'm not surprised that they're doing this....it'll probably end up as a research project or something!
Today so far has been busy, and tomorrow I'll be back to work after a week away. I'm as ready as I'm going to get right now. Back to housework...stay tuned.
Tuesday, November 4, 2008
Conference all day
Well, it's looking pretty official out here in the Emerald City...my package is on its way home, filled with smoked salmon, salted caramels and souvenirs for family and pens and all sorts of freebies to take to work.
I got lots and lots of pens and stuff. They had all sorts of medication branded stuff--even blue liquid soap. (I passed on that, since that doesn't ship well, nor would it pass the TSA 3-1-1 rule.) A, my cohort, packed her own box, then E, one of the other RNs from Texas who we met, came along with us shopping and then to the Post Office, so we could ship the goodies.
Tomorrow, we go to another class and to a tour of the local unit. Stay tuned!
Sleepless in Seattle
I'm busy messing with the wifi in the room on my Palm with keyboard.
So far, so good.
I voted already, have you? If you haven't, go vote!
More later from the Emerald City...
Saturday, November 1, 2008
Whew! Another week over!
It was busy going from evenings to days. Thankfully, when it got really hairy, I was not working evenings.
One nurse was off this week, since a family member recently passed away and she headed out of town for the memorial services. One night in particular was crazy without her. I heard about it on Friday. I'm glad I was not working evenings. I would have just gone crazy!
My time back on the day shift was not bad, just busy. I got to pass meds a couple of days, then just take care of people on Friday. That was lovely, even though I felt like all I did was draw labs and run back and forth. For some reason, labs pulled from PICC lines on our unit always get screwed up. I don't mean sometimes, but most of the time. We get screwy results from the PICC, so then the doc orders a redraw from a vein, which usually drives the patients crazy. I had to do this with one of my patients. He was getting persnickety, so I tried an easy vein, but it didn't work, so I had to use one in the hand for his blood draw. While I'm not the best IV sticker, I can get blood out of hands and arms pretty good. I also like to think that I keep people from getting all bruised up, too, which I normally do. This draw, happily, went as usual.
The same patient needed a Vancomycin trough, so I drew that from the PICC. He was not going to let me get it any other way. I looked up the protocol and followed it to the letter, so I knew
I would not mess it up! I did a lot of fluffing and buffing, so I was happy to be finished.
Today, while I was perusing the paper, I found out one of my favorite patients died. Mr. B., the crazy plumber I took care of at Saintarama died this past week. The obit showed a photo of him that I recognized. It was from a photo with his family that he had in his room. He tried but never succeeded in getting rid of the trach after his illness. I will miss him. He was so funny.
I'm getting up early, early, early Monday morning to drive to the airport. We're taking off to our Pacific Northwest conference. The weather says rain, rain, rain, but at least, we'll be away from Madison. It should be fun. I'm going to have to tinker with mobile Blogger and see how that goes.
Have a great weekend all....more next time!
One nurse was off this week, since a family member recently passed away and she headed out of town for the memorial services. One night in particular was crazy without her. I heard about it on Friday. I'm glad I was not working evenings. I would have just gone crazy!
My time back on the day shift was not bad, just busy. I got to pass meds a couple of days, then just take care of people on Friday. That was lovely, even though I felt like all I did was draw labs and run back and forth. For some reason, labs pulled from PICC lines on our unit always get screwed up. I don't mean sometimes, but most of the time. We get screwy results from the PICC, so then the doc orders a redraw from a vein, which usually drives the patients crazy. I had to do this with one of my patients. He was getting persnickety, so I tried an easy vein, but it didn't work, so I had to use one in the hand for his blood draw. While I'm not the best IV sticker, I can get blood out of hands and arms pretty good. I also like to think that I keep people from getting all bruised up, too, which I normally do. This draw, happily, went as usual.
The same patient needed a Vancomycin trough, so I drew that from the PICC. He was not going to let me get it any other way. I looked up the protocol and followed it to the letter, so I knew
I would not mess it up! I did a lot of fluffing and buffing, so I was happy to be finished.
Today, while I was perusing the paper, I found out one of my favorite patients died. Mr. B., the crazy plumber I took care of at Saintarama died this past week. The obit showed a photo of him that I recognized. It was from a photo with his family that he had in his room. He tried but never succeeded in getting rid of the trach after his illness. I will miss him. He was so funny.
I'm getting up early, early, early Monday morning to drive to the airport. We're taking off to our Pacific Northwest conference. The weather says rain, rain, rain, but at least, we'll be away from Madison. It should be fun. I'm going to have to tinker with mobile Blogger and see how that goes.
Have a great weekend all....more next time!
Tuesday, October 28, 2008
Bed bingo on a crazy Monday
You know you're in for some excitement when you get to work and everyone's all shuffled around. This is known as "bed bingo". Bed bingo happens for a number of reasons, and it's mostly related to isolation status. We had one patient come up positive for a new organism, so as a result, five people got moved around to get rooms ready and everyone in their correct group.
Note: our facility cohorts patients in the same room with the same organism and we only have one (yes, one) private room among our rooms.
I got the same assignment and the med wagon far away again. This can be frazzling, but I dealt with it. The thing that is most frazzling is when one shift forgets to do the things to which they're assigned. Since our boss has been in and out with things, the tasks that normally get done on the floor have gone to the wayside a bit.
The housekeepers are the biggest problem right now. They have had some turnover in the last few months and they can't seem to keep the paper towels in stock in the staff bathrooms, nor can they keep the trash emptied. I've mentioned this to one of the housekeepers who usually sets us up well, but I'm not sure why it's not getting done. A lot of people on the evening shift are getting frazzled, and I'm one of them. I'm not on evenings all the time, but I see things on days and then I go to evenings and it gets annoying. With cold and flu season here, I wish one of the docs would notice and throw a fit, since maybe that might get something done. Running out of paper towels in the bathrooms and patient rooms is not an option!
Besides that, some of our day staff are not even attempting to pull their weight. Unfortunately that saying, "When the cat's away, the mice will play" is very true. I dread working behind some people. You should not immediately have to empty urine bags when you get on your shift, but I have done it every single night on evenings this round. One day, I had to make the patient's bed and get all the linens. This is the job of nursing at the ranch, and the nurse who had this patient couldn't get it done before she left at noon, and the nurse who followed her for four hours had made no attempt, either. Thankfully, I had the bed made...just as the patient was returning with his family from a day pass. I also got lucky and had to empty the bed bag for this guy, too, since this was just one more thing they forgot. I have to say most people are consistent--when they don't do something, they really follow through and miss everything. End of soapbox.
Ahh...that venting felt better....on to more fun stuff. My younger patient is doing more every day. It's really good to work with him. He puts the active in active rehab. He's even paying attention to his diet, which is really important for SCI patients. We talked about his bowel routine protocol and despite the assessment of the docs and the charge nurse, he's probably going to stick to a daily routine.
One of my other patients was really depressed because his blood pressure would not stay up even with his TEDs, binder and Midodrine. We talked about it and hopefully, it can be resolved soon enough.
I'm going to stop here...more later! I'm going to enjoy my off day! (Happy Birthday, Mom!)
Note: our facility cohorts patients in the same room with the same organism and we only have one (yes, one) private room among our rooms.
I got the same assignment and the med wagon far away again. This can be frazzling, but I dealt with it. The thing that is most frazzling is when one shift forgets to do the things to which they're assigned. Since our boss has been in and out with things, the tasks that normally get done on the floor have gone to the wayside a bit.
The housekeepers are the biggest problem right now. They have had some turnover in the last few months and they can't seem to keep the paper towels in stock in the staff bathrooms, nor can they keep the trash emptied. I've mentioned this to one of the housekeepers who usually sets us up well, but I'm not sure why it's not getting done. A lot of people on the evening shift are getting frazzled, and I'm one of them. I'm not on evenings all the time, but I see things on days and then I go to evenings and it gets annoying. With cold and flu season here, I wish one of the docs would notice and throw a fit, since maybe that might get something done. Running out of paper towels in the bathrooms and patient rooms is not an option!
Besides that, some of our day staff are not even attempting to pull their weight. Unfortunately that saying, "When the cat's away, the mice will play" is very true. I dread working behind some people. You should not immediately have to empty urine bags when you get on your shift, but I have done it every single night on evenings this round. One day, I had to make the patient's bed and get all the linens. This is the job of nursing at the ranch, and the nurse who had this patient couldn't get it done before she left at noon, and the nurse who followed her for four hours had made no attempt, either. Thankfully, I had the bed made...just as the patient was returning with his family from a day pass. I also got lucky and had to empty the bed bag for this guy, too, since this was just one more thing they forgot. I have to say most people are consistent--when they don't do something, they really follow through and miss everything. End of soapbox.
Ahh...that venting felt better....on to more fun stuff. My younger patient is doing more every day. It's really good to work with him. He puts the active in active rehab. He's even paying attention to his diet, which is really important for SCI patients. We talked about his bowel routine protocol and despite the assessment of the docs and the charge nurse, he's probably going to stick to a daily routine.
One of my other patients was really depressed because his blood pressure would not stay up even with his TEDs, binder and Midodrine. We talked about it and hopefully, it can be resolved soon enough.
I'm going to stop here...more later! I'm going to enjoy my off day! (Happy Birthday, Mom!)
Monday, October 27, 2008
Topics of note
Here are a few items I've encountered in my day-to-day practice and some related articles.
Oral care
How many of you out there really know if your patients brush their teeth? For a lot of SCI patients, if the nurses don't do it, patients don't get their teeth brushed. Reuters Health ran an interesting article in the past week about the relationship between oral hygiene and pneumonia. It's not just associated with ventilators anymore, folks.
Devices and other goodies
On our unit, we have lots of people with Baclofen pumps. Baclofen pumps are wonderful things that can get a patient who's in what looks like a permanent fetal position back to the straight and narrow, so he or she can ride in their wheelchair and do lots of other normal things we take for granted.
One of our patients who came in this week has an interesting variant: he has a baclofen/morphine pump that delivers both drugs intrathecally.
Bugs!
A recent patient came in and screened positive for a UTI. The culprit: E coli, which according to Todar's Online Textbook of Bacteriology is responsible for 90% of UTIs. This same patient has a history of odd bugs, including Kocuria Kristinae.
Oral care
How many of you out there really know if your patients brush their teeth? For a lot of SCI patients, if the nurses don't do it, patients don't get their teeth brushed. Reuters Health ran an interesting article in the past week about the relationship between oral hygiene and pneumonia. It's not just associated with ventilators anymore, folks.
Devices and other goodies
On our unit, we have lots of people with Baclofen pumps. Baclofen pumps are wonderful things that can get a patient who's in what looks like a permanent fetal position back to the straight and narrow, so he or she can ride in their wheelchair and do lots of other normal things we take for granted.
One of our patients who came in this week has an interesting variant: he has a baclofen/morphine pump that delivers both drugs intrathecally.
Bugs!
A recent patient came in and screened positive for a UTI. The culprit: E coli, which according to Todar's Online Textbook of Bacteriology is responsible for 90% of UTIs. This same patient has a history of odd bugs, including Kocuria Kristinae.
Sunday, October 26, 2008
Way out in left field
Since I've been mindlessly meandering on the 'net today, I found this quirky item listed as a Rehab Nursing costume for Halloween. Oh, I really wonder who thought this one up...Hugh Hefner perhaps?
The only thing good about it is that pleather wipes down easily, especially if you get those spraying bowel program kind of folks.
The only thing good about it is that pleather wipes down easily, especially if you get those spraying bowel program kind of folks.
Sleepy Sunday
Try as I might, I just couldn't go back to sleep this morning. It probably has to do with waking up once and the old sleep button just does not re-engage for me....arrgh!
Last night was busy. I had three patients, two of whom were the same as the night before and two of the three were out on pass at dinnertime, which was nice. I also inherited the med wagon up in the front from J. when she left her 12 hour shift at 2000.
It's only one med run (around 2200) so what should be so hard? The answer: a whole lot of needy patients. If it wasn't one thing, it was another. People would not ask for stuff in advance, they all waited until I got to the room. I doubled back and got everything filled reasonably quickly, but I was still pushing pills at 2355, which really sucks. I just figured I get stuff done before the night shift came on to do their turns.
M. the charge was off last night and P. took over. That team has the neediest patient on the floor--Mr. B. He rang the light over and over and over. Poor P. was never out of the room for more than 5 minutes and the light would go on. Mr. B. is typical of many post-ICU patients: he thinks we only have 1-2 patients and are waiting outside his room for him to call. No dice. Most of the time, we have people assigned to us all over the place on the unit and we are trying to get them turned, bowel routines done, fluffed and buffed and ready for bed all at the same time. Hopefully, he'll get a little more relaxed, but so far, it's not happening. We shall see...
My people were pretty good for the most part and I got everything done by midnight. It was pushing it, though. I'm going to work with a few other things tonight, so hopefully, things will go more smoothly.
More later...
Last night was busy. I had three patients, two of whom were the same as the night before and two of the three were out on pass at dinnertime, which was nice. I also inherited the med wagon up in the front from J. when she left her 12 hour shift at 2000.
It's only one med run (around 2200) so what should be so hard? The answer: a whole lot of needy patients. If it wasn't one thing, it was another. People would not ask for stuff in advance, they all waited until I got to the room. I doubled back and got everything filled reasonably quickly, but I was still pushing pills at 2355, which really sucks. I just figured I get stuff done before the night shift came on to do their turns.
M. the charge was off last night and P. took over. That team has the neediest patient on the floor--Mr. B. He rang the light over and over and over. Poor P. was never out of the room for more than 5 minutes and the light would go on. Mr. B. is typical of many post-ICU patients: he thinks we only have 1-2 patients and are waiting outside his room for him to call. No dice. Most of the time, we have people assigned to us all over the place on the unit and we are trying to get them turned, bowel routines done, fluffed and buffed and ready for bed all at the same time. Hopefully, he'll get a little more relaxed, but so far, it's not happening. We shall see...
My people were pretty good for the most part and I got everything done by midnight. It was pushing it, though. I'm going to work with a few other things tonight, so hopefully, things will go more smoothly.
More later...
Saturday, October 25, 2008
Heard on the unit...
Yes, I haven't had an installment of this in a while, so here goes...
"I'm so happy to see your smiling face." Mr. J.
Some people love to see you come back to work. Others...well, they aren't exactly thrilled. Mr. J. is a riot and he's always got a funny perspective on things. I think some of that has to do with his previous job--police detective.
"It really smells down here." Nursing supervisor last night when he was on the unit.
"That's the smell of success." Yours truly (RehabRN)
Yes, it's not really a secret, but to all of you nursing students going to rehab, especially with SCI patients, evening shifts tend to be...shall we say, aromatic. Many patients who do active rehab have bowel programs in the evenings, usually immediately (30-60 minutes) following dinner. The reason? This allows the patients to get the most out of therapy, particularly, in terms of time, since while nurses work 24/7, therapists do not. Most of them work the day shift Monday through Friday and usually they rotate the weekends, where they work a max of four to eight hours, depending on the rules of the unit, etc.
If you smell something, that means we have people with good, working bowels. If they're consistent, this also means that they won't have accidents in between, either and will get the most out of therapy. We start everyone on bowel routines daily, and then after two weeks, they will move to qod (or every other day). Some people do well like that, and if that doesn't work, they stay on a daily schedule.
"I don't know what her (MD's) rationale is, but I'm getting out of here on Monday." Mr. R.
I admitted this guy on Tuesday. Sure he's in for a short trip, but for some reason, we get a lot of patients who get sick once they arrive and then they have to stay with us. Mr. R. is very impatient to leave, which is pretty unusual for most of our patients. We tend to keep people a long time.
"I'm so happy to see your smiling face." Mr. J.
Some people love to see you come back to work. Others...well, they aren't exactly thrilled. Mr. J. is a riot and he's always got a funny perspective on things. I think some of that has to do with his previous job--police detective.
"It really smells down here." Nursing supervisor last night when he was on the unit.
"That's the smell of success." Yours truly (RehabRN)
Yes, it's not really a secret, but to all of you nursing students going to rehab, especially with SCI patients, evening shifts tend to be...shall we say, aromatic. Many patients who do active rehab have bowel programs in the evenings, usually immediately (30-60 minutes) following dinner. The reason? This allows the patients to get the most out of therapy, particularly, in terms of time, since while nurses work 24/7, therapists do not. Most of them work the day shift Monday through Friday and usually they rotate the weekends, where they work a max of four to eight hours, depending on the rules of the unit, etc.
If you smell something, that means we have people with good, working bowels. If they're consistent, this also means that they won't have accidents in between, either and will get the most out of therapy. We start everyone on bowel routines daily, and then after two weeks, they will move to qod (or every other day). Some people do well like that, and if that doesn't work, they stay on a daily schedule.
"I don't know what her (MD's) rationale is, but I'm getting out of here on Monday." Mr. R.
I admitted this guy on Tuesday. Sure he's in for a short trip, but for some reason, we get a lot of patients who get sick once they arrive and then they have to stay with us. Mr. R. is very impatient to leave, which is pretty unusual for most of our patients. We tend to keep people a long time.
Life's a party...
If you're Bubba at our house. It's Halloween party season.
I'm so tired from evenings, but we're departing for the latest seasonal party at my sister's place.
More goodies later...
I'm so tired from evenings, but we're departing for the latest seasonal party at my sister's place.
More goodies later...
Thursday, October 23, 2008
A rainy Thursday
I'm looking out the window and it's gray and rainy. The wind is also cool, too. Fall is definitely here in our neck of the woods. There is some fall color, but most of the leaves have been blowing away and not really turning too well.
I need to clean my house before my in-laws come over this weekend, and I don't want to do it. The dog looks outside and sees the damp concrete and looks at me as if to say, "You want me to wait out HERE while you vacuum? No way!" This will make things very interesting (since he tends to chase the vacuum cleaner.)
To start today, I got Bubba to school and then I went to get Bubba some stuff and some Halloween makeup. I'm actually planning on wearing a costume this year. I have enough makeup for me, Dahey and Bubba to get made up a couple of times. Rest assured, all of the makeup I bought is water soluble, made in the good ol' US of A, and supposedly hypoallergenic. (We'll test it out and see...) No idea what the boys will be this year. Bubba keeps vacillating back and forth on what he wants to be. We have costumes galore Dahey has collected since the summer and of course, Bubba doesn't want to wear any of them.
After the trip to the store, I got out my carry-on and started packing some of my stuff for the conference coming up in early November. It's in the Pacific Northwest, so I'm expecting more of the cold, rainy stuff. I won't pack everything yet, but it's easier to inventory and get stuff when you have to look at the bag every day. I just throw something in once I think of it, then I reassess when doing the final packing and checking off the list (yes, I have a list for everything I pack). I do this in an effort not to forget the important stuff, like underwear and socks (I have done this several times on trips).
I'm still working on my CRRN review. I really like the Datachem software, since it has a lot of questions and answers (about 750 in the database). If you buy it at www.rehabnurse.org (in the Bookstore section) and you're a ARN member, you get $10 off the list price. I got the Certification Review software, too, and it's a little more flashy, with a lot of sounds and feedback when you answer questions.
Well, since I'm back to work this evening, I'll stop for now and start cleaning. Hopefully, the dog will stay out of trouble! More later...
I need to clean my house before my in-laws come over this weekend, and I don't want to do it. The dog looks outside and sees the damp concrete and looks at me as if to say, "You want me to wait out HERE while you vacuum? No way!" This will make things very interesting (since he tends to chase the vacuum cleaner.)
To start today, I got Bubba to school and then I went to get Bubba some stuff and some Halloween makeup. I'm actually planning on wearing a costume this year. I have enough makeup for me, Dahey and Bubba to get made up a couple of times. Rest assured, all of the makeup I bought is water soluble, made in the good ol' US of A, and supposedly hypoallergenic. (We'll test it out and see...) No idea what the boys will be this year. Bubba keeps vacillating back and forth on what he wants to be. We have costumes galore Dahey has collected since the summer and of course, Bubba doesn't want to wear any of them.
After the trip to the store, I got out my carry-on and started packing some of my stuff for the conference coming up in early November. It's in the Pacific Northwest, so I'm expecting more of the cold, rainy stuff. I won't pack everything yet, but it's easier to inventory and get stuff when you have to look at the bag every day. I just throw something in once I think of it, then I reassess when doing the final packing and checking off the list (yes, I have a list for everything I pack). I do this in an effort not to forget the important stuff, like underwear and socks (I have done this several times on trips).
I'm still working on my CRRN review. I really like the Datachem software, since it has a lot of questions and answers (about 750 in the database). If you buy it at www.rehabnurse.org (in the Bookstore section) and you're a ARN member, you get $10 off the list price. I got the Certification Review software, too, and it's a little more flashy, with a lot of sounds and feedback when you answer questions.
Well, since I'm back to work this evening, I'll stop for now and start cleaning. Hopefully, the dog will stay out of trouble! More later...
Wednesday, October 22, 2008
Nuggets for October 22
Yes, it's my day off and I'm again scouring the blogosphere for some good stuff. I've had a few people send me links to their blogs, so I'm adding those as I can, to share the link love. Check out the sidebar for some from the good ol' USA to Canada and even one from the Czech Republic about a nurse who snaps photos for fun while checking out nature.
In the MIA section
I'm also lamenting the loss of Podunk Memorial. Mielikki, where ever you are, I really enjoyed your blog. I wish you the best!
Terry at Counting Sheep sold www.everydaynurses.com, so I haven't seen anything from her in eons. Good luck Terry!
Here are a few things I found meandering today. Enjoy!
From the ER (ED, or whatever you choose to call it for the moment...)
Braden from 20 out of 10 has a great post on never events. Bayer may be right and the government may indeed be idiots if they buy this renaming thing. Why call it a never event if it can get renamed? Perhaps some funding in the way of adequate equipment and staffing from CMS might help. Naw...that would be too logical.
You can get more than you bargain for if you tagalong on a ER visit. CrassPollination has this great tagalong story you'll enjoy, even if you don't work in the ER.
From transplant city...
Donorcycle is one of my favorite transplant blogs to read. While there haven't been a ton of posts lately, I'd suspect she's busy. Some days are better than others according to this post. I really like the bird imagery, TC!
And finally, in the 'tis the season category...
Awake in Rochester has this great post about ghosts. My answer is yes....maybe not seen but have heard and felt some around me, and it wasn't even scary.
In the MIA section
I'm also lamenting the loss of Podunk Memorial. Mielikki, where ever you are, I really enjoyed your blog. I wish you the best!
Terry at Counting Sheep sold www.everydaynurses.com, so I haven't seen anything from her in eons. Good luck Terry!
Here are a few things I found meandering today. Enjoy!
From the ER (ED, or whatever you choose to call it for the moment...)
Braden from 20 out of 10 has a great post on never events. Bayer may be right and the government may indeed be idiots if they buy this renaming thing. Why call it a never event if it can get renamed? Perhaps some funding in the way of adequate equipment and staffing from CMS might help. Naw...that would be too logical.
You can get more than you bargain for if you tagalong on a ER visit. CrassPollination has this great tagalong story you'll enjoy, even if you don't work in the ER.
From transplant city...
Donorcycle is one of my favorite transplant blogs to read. While there haven't been a ton of posts lately, I'd suspect she's busy. Some days are better than others according to this post. I really like the bird imagery, TC!
And finally, in the 'tis the season category...
Awake in Rochester has this great post about ghosts. My answer is yes....maybe not seen but have heard and felt some around me, and it wasn't even scary.
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!).
Nuggets for October 20
Here are a few of the interesting items I've found lately. Enjoy!
Think pushing someone in a wheelchair is hard? Imagine running a half marathon with your favorite patient? This nurse in Michigan will be running with hers and he wants to win! (from the Detroit Free Press)
There's a new type of bariatric surgery out there--TOGA--which eliminates all of those incisions. (from www.nytimes.com)
Is this opening a Pandora's box? The DNA Age-Taking a Peek at the Experts' Genetic Secrets (from www.nytimes.com) may not be for these folks who have lots of resources, but it could be for you.
And now for something completely different....
If you missed it, check out the Palin rap sketch from SNL this weekend. It's not Tina Fey, but it's funny.
Think pushing someone in a wheelchair is hard? Imagine running a half marathon with your favorite patient? This nurse in Michigan will be running with hers and he wants to win! (from the Detroit Free Press)
There's a new type of bariatric surgery out there--TOGA--which eliminates all of those incisions. (from www.nytimes.com)
Is this opening a Pandora's box? The DNA Age-Taking a Peek at the Experts' Genetic Secrets (from www.nytimes.com) may not be for these folks who have lots of resources, but it could be for you.
And now for something completely different....
If you missed it, check out the Palin rap sketch from SNL this weekend. It's not Tina Fey, but it's funny.
Saturday, October 18, 2008
Loss, greaving and removal
There's been a lot of all these things going on lately in my life. Last week seemed like funeral central between the funerals, wakes, and news of people we know (or know their families) dying.
On the removal topic, my one patient of the day Friday got his halo removed. It was not a painless procedure, either. I had to go with him to Washington to see the neurologist. It involved unscrewing some pretty deeply seated screws and my (and his family's) attempts at diversion weren't always the best. I premedicated him for the trip, but by the time we got to the removal, he could have used another PRN dose of morphine.
We found out from the neurologist that the halo and its rods were actually made from carbon fiber. The patient's family took one of the rods (and one screw--the clean one) home as a souvenir. He didn't want anything else--just to get rid of it. As a replacement, he got a Miami J collar and he has to get used to that. I washed his hair once we got back, cleaned the pin sites and he ate some lunch. He can shower on Monday, which he's really looking forward to doing. On a related note, I found this great post from a woman who described her own halo removal happiness in an ABC format. I'm thinking about passing it along to him.
The actual procedure and x-rays didn't take very long, but the whole trip to Washington and back surely did. I was happy to get back at about 1300, so I could finally sit down. I charted and straightened up his room, and before I knew it, it was time to go home.
I'm off this weekend, so more goodies next week. Stay tuned.
On the removal topic, my one patient of the day Friday got his halo removed. It was not a painless procedure, either. I had to go with him to Washington to see the neurologist. It involved unscrewing some pretty deeply seated screws and my (and his family's) attempts at diversion weren't always the best. I premedicated him for the trip, but by the time we got to the removal, he could have used another PRN dose of morphine.
We found out from the neurologist that the halo and its rods were actually made from carbon fiber. The patient's family took one of the rods (and one screw--the clean one) home as a souvenir. He didn't want anything else--just to get rid of it. As a replacement, he got a Miami J collar and he has to get used to that. I washed his hair once we got back, cleaned the pin sites and he ate some lunch. He can shower on Monday, which he's really looking forward to doing. On a related note, I found this great post from a woman who described her own halo removal happiness in an ABC format. I'm thinking about passing it along to him.
The actual procedure and x-rays didn't take very long, but the whole trip to Washington and back surely did. I was happy to get back at about 1300, so I could finally sit down. I charted and straightened up his room, and before I knew it, it was time to go home.
I'm off this weekend, so more goodies next week. Stay tuned.
Thursday, October 16, 2008
A pretty good day
I was lucky enough to have my three same patients back and my day was reasonably easy. The Slug was coordinating our Boss's Day festivities, so it was pretty haphazard as I expected, and she disappeared for not just one plus hour, but two and a half hours. Heaven forbid you actually do this stuff on your OWN time!
I got Mr. B. ready and he kept having orthostatic hypertension. He'd get set up in his chair and in an upright driving position and his BP would just plummet. I had no choice but to contact the NP. He kept dropping in spite of his TED hose, abdominal binder and his 5 mgs of Midodrine. I got an order for another 5 mgs of Midodrine at lunch time and he did well, but he got woozy again on me late in the afternoon as I was leaving. I passed this on to the evening shift. Tomorrow, I get to go with Mr. B. up to Washington to see the neurosurgeon. They will do some flexion-extension x-rays to determine if he can get his halo removed.
The other Mr. B. got back from his trip to Washington without a hitch. The GI docs found a cancerous polyp on his last colonoscopy and were looking for the area where it was removed today. They searched his entire colon and could not find it, even though he had a tattoed polypectomy last time.
Mr. W., my other patient, a para who did all of his own care left today. He was very nice and was very happy that his colonoscopy didn't show anything bad at all. I put in his discharge notes and wished him well.
The afternoon went reasonably well. I got my hotel confirmed for the conference I'm attending in November. I'm still getting the flight situated. I missed two Accuchecks at lunch time because two of the diabetic patients escaped to the free lunch one of the veteran's organizations has each month. I managed to get all the Accuchecks done before anyone ate anything else and I escaped at 1600. Fall is definitely here in our neck of the woods. It was blue skies and sunny, but the wind was cool and crisp.
More later...
I got Mr. B. ready and he kept having orthostatic hypertension. He'd get set up in his chair and in an upright driving position and his BP would just plummet. I had no choice but to contact the NP. He kept dropping in spite of his TED hose, abdominal binder and his 5 mgs of Midodrine. I got an order for another 5 mgs of Midodrine at lunch time and he did well, but he got woozy again on me late in the afternoon as I was leaving. I passed this on to the evening shift. Tomorrow, I get to go with Mr. B. up to Washington to see the neurosurgeon. They will do some flexion-extension x-rays to determine if he can get his halo removed.
The other Mr. B. got back from his trip to Washington without a hitch. The GI docs found a cancerous polyp on his last colonoscopy and were looking for the area where it was removed today. They searched his entire colon and could not find it, even though he had a tattoed polypectomy last time.
Mr. W., my other patient, a para who did all of his own care left today. He was very nice and was very happy that his colonoscopy didn't show anything bad at all. I put in his discharge notes and wished him well.
The afternoon went reasonably well. I got my hotel confirmed for the conference I'm attending in November. I'm still getting the flight situated. I missed two Accuchecks at lunch time because two of the diabetic patients escaped to the free lunch one of the veteran's organizations has each month. I managed to get all the Accuchecks done before anyone ate anything else and I escaped at 1600. Fall is definitely here in our neck of the woods. It was blue skies and sunny, but the wind was cool and crisp.
More later...
Wednesday, October 15, 2008
Back to days
I got the pleasure of no med cart today with my patients. Hooray! I always feel trapped every time I have to drive that thing.
I had two colonoscopy patients (one got his today, other gets his tomorrow) and Mr. B., who I took care of over the weekend. It was relatively placid. I got Mr. B. up in his chair by 1030. He had one big request, "Don't scrub me today. I feel like my skin is falling off." Ah, yes, we do offer spa services at Madison--the VA has a laundry contractor who doesn't use fabric softener, so we have really hard washcloths and towels. I try to pat carefully, so people don't feel like they're getting their skin rubbed off. I also use lotion, which for some strange reason, many of our employees will not use.
Mr. B #2 was getting his second gallon of GoLytely today at noon. He's scheduled for a colonoscopy tomorrow, so you can guess what I was doing all afternoon--cleaning. He'd turn and he'd be dirty. Turn him again to get it out from under him, and more came out in spurts. He is a very nice man, so I made sure to keep him clean. He just couldn't keep his external catheter on, and he used about four this morning. He ran out of his own, so I had to get him a couple of ours. Hopefully, they lasted until C. got back there this afternoon. I left her with a hamper, bags and a large supply of towels, pads and washcloths, just so she could deal with the outflow.
I was really, really happy to hit the road today. More tomorrow...
I had two colonoscopy patients (one got his today, other gets his tomorrow) and Mr. B., who I took care of over the weekend. It was relatively placid. I got Mr. B. up in his chair by 1030. He had one big request, "Don't scrub me today. I feel like my skin is falling off." Ah, yes, we do offer spa services at Madison--the VA has a laundry contractor who doesn't use fabric softener, so we have really hard washcloths and towels. I try to pat carefully, so people don't feel like they're getting their skin rubbed off. I also use lotion, which for some strange reason, many of our employees will not use.
Mr. B #2 was getting his second gallon of GoLytely today at noon. He's scheduled for a colonoscopy tomorrow, so you can guess what I was doing all afternoon--cleaning. He'd turn and he'd be dirty. Turn him again to get it out from under him, and more came out in spurts. He is a very nice man, so I made sure to keep him clean. He just couldn't keep his external catheter on, and he used about four this morning. He ran out of his own, so I had to get him a couple of ours. Hopefully, they lasted until C. got back there this afternoon. I left her with a hamper, bags and a large supply of towels, pads and washcloths, just so she could deal with the outflow.
I was really, really happy to hit the road today. More tomorrow...
Tuesday, October 14, 2008
Dumb, de dumb, dum...
That was a lot of my night last night. Dumb, crazy stuff happening. Can I just blame it on the upcoming full moon? Nope, probably has something to do with the fact that I was just tired with a capital T last night and required several caffeine infusions to get rolling.
Here's a list of some of the dumb things that happened on my last spate of evenings.
1. While I was driving the med cart one night, I noticed that one of my patients had an order for Mupirocin to his nose. The order wasn't really specific in the med software, so I had to open the charting software to see what was happening.
From the MD's note, the Mupirocin is being used for MRSA prophylaxis. When I went to administer this to the patient, I explained the procedure I was going to use (put it on a swab and swab inside his nose). The patient then proceeds to tell me that the other nurses put the Mupirocin ON the outside of his nose.
This is just more evidence of why we need more in-services on how to do the cultures and the treatment for MRSA. It also helped that the pharmacist added the important details (put in nose) and it now shows up in red on the screen when it's due.
2. Another classic case of don't look it up and learn. I just heard about this one last night.
We have another patient on Lidoderm patches. One of our very experienced nurses only looked up lidocaine and saw an odd side effect. She called the doc and he screamed at her, telling her that there should be none of those side effects because the lidocaine was not going directly into a vein.
Thankfully, I used Lidoderm patches a lot at Saintarama, but I wasn't working that day to pass that helpful information along.
3. Don't adjust the roller clamp, don't get any IV going.
I hate it when pumps go off all the time. One of my patients, Mr. AB #1 who's going back to the western state he came from today kept having problems with his IV pump last night. I kept missing releasing the roller clamp before I got the pump started. His tube feeding pump was also acting crazy, but I managed to fix that.
4. Just put one pad beneath the guy you just gave a gallon of GoLytely to five minutes ago.
That's just horrible. One of our new nurses (literally--one year in December) had this guy in the AM and K. the LPN got lucky and got this guy padded up before the first explosion. He still was messy, though. Colonoscopy preps are just a nightmare, not just for the nurses, but for the roommates, too. You'd think they'd put all the colo prep people in the same room. Our patients come in two to three days ahead for prep so they can keep their skin intact. It is very hard for SCI patients to do this at home without 24/7 support.
Now that I've created some interesting pictures, I'm heading out to go run more errands and clean more stuff. Back to work tomorrow, so more excitement ahead. Stay tuned!
Here's a list of some of the dumb things that happened on my last spate of evenings.
1. While I was driving the med cart one night, I noticed that one of my patients had an order for Mupirocin to his nose. The order wasn't really specific in the med software, so I had to open the charting software to see what was happening.
From the MD's note, the Mupirocin is being used for MRSA prophylaxis. When I went to administer this to the patient, I explained the procedure I was going to use (put it on a swab and swab inside his nose). The patient then proceeds to tell me that the other nurses put the Mupirocin ON the outside of his nose.
This is just more evidence of why we need more in-services on how to do the cultures and the treatment for MRSA. It also helped that the pharmacist added the important details (put in nose) and it now shows up in red on the screen when it's due.
2. Another classic case of don't look it up and learn. I just heard about this one last night.
We have another patient on Lidoderm patches. One of our very experienced nurses only looked up lidocaine and saw an odd side effect. She called the doc and he screamed at her, telling her that there should be none of those side effects because the lidocaine was not going directly into a vein.
Thankfully, I used Lidoderm patches a lot at Saintarama, but I wasn't working that day to pass that helpful information along.
3. Don't adjust the roller clamp, don't get any IV going.
I hate it when pumps go off all the time. One of my patients, Mr. AB #1 who's going back to the western state he came from today kept having problems with his IV pump last night. I kept missing releasing the roller clamp before I got the pump started. His tube feeding pump was also acting crazy, but I managed to fix that.
4. Just put one pad beneath the guy you just gave a gallon of GoLytely to five minutes ago.
That's just horrible. One of our new nurses (literally--one year in December) had this guy in the AM and K. the LPN got lucky and got this guy padded up before the first explosion. He still was messy, though. Colonoscopy preps are just a nightmare, not just for the nurses, but for the roommates, too. You'd think they'd put all the colo prep people in the same room. Our patients come in two to three days ahead for prep so they can keep their skin intact. It is very hard for SCI patients to do this at home without 24/7 support.
Now that I've created some interesting pictures, I'm heading out to go run more errands and clean more stuff. Back to work tomorrow, so more excitement ahead. Stay tuned!
Sunday, October 12, 2008
Working the weekend
It's been very busy outside of work this weekend, so I'll be back later for more posting fun.
Meanwhile, the evening shift continues along swimmingly....stay tuned!
Meanwhile, the evening shift continues along swimmingly....stay tuned!
Thursday, October 9, 2008
Nuggets for October 9
Yes, I was off yesterday. I found quite a variety of goodies out there I hope you all enjoy! Here's the fall harvest this week...
In the "you'll never look the same way at this again" category
Remember all that debate over embryonic stem cells? Well, scientists may be able to use cells found elsewhere on the body to do the same job. Head on over to the WSJ Health blog and this article to find out the latest stem cell generation location.
Last week, I pointed you in the direction of impactED's helminth therapy article. Yes, indeed, according to my allergist (a top researcher at PrivateU), people with worms tend to have less allergies. If you really want to get your own set of worms, you can't get it from him, you'll have to head to http://www.wormtherapy.com/ and figure that out on your own! I think I'll pass on that, thank you!
Health promotion articles
Like dark chocolate? Your heart may like it, too, if you eat small amounts every day according to this Reuters article.
More infection control guidelines courtesy of our friends at the AHA and JCAHO. (from http://www.nytimes.com/)
Another reason for a healthy economy and plenty of jobs: Family income impacts children's health (from Yahoo! News Health)
Quote
"I'm beginning to understand myself. But it would have been great to be able to understand myself when I was 20 rather than when I was 82." Dave Brubeck, jazz pianist
In the "you'll never look the same way at this again" category
Remember all that debate over embryonic stem cells? Well, scientists may be able to use cells found elsewhere on the body to do the same job. Head on over to the WSJ Health blog and this article to find out the latest stem cell generation location.
Last week, I pointed you in the direction of impactED's helminth therapy article. Yes, indeed, according to my allergist (a top researcher at PrivateU), people with worms tend to have less allergies. If you really want to get your own set of worms, you can't get it from him, you'll have to head to http://www.wormtherapy.com/ and figure that out on your own! I think I'll pass on that, thank you!
Health promotion articles
Like dark chocolate? Your heart may like it, too, if you eat small amounts every day according to this Reuters article.
More infection control guidelines courtesy of our friends at the AHA and JCAHO. (from http://www.nytimes.com/)
Another reason for a healthy economy and plenty of jobs: Family income impacts children's health (from Yahoo! News Health)
Quote
"I'm beginning to understand myself. But it would have been great to be able to understand myself when I was 20 rather than when I was 82." Dave Brubeck, jazz pianist
Tuesday, October 7, 2008
Crazy, crazy day
I ran and ran again today, but at least, things were a little calmer than yesterday. Some people remembered that I helped them out a lot, so they helped me on a couple of things. It was nice. We had two call-ins, so the boss called one of our night people who was off and she came in pronto. I was happy because she took one of my assigned people, so I only had two patients and the med cart.
The Slug was in and she was slacking away as usual. She had to do one admission, but after that, when the boss left for his meeting, she took her 2 hour lunch while the rest of us scrambled to set up and/or feed our people who needed it. She does not get it that the time you take to run to X sandwich shop on your lunch hour is part of your lunch hour (which isn't really an hour--it's just 30 minutes).
Nope, she takes that time (anywhere from 15-30 minutes) and doesn't count it when she comes back and sits on her derriere. She started eating at 1215, and I ate my sandwich, and she didn't leave the lunch room until 1345. This did not include the time it took her to go get her lunch. This was just the time I observed. Management looks the other way.
Besides that, I just pray I work a shift that she doesn't because I get tired of these antics and all the "emergency" calls she gets. One of her callers actually sounded indignant today because I told him she was at lunch. "Well can't you just go get her?" "Well, no. I'm busy taking care of patients." I told him. (I was getting ready to give some meds and the secretary was at lunch. No one else was in sight.) I put the idiot on hold and I overhead paged her, even though I knew exactly where she was. I figured she needed the exercise to walk over to the phone, and I could go do something else.
I had my same two patients as yesterday. Mr. S. needed a new Foley (a special one at that--16 FR with 30cc balloon Coude) and I put it in as soon as it arrived on the unit. We change indwelling catheters once a month and then, per policy, we send a UA and C&S to the lab when we're done.
Mr. S. was supposed to get a loaner wheelchair so he could get up, but the PT couldn't get his configured right away because she was too busy. Mr. S. was very understanding, though. His neighbor, Mr. HIJ #1, who recently moved to this room since he got a special bed, was as demanding as ever, but I kept him relatively quiet. He wanted me to get him a soda, but he got distracted doing some crafts, so he didn't even worry about it.
I ran back and forth giving the meds on the last run, which at 1600 really isn't too bad. People were streaming in and out of the latest group meeting in our main gathering area, so I had to chase some of them. I got everything straightened up and passed on to C., who was taking my med cart. I got out of there as fast as my legs could carry me without running. P and I walked out the door as a camera crew was coming in to film a story. P. told me, "Stay here long enough and you'll be on TV, too! I've been on one show already. With those powder puffs, I felt like Oprah!"
Even though, it was gray and cloudy, it was good to escape. Off tomorrow and back to evenings on Thursday...stay tuned.
The Slug was in and she was slacking away as usual. She had to do one admission, but after that, when the boss left for his meeting, she took her 2 hour lunch while the rest of us scrambled to set up and/or feed our people who needed it. She does not get it that the time you take to run to X sandwich shop on your lunch hour is part of your lunch hour (which isn't really an hour--it's just 30 minutes).
Nope, she takes that time (anywhere from 15-30 minutes) and doesn't count it when she comes back and sits on her derriere. She started eating at 1215, and I ate my sandwich, and she didn't leave the lunch room until 1345. This did not include the time it took her to go get her lunch. This was just the time I observed. Management looks the other way.
Besides that, I just pray I work a shift that she doesn't because I get tired of these antics and all the "emergency" calls she gets. One of her callers actually sounded indignant today because I told him she was at lunch. "Well can't you just go get her?" "Well, no. I'm busy taking care of patients." I told him. (I was getting ready to give some meds and the secretary was at lunch. No one else was in sight.) I put the idiot on hold and I overhead paged her, even though I knew exactly where she was. I figured she needed the exercise to walk over to the phone, and I could go do something else.
I had my same two patients as yesterday. Mr. S. needed a new Foley (a special one at that--16 FR with 30cc balloon Coude) and I put it in as soon as it arrived on the unit. We change indwelling catheters once a month and then, per policy, we send a UA and C&S to the lab when we're done.
Mr. S. was supposed to get a loaner wheelchair so he could get up, but the PT couldn't get his configured right away because she was too busy. Mr. S. was very understanding, though. His neighbor, Mr. HIJ #1, who recently moved to this room since he got a special bed, was as demanding as ever, but I kept him relatively quiet. He wanted me to get him a soda, but he got distracted doing some crafts, so he didn't even worry about it.
I ran back and forth giving the meds on the last run, which at 1600 really isn't too bad. People were streaming in and out of the latest group meeting in our main gathering area, so I had to chase some of them. I got everything straightened up and passed on to C., who was taking my med cart. I got out of there as fast as my legs could carry me without running. P and I walked out the door as a camera crew was coming in to film a story. P. told me, "Stay here long enough and you'll be on TV, too! I've been on one show already. With those powder puffs, I felt like Oprah!"
Even though, it was gray and cloudy, it was good to escape. Off tomorrow and back to evenings on Thursday...stay tuned.
Monday, October 6, 2008
Back to work
Oh, I had to wake up this morning to the alarm clock, which I have not done in days!
I got up early so I could make my breakfast and lunch and get ready to take Bubba to school. Dahey leaves before we do, so he was out and off to work in the dark.
I got Bubba to his latchkey program and away to work I went. I checked my e-mails and boy, there were a lot! The most exciting one was the invite to a special out-of-town conference in November. I have to get all my paperwork done tomorrow so I can go. The admin upstairs, L., has been assigned to help me. (You know it's going to be interesting when she tells you that you have to fill out a 12 page form...in order to book your flight.)
I had two patients I haven't had in a long time and I was the med nurse on one hall. It kept me busy. Today, the docs make group rounds to inspect wounds, so this is also interesting. I try to hang out in the room, undo the dressing, then get everyone cleaned up. They got into my room early, but I was really busy with these two guys...and their roommate had me helping him, too. Mr. R. is very needy, which is not unusual for a COPDer. He's always worried about something--his mask, his bowel program, his turns. He looked a bit ashen today, which is very scary in light of the fact that even with his fragile health, he's a full code. I pray we don't have to do CPR on him while I'm working!
I met some new LPNs visiting us with the recruiter. We're looking for them, so we'll see if they come to work for us!
More tomorrow...getting tired and I need to go to bed!
I got up early so I could make my breakfast and lunch and get ready to take Bubba to school. Dahey leaves before we do, so he was out and off to work in the dark.
I got Bubba to his latchkey program and away to work I went. I checked my e-mails and boy, there were a lot! The most exciting one was the invite to a special out-of-town conference in November. I have to get all my paperwork done tomorrow so I can go. The admin upstairs, L., has been assigned to help me. (You know it's going to be interesting when she tells you that you have to fill out a 12 page form...in order to book your flight.)
I had two patients I haven't had in a long time and I was the med nurse on one hall. It kept me busy. Today, the docs make group rounds to inspect wounds, so this is also interesting. I try to hang out in the room, undo the dressing, then get everyone cleaned up. They got into my room early, but I was really busy with these two guys...and their roommate had me helping him, too. Mr. R. is very needy, which is not unusual for a COPDer. He's always worried about something--his mask, his bowel program, his turns. He looked a bit ashen today, which is very scary in light of the fact that even with his fragile health, he's a full code. I pray we don't have to do CPR on him while I'm working!
I met some new LPNs visiting us with the recruiter. We're looking for them, so we'll see if they come to work for us!
More tomorrow...getting tired and I need to go to bed!
Why nursing school is a lot like hazing
Yes, I've been thinking about the halycion days of nursing school for me and only one word fits: hazing.
Here's the top 10 reasons why nursing school is a lot of hazing.
10. Everyone gets herded into a big room and then you have to stand in line and get your mug shot taken. This is so all the humiliators, I mean, instructors, know you and you can't hide behind anonymity. Everyone is anxious--what is a care plan, what is a clinical, where do I get comfortable white shoes, anyone got cheap books?
9. You have to learn to wash your hands...again. (Yes, this was one of the first "labs" I participated in during nursing school...no joke!)
8. You have to wear a uniform that rarely looks good on anyone, with or without accessories.
7. You have to sit in large lecture halls for weeks on end with people who are sick and too worried about flunking to stay home. This means any and all germs circulate around the HVAC system, so eventually, everyone gets sick.
6. Instructors wear you down at every turn. You are very, very tired. They make you read hundreds of pages a night for one exam a week. They want you to answer questions in class so they can make you look stupid, even if you have the right answer.
5. Care plans. Enough said. Thank goodness some places have easy to use automated ones!
4. APA paper format. I came from a business background and have long used MLA and Chicago style. APA still sends shivers down my spine just thinking about it.
3. You don't get the true stats on how many nurses survive one year out post school until you're in your last semester. That was when they sprung it on my class in nursing management. (If they told you that in advance, you wouldn't give them the money for nursing school, now would you?)
2. You develop bowel and bladder problems from your clinicals. "This is just like floor nursing," your assigned nurse says. "No one goes to the bathroom on our shift."
and finally...you realize nursing school is like hazing because....
1. You survived nursing school with just a few scars (or sprained ankles, like me, because you tripped in the hall or on the steps) only to get to be the newbie again when you orient to your new job...and surprise! The hazing starts all over again.
Here's the top 10 reasons why nursing school is a lot of hazing.
10. Everyone gets herded into a big room and then you have to stand in line and get your mug shot taken. This is so all the humiliators, I mean, instructors, know you and you can't hide behind anonymity. Everyone is anxious--what is a care plan, what is a clinical, where do I get comfortable white shoes, anyone got cheap books?
9. You have to learn to wash your hands...again. (Yes, this was one of the first "labs" I participated in during nursing school...no joke!)
8. You have to wear a uniform that rarely looks good on anyone, with or without accessories.
7. You have to sit in large lecture halls for weeks on end with people who are sick and too worried about flunking to stay home. This means any and all germs circulate around the HVAC system, so eventually, everyone gets sick.
6. Instructors wear you down at every turn. You are very, very tired. They make you read hundreds of pages a night for one exam a week. They want you to answer questions in class so they can make you look stupid, even if you have the right answer.
5. Care plans. Enough said. Thank goodness some places have easy to use automated ones!
4. APA paper format. I came from a business background and have long used MLA and Chicago style. APA still sends shivers down my spine just thinking about it.
3. You don't get the true stats on how many nurses survive one year out post school until you're in your last semester. That was when they sprung it on my class in nursing management. (If they told you that in advance, you wouldn't give them the money for nursing school, now would you?)
2. You develop bowel and bladder problems from your clinicals. "This is just like floor nursing," your assigned nurse says. "No one goes to the bathroom on our shift."
and finally...you realize nursing school is like hazing because....
1. You survived nursing school with just a few scars (or sprained ankles, like me, because you tripped in the hall or on the steps) only to get to be the newbie again when you orient to your new job...and surprise! The hazing starts all over again.
Thursday, October 2, 2008
Clinical narratives, nursing and image
I read my latest AJN and there is an article that discusses Benner's concept of clinical narratives and how they work in nursing.
If you read this above-linked PDF in detail, you may already realize that many bloggers, including myself, already describe many of these situations. We may obfuscate, consolidate and agglomerate our people and situations, but the comings and goings of our lives as nurses are on the screen. Take note, that this nursing narrative concept was developed in 1993.
I wonder, if Professor Benner looks out in the blogosphere and sees the narrative she defines in this document. I ask you, the lurkers and the bloggers, to start your story if you haven't written at all and if you have, I ask you, please continue to tell your story.
Besides the narratives, there are things we can do daily. We can project a positive image in how we carry ourselves and how we do our jobs. I got the e-mail below in a mailing list digest which discusses the image of nursing. Note the items in bold below, that I've chosen to highlight.
RE: [ni-wg] Are you proud to be a nurse? (from a faculty member at http://nursing.umaryland.edu/)
"Yes, I am proud to be a nurse, but am I proud of how nursing promotes itself and how others perceive us? Not really. Each semester, I ask my first semester undergraduate NI students to close their eyes, picture a physician and a nurse, and then describe what they see. These students, who have no nursing background, usually describe the physician as middle-aged, well-dressed (frequently wearing a lab coat), and very professional looking man. This description has not changed much over the years – varying little with student age and background, but changing somewhat with race and national origin. The nurse students pictured has changed a great deal over the past several years. At first, many students reported picturing a middle-aged, somewhat matronly looking woman in white, occasionally wearing a cap. However, as the incoming students are getting younger (actually younger, not just in context of my age), the nurses they picture look different. Many students report younger women wearing ill-fitting, multi-colored scrubs with animal prints. They reported them as looking harried and dour. Overall, the reports are of nurses that look overworked, unprofessional, and unhappy. This is not something I am particularly proud of. I asked several students who made such negative reports why they chose nursing if they see it in such a negative light. A common response was that they want to be part of changing nursing from a devalued occupation to a respected profession.
Yes, I am proud to be a nurse. I am even prouder of my students who want to be better nurses than those they pictured in their minds eyes."
Yes, Professor. I am proud, too, and this fuels me to do better.
If you read this above-linked PDF in detail, you may already realize that many bloggers, including myself, already describe many of these situations. We may obfuscate, consolidate and agglomerate our people and situations, but the comings and goings of our lives as nurses are on the screen. Take note, that this nursing narrative concept was developed in 1993.
I wonder, if Professor Benner looks out in the blogosphere and sees the narrative she defines in this document. I ask you, the lurkers and the bloggers, to start your story if you haven't written at all and if you have, I ask you, please continue to tell your story.
Besides the narratives, there are things we can do daily. We can project a positive image in how we carry ourselves and how we do our jobs. I got the e-mail below in a mailing list digest which discusses the image of nursing. Note the items in bold below, that I've chosen to highlight.
RE: [ni-wg] Are you proud to be a nurse? (from a faculty member at http://nursing.umaryland.edu/)
"Yes, I am proud to be a nurse, but am I proud of how nursing promotes itself and how others perceive us? Not really. Each semester, I ask my first semester undergraduate NI students to close their eyes, picture a physician and a nurse, and then describe what they see. These students, who have no nursing background, usually describe the physician as middle-aged, well-dressed (frequently wearing a lab coat), and very professional looking man. This description has not changed much over the years – varying little with student age and background, but changing somewhat with race and national origin. The nurse students pictured has changed a great deal over the past several years. At first, many students reported picturing a middle-aged, somewhat matronly looking woman in white, occasionally wearing a cap. However, as the incoming students are getting younger (actually younger, not just in context of my age), the nurses they picture look different. Many students report younger women wearing ill-fitting, multi-colored scrubs with animal prints. They reported them as looking harried and dour. Overall, the reports are of nurses that look overworked, unprofessional, and unhappy. This is not something I am particularly proud of. I asked several students who made such negative reports why they chose nursing if they see it in such a negative light. A common response was that they want to be part of changing nursing from a devalued occupation to a respected profession.
Yes, I am proud to be a nurse. I am even prouder of my students who want to be better nurses than those they pictured in their minds eyes."
Yes, Professor. I am proud, too, and this fuels me to do better.
Wednesday, October 1, 2008
Nuggets for October 1
Here are a few goodies I've encountered on my meanderings on the internet recently. Enjoy!
From the blogosphere...
Hell on White Clogs had this crazy scenario involving Google and residents on fhe floor of one unit. All I have to say is...I'd have to say no to that cath if I didn't see the "real doc" with experience, thank you very much!
ImpactEDnurse had this post about helminth therapy...ugh! I think I'll have to show my allergist this one. I'd be scratching my eyes out, too.
Code blog has this story of the Bigger Picture. Oh, yes, I go there so many times. What do they not understand?
Out in news land...
The Chicago Tribune had this recent article about ways to combat compassion fatigue (aka burnout) among nurses.
The NY Times is running a special section called Decoding Your Health. In today's installment the author discusses using the internet to get medical information. I particularly like this line, "The goal is to find an M.D., not become one."
TV station KTTC of Rochester, MN ran this article about nurse practitioners recently on their web site. It also points out that Nurse Practioner Week is November 9th through the 15th.
NursingLink has this article about avoiding back injuries, which is a good thing, no matter what type of setting.
A subject near and dear to a rehab nurse's heart...bowel routines. Since it was recently National Rehabilitation Awareness Week, this article discusses how one Delaware hospital works with patients to relieve constipation.
From the blogosphere...
Hell on White Clogs had this crazy scenario involving Google and residents on fhe floor of one unit. All I have to say is...I'd have to say no to that cath if I didn't see the "real doc" with experience, thank you very much!
ImpactEDnurse had this post about helminth therapy...ugh! I think I'll have to show my allergist this one. I'd be scratching my eyes out, too.
Code blog has this story of the Bigger Picture. Oh, yes, I go there so many times. What do they not understand?
Out in news land...
The Chicago Tribune had this recent article about ways to combat compassion fatigue (aka burnout) among nurses.
The NY Times is running a special section called Decoding Your Health. In today's installment the author discusses using the internet to get medical information. I particularly like this line, "The goal is to find an M.D., not become one."
TV station KTTC of Rochester, MN ran this article about nurse practitioners recently on their web site. It also points out that Nurse Practioner Week is November 9th through the 15th.
NursingLink has this article about avoiding back injuries, which is a good thing, no matter what type of setting.
A subject near and dear to a rehab nurse's heart...bowel routines. Since it was recently National Rehabilitation Awareness Week, this article discusses how one Delaware hospital works with patients to relieve constipation.
Tuesday, September 30, 2008
Vacation...all I ever wanted!
Yes, I'm now officially on vacation until next Monday from Madison. Hooray! Hooray!
Yesterday's evening shift wasn't too terrible, but had enough weird little things going on to keep me busy. Our charge nurse, C., was busy getting mechanical problems resolved. One patient's bed stopped working (no head up, no head down, no lifting up or down.) and the air handler in one room became so noisy we could hear it hundreds of feet down the hall it was squealing so loud. It only took three hours, but the maintenance guy finally showed up to fix that.
I was the IV nurse, so I was busy hanging all the piggybacks on the floor. We have a couple of people on the famous osteomyelitis combo of Vancomycin and Zosyn and one guy on Phenergan and Tygacil. To top that off, Mr. K. was still on IV fluids. I brought him his Pepsi, so his locker should be full of them. Sometimes he won't take in any fluids, but he will cave in for a Pepsi. That usually gets him in a good enough mood that he'll actually take in enough orally for the shift. It's a sneaky way of getting him to drink, but we have to do it.
One of our patients will be coming back from flap surgery to a new Clinitron bed. The main problem: his roommate, who's also on MRSA isolation just like him, has an allergy to something in the Clinitron. (He had to move rooms the last time he was with a patient on a Clinitron) The charge nurse will have a fun task today figuring out what they'll do with Mr. HIJ #2 when Mr. HIJ #1 comes back and they have to turn the bed on and run it.
I had my same three patients that I had all weekend. The two in the same room were reasonably pleasant, and they work well with their third roommate, who is really funny. The three of them were having a blast making fun of the rubbery roast beef served for dinner. That's always helpful, especially, since the one patient, a COPDer can get anxious pretty quickly. He doesn't get so bad when he's busy chatting with the other guys. My other patient, Mr. AB #1 was vomiting again, but not as much. It never fails...he vomits just before I can hang the Promethazine, and then he promptly falls asleep once I hang it.
We had an interesting chat at the nurses' station last night. Some people are amazed that certain people on our unit have so much time to chat and lounge around when they have a bunch of patients and others seem to disappear for way longer than their assigned breaks. How do they do it? One RN figured out that they aren't doing the work. You look at their patients, the charting that's done on their shift and what do you find? Nothing. Our state says you have to have two assessments in 24 hours (usually no more than 12 hours apart) and if you leaf through our flowsheet book, sometimes you only see one assessment and that's from the night shift.
I followed one nursing assistant on our unit and took care of her patients on evenings. I discovered when she worked a double shift recently, she only recorded vital signs. She didn't record even one assessment. This is also the same person who has a habit of disappearing off the unit for a couple of hours each day (she's not a smoker) without notifying anyone. I discovered one of her hiding places on my way into work yesterday--her car. She goes off the unit to the parking lot and sits in her car, so she can avoid any of the end-of-shift work, like putting people back into bed or taking care of her assigned patients.
As I talked to some other folks about this, they mentioned that this is a management problem. It surely is. Our manager is loathe to call anyone on any infractions because he/she is afraid that the person will retaliate by not showing up to work for upcoming shifts. And, surprise, surprise, there are no regulations at Madison which say if you're out of work for three days or more that you need a doctor's excuse. It is just terrible. I understand now why I'm not a manager! What good is it if you cannot enforce any sort of rules of conduct?
Alas, I am on vacation. I'm going to putter around the house and do stuff, like get the cars maintained, get a manicure and pedicure and then get all dressed up and go out with my husband on Friday night to celebrate our anniversary. Bubba will be staying with my friends and their children and will get to have a day running around with them this weekend. It should be fun!
Stay tuned...back to work next week!
Yesterday's evening shift wasn't too terrible, but had enough weird little things going on to keep me busy. Our charge nurse, C., was busy getting mechanical problems resolved. One patient's bed stopped working (no head up, no head down, no lifting up or down.) and the air handler in one room became so noisy we could hear it hundreds of feet down the hall it was squealing so loud. It only took three hours, but the maintenance guy finally showed up to fix that.
I was the IV nurse, so I was busy hanging all the piggybacks on the floor. We have a couple of people on the famous osteomyelitis combo of Vancomycin and Zosyn and one guy on Phenergan and Tygacil. To top that off, Mr. K. was still on IV fluids. I brought him his Pepsi, so his locker should be full of them. Sometimes he won't take in any fluids, but he will cave in for a Pepsi. That usually gets him in a good enough mood that he'll actually take in enough orally for the shift. It's a sneaky way of getting him to drink, but we have to do it.
One of our patients will be coming back from flap surgery to a new Clinitron bed. The main problem: his roommate, who's also on MRSA isolation just like him, has an allergy to something in the Clinitron. (He had to move rooms the last time he was with a patient on a Clinitron) The charge nurse will have a fun task today figuring out what they'll do with Mr. HIJ #2 when Mr. HIJ #1 comes back and they have to turn the bed on and run it.
I had my same three patients that I had all weekend. The two in the same room were reasonably pleasant, and they work well with their third roommate, who is really funny. The three of them were having a blast making fun of the rubbery roast beef served for dinner. That's always helpful, especially, since the one patient, a COPDer can get anxious pretty quickly. He doesn't get so bad when he's busy chatting with the other guys. My other patient, Mr. AB #1 was vomiting again, but not as much. It never fails...he vomits just before I can hang the Promethazine, and then he promptly falls asleep once I hang it.
We had an interesting chat at the nurses' station last night. Some people are amazed that certain people on our unit have so much time to chat and lounge around when they have a bunch of patients and others seem to disappear for way longer than their assigned breaks. How do they do it? One RN figured out that they aren't doing the work. You look at their patients, the charting that's done on their shift and what do you find? Nothing. Our state says you have to have two assessments in 24 hours (usually no more than 12 hours apart) and if you leaf through our flowsheet book, sometimes you only see one assessment and that's from the night shift.
I followed one nursing assistant on our unit and took care of her patients on evenings. I discovered when she worked a double shift recently, she only recorded vital signs. She didn't record even one assessment. This is also the same person who has a habit of disappearing off the unit for a couple of hours each day (she's not a smoker) without notifying anyone. I discovered one of her hiding places on my way into work yesterday--her car. She goes off the unit to the parking lot and sits in her car, so she can avoid any of the end-of-shift work, like putting people back into bed or taking care of her assigned patients.
As I talked to some other folks about this, they mentioned that this is a management problem. It surely is. Our manager is loathe to call anyone on any infractions because he/she is afraid that the person will retaliate by not showing up to work for upcoming shifts. And, surprise, surprise, there are no regulations at Madison which say if you're out of work for three days or more that you need a doctor's excuse. It is just terrible. I understand now why I'm not a manager! What good is it if you cannot enforce any sort of rules of conduct?
Alas, I am on vacation. I'm going to putter around the house and do stuff, like get the cars maintained, get a manicure and pedicure and then get all dressed up and go out with my husband on Friday night to celebrate our anniversary. Bubba will be staying with my friends and their children and will get to have a day running around with them this weekend. It should be fun!
Stay tuned...back to work next week!
Sunday, September 28, 2008
Not so late
Thankfully, everyone showed up for the night crew. I was warned in advance because as a rule, the charge nurse must stay over if anyone is missing from this shift. Since our charge had already volunteered to work as the fourth person, if someone called in, I'd have to stay. (We have other people who could, but usually they decline or have already left by the end of shift...which is a whole other story). Alas, this did not come to pass.
I found out from Dahey that his uncle passed away in another state. He debated going to the wake today, but was not up to driving 10 hours total in order to get back in time for work. With a kindergartener in the car, this is a LONG trip! One of these days, we'll have to get a portable DVD player, but since our car trips have been few and far between, we don't need one yet.
I ended up with three patients, administering the IVPBs and I picked up another patient until midnight when our 12 hour LPN went home at 2000. Everyone was pretty good, but Mr. R. was needy again. His O2 sats were good, but I think he's finally realizing the gravity of his situation and grasping for straws. He was fairly reasonable, but would complain that "you keep escaping." even when I'd tell him a ballpark amount of time that I'd be gone to work with the IVs and the other patients. Most likely, he will leave us to be closer to his family this week, but that remains to be seen. Nursing homes have a habit of losing spots for some of our people. Hopefully it helps that the first of the month is Wednesday.
My other patients were good. I got one of Mr. R.'s other roommates, and he is a delight. He's no trouble at all. I fed him and got his bowel program going and then I cleaned up and got Mr. R's dinner ready. (He was tired and didn't want to eat right away.) Mr. AB #1 was my other patient and he was relatively quiet, too, which was nice. He's hoping to get sent back west once he gets the clearance from the surgeon, since his family is all out that way. Happily, I had help watching the IVs, since K the LPN and our charge M., turned off some when I couldn't get to them.
Bubba and Dahey went to the pumpkin patch today with C. and C. We'll go to my friend's house a little later so Bubba can see her kids and get ready to visit on Friday, when he'll spend his first night away from home without Mom and Dad. It should be interesting!
More later.
I found out from Dahey that his uncle passed away in another state. He debated going to the wake today, but was not up to driving 10 hours total in order to get back in time for work. With a kindergartener in the car, this is a LONG trip! One of these days, we'll have to get a portable DVD player, but since our car trips have been few and far between, we don't need one yet.
I ended up with three patients, administering the IVPBs and I picked up another patient until midnight when our 12 hour LPN went home at 2000. Everyone was pretty good, but Mr. R. was needy again. His O2 sats were good, but I think he's finally realizing the gravity of his situation and grasping for straws. He was fairly reasonable, but would complain that "you keep escaping." even when I'd tell him a ballpark amount of time that I'd be gone to work with the IVs and the other patients. Most likely, he will leave us to be closer to his family this week, but that remains to be seen. Nursing homes have a habit of losing spots for some of our people. Hopefully it helps that the first of the month is Wednesday.
My other patients were good. I got one of Mr. R.'s other roommates, and he is a delight. He's no trouble at all. I fed him and got his bowel program going and then I cleaned up and got Mr. R's dinner ready. (He was tired and didn't want to eat right away.) Mr. AB #1 was my other patient and he was relatively quiet, too, which was nice. He's hoping to get sent back west once he gets the clearance from the surgeon, since his family is all out that way. Happily, I had help watching the IVs, since K the LPN and our charge M., turned off some when I couldn't get to them.
Bubba and Dahey went to the pumpkin patch today with C. and C. We'll go to my friend's house a little later so Bubba can see her kids and get ready to visit on Friday, when he'll spend his first night away from home without Mom and Dad. It should be interesting!
More later.
Saturday, September 27, 2008
Shifting gears
RIP Paul Newman...now there was a guy who could really shift gears!
Yes, I'm back to the evening shift and so far, things have not been too bad. I've had two patients and a med cart to lug around, but since our census is lower than it's been in a while, it's not too terrible. Our nurse who's famous for calling in on his/her shift to work on Friday even showed up last night.
Our census may stay low for a while since we don't have too many admissions scheduled for next week and only one or maybe two discharges. I'm sure all of the admissions will wait until I come back from my time off next week (Sometimes I think my middle name should be Murphy...as in Murphy's Law.)
My patients have been pretty good considering everything. Mr. AB #1 was back on my list. For some reason, I don't complain about people and I get to take care of the same people over and over. I hear my co-workers say things like, "If I have Mr. X for another day, I'll kill myself." so the boss reassigns them...to me. I must have "team player" or something stamped on my forehead in invisible ink, since I'm always "taking one for the team." At this point, I'm beginning to think that some of my coworkers have more mental issues than some of our patients, or just a heck of a case of compassion fatigue. I think my own compassion fatigue and stress from being the newbie has resolved itself...for now, anyway.
Mr. R. is also one of my customers. He's a trainwreck, who's heading to Washington this week for surgery. He's been made aware that it's very likely he could die during the surgery or not be weaned off a vent after, but he's going for it anyway. His chances of long-term survival are slim. I watch him very carefully, and thankfully, he's been pretty calm when I'm working. He desats when we reposition him in bed, so it makes things really interesting. The one good thing is that his bed actually goes into Trendelenburg mode, so we can move him more quickly and easily.
Finally, I have been busy planning in my off time along with other things, like buying a new furnace and air conditioner (ours is 20 years old and the furnace is dead) and going to doctors appointments. I'll get to do some fun stuff (manicure and pedicure) before Dahey and I go out and celebrate our anniversary. What joy! I love the pedicure place and by a stroke of luck, I found out about a deal with them, and it starts next week!
Gotta run and do work before I go to work. More later...
Yes, I'm back to the evening shift and so far, things have not been too bad. I've had two patients and a med cart to lug around, but since our census is lower than it's been in a while, it's not too terrible. Our nurse who's famous for calling in on his/her shift to work on Friday even showed up last night.
Our census may stay low for a while since we don't have too many admissions scheduled for next week and only one or maybe two discharges. I'm sure all of the admissions will wait until I come back from my time off next week (Sometimes I think my middle name should be Murphy...as in Murphy's Law.)
My patients have been pretty good considering everything. Mr. AB #1 was back on my list. For some reason, I don't complain about people and I get to take care of the same people over and over. I hear my co-workers say things like, "If I have Mr. X for another day, I'll kill myself." so the boss reassigns them...to me. I must have "team player" or something stamped on my forehead in invisible ink, since I'm always "taking one for the team." At this point, I'm beginning to think that some of my coworkers have more mental issues than some of our patients, or just a heck of a case of compassion fatigue. I think my own compassion fatigue and stress from being the newbie has resolved itself...for now, anyway.
Mr. R. is also one of my customers. He's a trainwreck, who's heading to Washington this week for surgery. He's been made aware that it's very likely he could die during the surgery or not be weaned off a vent after, but he's going for it anyway. His chances of long-term survival are slim. I watch him very carefully, and thankfully, he's been pretty calm when I'm working. He desats when we reposition him in bed, so it makes things really interesting. The one good thing is that his bed actually goes into Trendelenburg mode, so we can move him more quickly and easily.
Finally, I have been busy planning in my off time along with other things, like buying a new furnace and air conditioner (ours is 20 years old and the furnace is dead) and going to doctors appointments. I'll get to do some fun stuff (manicure and pedicure) before Dahey and I go out and celebrate our anniversary. What joy! I love the pedicure place and by a stroke of luck, I found out about a deal with them, and it starts next week!
Gotta run and do work before I go to work. More later...
Wednesday, September 24, 2008
Life's comings and goings
Lots and lots of stuff happening this week...so today on my day off, I'm doing the usual errands including taking our dog to the groomer. He hates getting a bath, but he needs it. He's been shedding like mad and really needs the haircut.
The story of the last few days has involved that famous (or infamous) condom catheter.
They are a real issue getting them on and staying on for men who have what we facetiously call a "hider", or a penis that really, really retracts. One patient got wet, not once, but twice Monday because no matter how I put his catheter on (with SkinPrep or without), it came loose when he urinated. This meant clothes changes, equipment changes and a few transfers for me and for him.
Luckily, my other patient who used these catheters was not spontaneously voiding, so there was no leakage issue with him. If I only had a cath with a removable tip, it would make his intermittent caths a cinch, since I'd only have to put a condom catheter on once a day. (Now I have to put one on after every four hour catheterization.)
We also have a patient who's on our unit while he's completing SATP. He's a relatively quiet fellow, but something yesterday's program spooked him because he came back all breathless and he has an electric wheelchair. His heart rate was way over 100, so I called the doc. She checked him out and declared he could rest for the afternoon (He has several other health issues, too.) He took a nap, ate his lunch at 1400 and vegged the rest of the day in the room. When I read the notes I noticed the topic of the AM session--Grief and loss while giving up drugs. My guess is that he's still on the fence about staying clean. It's going to be a rough road, but hopefully, we can help him get there.
More goodies later....gotta take the dog to his groomer.
The story of the last few days has involved that famous (or infamous) condom catheter.
They are a real issue getting them on and staying on for men who have what we facetiously call a "hider", or a penis that really, really retracts. One patient got wet, not once, but twice Monday because no matter how I put his catheter on (with SkinPrep or without), it came loose when he urinated. This meant clothes changes, equipment changes and a few transfers for me and for him.
Luckily, my other patient who used these catheters was not spontaneously voiding, so there was no leakage issue with him. If I only had a cath with a removable tip, it would make his intermittent caths a cinch, since I'd only have to put a condom catheter on once a day. (Now I have to put one on after every four hour catheterization.)
We also have a patient who's on our unit while he's completing SATP. He's a relatively quiet fellow, but something yesterday's program spooked him because he came back all breathless and he has an electric wheelchair. His heart rate was way over 100, so I called the doc. She checked him out and declared he could rest for the afternoon (He has several other health issues, too.) He took a nap, ate his lunch at 1400 and vegged the rest of the day in the room. When I read the notes I noticed the topic of the AM session--Grief and loss while giving up drugs. My guess is that he's still on the fence about staying clean. It's going to be a rough road, but hopefully, we can help him get there.
More goodies later....gotta take the dog to his groomer.
Saturday, September 20, 2008
Heard on the unit...
Here are a few of the gems I heard this weekend on our unit.
"I'm getting my own room in front to be closer to you." Mr. J.
Mr. J. said this to me when he got moved up to our private room when Ms. R. left this week.
What did he do to win the suite, you ask? Why he came up positive on his last UAC&S for acinetobacter in addition to the MRSA he already has in his wound. He was just saying that because my boss seems to assign me to the patients on the front end of the unit a lot more than the back.
"Ah. My Pepsi angel!" Mr. K.
I brought in a couple for him to keep him quiet but it didn't work. His behavior may or may not have been related to his suddenly missing Gabapentin order. He's got it back now and is more lucid than he's been in days.
"I hear the boss is alphabetizing everyone." Mr. J. (again)
Mr. J. got booted from his private suite when the other Mr. J. came up positive for acinetobacter, too. Besides that, two of our Mr. HIJ's (not their real names, but they are similar) got put in the same room, too, because the boss needed a three-bed room available for our new admissions next week. So much for avoiding similar names in the same room. It just makes for more excitement with the bed bingo that always seems to happen on our unit.
"I'm getting my own room in front to be closer to you." Mr. J.
Mr. J. said this to me when he got moved up to our private room when Ms. R. left this week.
What did he do to win the suite, you ask? Why he came up positive on his last UAC&S for acinetobacter in addition to the MRSA he already has in his wound. He was just saying that because my boss seems to assign me to the patients on the front end of the unit a lot more than the back.
"Ah. My Pepsi angel!" Mr. K.
I brought in a couple for him to keep him quiet but it didn't work. His behavior may or may not have been related to his suddenly missing Gabapentin order. He's got it back now and is more lucid than he's been in days.
"I hear the boss is alphabetizing everyone." Mr. J. (again)
Mr. J. got booted from his private suite when the other Mr. J. came up positive for acinetobacter, too. Besides that, two of our Mr. HIJ's (not their real names, but they are similar) got put in the same room, too, because the boss needed a three-bed room available for our new admissions next week. So much for avoiding similar names in the same room. It just makes for more excitement with the bed bingo that always seems to happen on our unit.
Fun Friday
This happens when one, the census is down, two, both of your patients have doctor's appointments at the same time and three, you are not working the weekend. Oh, what joy!
That was my day yesterday. I felt like I actually accomplished something. I had two patients all day. My patients got a clean room, which was wonderful. I kept picking up my mess as I made it when working on my patients' dressings, etc., but some other nurses did not. There were wrappers and saline flushes and IV blue rubber stoppers and Tempadots all over the floor will-nilly. There were even some of these said items in one patient's bed. Arrgh! This is the same man who is a trainwreck in terms of skin integrity (massive sores--two out of four are unstageable), tubes galore and psych issues on top of everything. Let's just give him one more thing to mess him up! (Yes, I'm being facetious...)
Once both patients were out, I got the antibacterial, it-kills-everything wipes and wiped down their low-airloss mattresses. I did them well enough so that they actually stayed wet for the required two minutes. This requires a few wipes, but I had them. After that, I picked up all the stuff I could on the floor, including Mr. AB #1's case of 20oz. Sprite bottles, so the housekeeper could sweep and mop everywhere. He surely did. He did everything but burnish (aka super wax) the floors and that would have required both patients be out of the room most of the day. He was still working when AB #1 came back, so I had an even better excuse to keep him up and out of the room.
Mr. AB #1 stays in his room all day because of his sores. He's to be turned and repositioned every two hours, but often, he refuses to turn. This is really bad when you have the sores he has. The docs have been trying to figure out a way to get him up on a stretcher for an hour a day to just get him out of the room. (We put these patients on Roho mattresses or waffle air mattresses while on a stretcher). I tried selling him on going outside Thursday and he refused my offer. The neuropsych came in and she talked to him about going out of his room. Still, he refused. I thought about it, and when I talked to the neuropsych later, I told her about my plan to keep him out of the room...nothing like a little subterfuge. My plan: say the bed is not working. If a no-airloss mattress is not working, you can't put someone in it, since they sink like a rock. She thought this was a great idea. I told the other MDs and they went with it, too. I even told my boss that was the plan, so no one would goof up and tell Mr. AB #1 that it was not true.
The housekeeper was a great backup. He played along, too, and kept on cleaning. He was the real, physical excuse why I couldn't put AB #1 back in his room...whoops! He's still cleaning, I said, with his massive stainless cart and buckets galore, so the ambulance drivers put him in the TV room where I had a stretcher waiting. We got him on the stretcher and then he talked to the docs about his appointment. I set him up with a bedside table and some Sprite which was in the room. (No one is in a hurry to leave if they have a drink or snacks, I've found.) Apparently, it went better than what they had thought it would. His prognosis is still not the best, but if he keeps gradually improving, he may avoid the draconian measures we know in which he refuses participate, which could include amputation or worst of all, his lower body, in a hemicorpectomy.
All in all, Mr. AB #1 stayed up for an entire hour before I put him back in his room. His neighbor, Mr. AB #2 came back at around 1030 and I snuck out and checked him out and changed his dressings before I got AB #1 back in the room. I also primed and set up his feeding pump, so he'd be ready. I really like those Kangaroo e-Pumps. They are so user-friendly compared to our other pumps, and the water flush has it's own bag. No stopping to remember in four hours that the patient needs his water flush. It is such a time-saver! Now if they could get it to use 1000cc bricks, it would really be ideal (We use the bags and cans of formula).
Mr. AB #1 needed his dressings changed, too. The residents do the dressings when they do the debridement, but they never last very long after the ride back to Madison. Mr. AB #1 was leaking all over, so I just re-did his dressing so it would last until evenings changed it again. Mr. AB #2's was changed, too, but one hip started draining out of the dressing.I reinforced his, because I didn't want to disturb the packing again. He had some clots and is prone to draining, so this was the better solution and the NP and my collegues concurred.
I kept the guys fluffed and buffed. Mr. AB #2 even got a haircut when I saw the beautician on the unit. In theory, she's supposed to be coming every Tuesday, but since I was off, I didn't know if she had be on the unit. Once I saw her, I talked to her about AB2 and she did. He was thrilled with his haircut. Once she was done, I set him up and washed his hair and changed his shirt. "I feel like a new man!" he said.
Finally, I finished my day doing paperwork and hanging out at the front desk. It wasn't bad at all. Now it's time to cram everything into the weekend. Dahey is working this weekend, so Bubba and I will be keeping busy. Stay tuned for more next week!
That was my day yesterday. I felt like I actually accomplished something. I had two patients all day. My patients got a clean room, which was wonderful. I kept picking up my mess as I made it when working on my patients' dressings, etc., but some other nurses did not. There were wrappers and saline flushes and IV blue rubber stoppers and Tempadots all over the floor will-nilly. There were even some of these said items in one patient's bed. Arrgh! This is the same man who is a trainwreck in terms of skin integrity (massive sores--two out of four are unstageable), tubes galore and psych issues on top of everything. Let's just give him one more thing to mess him up! (Yes, I'm being facetious...)
Once both patients were out, I got the antibacterial, it-kills-everything wipes and wiped down their low-airloss mattresses. I did them well enough so that they actually stayed wet for the required two minutes. This requires a few wipes, but I had them. After that, I picked up all the stuff I could on the floor, including Mr. AB #1's case of 20oz. Sprite bottles, so the housekeeper could sweep and mop everywhere. He surely did. He did everything but burnish (aka super wax) the floors and that would have required both patients be out of the room most of the day. He was still working when AB #1 came back, so I had an even better excuse to keep him up and out of the room.
Mr. AB #1 stays in his room all day because of his sores. He's to be turned and repositioned every two hours, but often, he refuses to turn. This is really bad when you have the sores he has. The docs have been trying to figure out a way to get him up on a stretcher for an hour a day to just get him out of the room. (We put these patients on Roho mattresses or waffle air mattresses while on a stretcher). I tried selling him on going outside Thursday and he refused my offer. The neuropsych came in and she talked to him about going out of his room. Still, he refused. I thought about it, and when I talked to the neuropsych later, I told her about my plan to keep him out of the room...nothing like a little subterfuge. My plan: say the bed is not working. If a no-airloss mattress is not working, you can't put someone in it, since they sink like a rock. She thought this was a great idea. I told the other MDs and they went with it, too. I even told my boss that was the plan, so no one would goof up and tell Mr. AB #1 that it was not true.
The housekeeper was a great backup. He played along, too, and kept on cleaning. He was the real, physical excuse why I couldn't put AB #1 back in his room...whoops! He's still cleaning, I said, with his massive stainless cart and buckets galore, so the ambulance drivers put him in the TV room where I had a stretcher waiting. We got him on the stretcher and then he talked to the docs about his appointment. I set him up with a bedside table and some Sprite which was in the room. (No one is in a hurry to leave if they have a drink or snacks, I've found.) Apparently, it went better than what they had thought it would. His prognosis is still not the best, but if he keeps gradually improving, he may avoid the draconian measures we know in which he refuses participate, which could include amputation or worst of all, his lower body, in a hemicorpectomy.
All in all, Mr. AB #1 stayed up for an entire hour before I put him back in his room. His neighbor, Mr. AB #2 came back at around 1030 and I snuck out and checked him out and changed his dressings before I got AB #1 back in the room. I also primed and set up his feeding pump, so he'd be ready. I really like those Kangaroo e-Pumps. They are so user-friendly compared to our other pumps, and the water flush has it's own bag. No stopping to remember in four hours that the patient needs his water flush. It is such a time-saver! Now if they could get it to use 1000cc bricks, it would really be ideal (We use the bags and cans of formula).
Mr. AB #1 needed his dressings changed, too. The residents do the dressings when they do the debridement, but they never last very long after the ride back to Madison. Mr. AB #1 was leaking all over, so I just re-did his dressing so it would last until evenings changed it again. Mr. AB #2's was changed, too, but one hip started draining out of the dressing.I reinforced his, because I didn't want to disturb the packing again. He had some clots and is prone to draining, so this was the better solution and the NP and my collegues concurred.
I kept the guys fluffed and buffed. Mr. AB #2 even got a haircut when I saw the beautician on the unit. In theory, she's supposed to be coming every Tuesday, but since I was off, I didn't know if she had be on the unit. Once I saw her, I talked to her about AB2 and she did. He was thrilled with his haircut. Once she was done, I set him up and washed his hair and changed his shirt. "I feel like a new man!" he said.
Finally, I finished my day doing paperwork and hanging out at the front desk. It wasn't bad at all. Now it's time to cram everything into the weekend. Dahey is working this weekend, so Bubba and I will be keeping busy. Stay tuned for more next week!
Subscribe to:
Posts (Atom)