Hi, everyone! I work on a Med-Surg, Hospice and Oncology unit. I was a PCT for 8 months on the same floor while finishing my ADN degree. I've been on new grad orientation for the past 12 weeks at my hospital. I was of course a little worried to be by myself, however, on my floor, you're never alone. Yesterday, my first day off orientation, wasn't bad at all. I was surprised they gave me a full load (5 patients), but it wasn't bad because I need 3 out of 5 of them.
Today I come in and have four patients. Some things happened with each of them that made me proud. Nothing big, but I left happy.
Patient #1: Order for 0.9NS to be run at 75mL/hr. Went into room at 0800 and it was infusing at 50mL/hr. Ted/SCDs were ordered 4 days ago. Guess what??? Nothing in the room. Patient on Levaquin for UTI. Came back Levaquin resistant. Talked to PharmD who spoke with MD and was told they don't want to continue antibiotics since the patient is showing no signs/symptoms. Their decision, but at least I know the story.
Patient #2: Hospice. Comforted family. Extremities were beginning to mottle so I put on some socks. Answered questions about patient comfort, etc. Able to take care of everything myself.
Patient #3: 80 year old female with Stage IV Breast CA and massive back pain. I've had her with my preceptor since Friday. She takes 10/325 Norco q4h PRN and a Lidocaine patch. Fentanyl patch has been increased from 25, 50 to 75mcg since Friday. Still states 10/10 back pain. Refuses to get OOB. Watches TV all day. Yesterday o2 went down to 88. Applied oxygen. Today finally got a pain consult going. She seems more loopy. I think the Fentanyl patch is kicking in or something. Something has to be done so the MD is coming tomorrow to give his opinion. Now is beginning to choke when she eats. She needs to raise the HOB. Ordered bedside swallow eval in case something else is going on.
Patient #4.......I admitted her w/ my preceptor over a week ago. Taking oral antibiotics for a foot wound which is a Diabetic Ulcer. This has been going on for close to 6 months. DX DM II and Diabetic Ulcer. Debridement surgery was Friday and Wound Vac in place Sat. Today I saw how much they took out and it was a lot. They're just trying to save the limb. Osteomyletis. Had PICC inserted b/c she'll be on antiobiotics at home (no insurance). Arm today 4 inches larger. Dopplers ordered; dx with DVT. In the meantime she will have to go to IR to have PICC removed and replaced tomorrow. Needed Vanco trough and PTT. Had IV Therapy insert two peripheral lines because I needed to start a Heparin Drip and possibly continue the Vanco. Labeled the machine correctly, set up the Heparin and verified it with my charge RN. Spoke to the intern and IV Therapy throughout the day about this patient.
I know it's not a RRT or Code Blue, but catching the little things and taking care of some of these other big things such as a Heparin Drip, and doing it mainly on my own was a great feeling. Granted, I ask for help from a lot of people and if they don't know me, I always tell them I'm new. So far so good. I'm sure not every day is going to be great. I'm off tomorrow so when I go back Wed I'll have different patients but I am learning A LOT!!