Ya'll know I don't post here often, but I really need some support right now!
The other day I had a patient that was c/o pain in his legs. He had had lortab 5 about 3 hours prior and it would be another hour before he could have it again, so I gave him tylenol 325 x 2. Then an hour later I gave him the lortab when he asked for it. When I was reporting off to the oncoming nurse (who graduated with me and is miles ahead of me) looked at me like I was stupid and said "what about the 4000 mg limit?" I had no idea what she was talking about!!! I feel so stupid!!! This is basic nursing stuff and I don't know it. I've been beating myself up over it for days now. Don't get me wrong, I'll not forget it now, but I just keep thinking about how much damage I could do with what I don't know.
As if this isn't bad enough, I got an admit the other night who's ABGs were showing metabolic acidosis and I couldn't figure it out. The nurse who I reported off to gave me attitude...let me sum up...
I had one patient and was waiting for the admit from ER. At 2030, I gave my patient his 2100 meds so I could be ahead of the game when the admit came. I missed his zantac. I gave him his lipator and flushed his SL with NS and Hep-Lock solution. My admit came in and I got her settled in and assessed. She was pretty out of it. She would wake up long enough to answer a question or two and then fall back asleep (snoring). She was real thick tounged and wasn't oriented to time or place. She started wriggling around on the bed and moaning, so I went back in (I was at the desk tring to get the chart together b/c the doc was there) and she told me she had a bladder infection and it hurt "down there". So I asked the doc if he wanted me to get a UA. He said yes and I asked if he wanted me to cath her. He said "what ever it takes". Well, I got her OOB to the bedside commode at her request, got the sample in a nurse's hat, and sent it to lab. The nurse that was taking my place came on at 2300 and started going thru pt A's chart. She immediately found that I missed the zantac and asked - demanded - what I was going to do about it. I told her I would take care of it before I left, but I was trying to get the chart together and the orders done for pt B so she wouldn't have to do it. (Nothing makes the nurses on my unit angrier than leaving unfinished orders for them.) Then pt A calls and says, of all things, his stomach is upset. So she says, "I'll get you something for that" and tells me she is going to get the zantac for him. I say "thank you". Then she comes out of the med room and says "Are you sure you didn't give the zantac because it's not in his drawer." I say "No. I only gave the lipator." She says "Are you sure, it's not there. Are you sure you didn't give it?" I say no, "I gave two lipator and flushed the hep-lock" She says "but it's PO zantac" I say, "that's what I'm saying the only PO med I gave is the lipator and I flushed the hep-lock" She says, "Calm down. I just need to be sure" (so the 1st 2 times I told her wasn't good enough?) Anyway, by this time it's 2400 and RT comes to draw the ABG on pt B, comes back, gives the results to the other nurse and says "She's compensating somewhere, it obviously metabolic". Now the other nurse go in to look at the pt, comes out, goes to the supply room, and comes out with a foley kit. I ask why she is going to cath the pt and get ignored. I tell her that I got her up to the bedside commode and I don't think she needs cathed. She says "Well do you know how much she put out when you got her up?" I say yes, and tell her the amount. At which point she goes into the room to cath the pt. Then she tells me the pt is getting septic and needs to be cathed because we need to keep and hour by hour update on her output. I remind her that we don't have an order to cath - the doc only said to do it if it was necessary. (This gets ignored) I then tell her I'm going to ER to get pt B's pm meds and that I'll get the antac for pt A. (this gets ignored too) I go to ER, get the meds, come back, give the PM meds to pt B, the zantac to pt A, wrap up a couple more things, and left for the night. Again feeling like the stupidist nurse in the world. How do I know when a pt is "going septic" and is in metabolic acidosis and...and.....and......
I know this post is long, and I apologize for it. I don't know what I'm looking for - support, acknowledgement, sympathy, empathy, all of the above....
This is basic nursing stuff and I don't know it. I've been beating myself up over it for days now. Don't get me wrong, I'll not forget it now, but I just keep thinking about how much damage I could do with what I don't know. 