germensano (1,573 Views)
Joined Mar 2, '10.
Posts: 25 (16% Liked)
Mae was a 72 year old congestive heart failure patient who was sharp as a tack and always making jokes. She was what we called a frequent flyer, since her chronic condition flared up frequently landing her in the hospital.
She was a sound sleeper and always in good sprits, which is why her current less than happy state on this sunny morning caught me off guard. I asked her how she was felling and she snapped, "fine but tired!".
Like any good nurse I asked her if she was having difficulty breathing and laying down to sleep.
She knew the drill and responded back no my hearts doing fine today!
It was all the giggling that kept me awake!
I was puzzled by her statement since I was unsure who was giggling on a unit full of elderly cardiac patients so I brushed it off, and assured her I would make sure to let everyone know they needed to keep it down at night. She nodded and we went about our day.
The next morning I returned and had Mae on my assignment list. I enjoyed caring for patients I knew so I happily started my day by checking on her. Mae again insisted that someone was in her room at night giggling. This time I mentioned her complaint to my charge nurse who laughed at me and said is Mae in 421?
I shook my head and quickly tried to figure out how my charge nurse knew Mae's room without me telling her. Within a few minutes I had 3 senior nurses and my charge nurse trying to convince me that room 421 was haunted by a child from the pediatric unit who died a slow lonely death by cancer.
The child was a foster child who only knew nursing staff as her family. Families tried to care for her but her illness always proved to be too much to handle and they gave her up time after time.
That did not keep the little girl from fighting a long hard fight before passing away. I was not sure how I felt about hearing this story or if passing this information on to my patient was a good idea. Later that day I received discharge orders for Mae. So lips sealed about the story I sent Mae home.
About 2 months later I agreed to work midnights for a few months until a nurse returned from maternity leave. I had long forgotten the story of the giggling girl in room 421 but I was quickly reminded.
I was making my 3 am rounds checking on all of my patients. I slipped into my patients room to ensure he was sleeping, safe, and not in any distress when I heard a rustling noise in his bathroom. I opened the bathroom door and did not see anything. Then I heard a little girlish giggle behind me.
I turned around so fast I almost fell over.
I could feel my heart racing in my chest and I could not get out of the room fast enough.
I had not seen anything but that giggle I heard was plain as day. It sounded as if a young girl was standing right behind me giggling at me for falling for her bathroom noise joke and then getting scared.
When I told the nurses in the station what had happened they all laughed at me and reassured me that the sweet giggling girls ghost would not harm me or my patients. They informed me that if my patient complains about the giggling they come up with an excuse to switch rooms.
I have never been a believer of ghosts but I guess I have never been a non-believer either. I just coasted through life never having an experience that made me ask myself, do I believe in ghosts?
Now that I have heard and met the giggling girl who makes 421 her home I know that I am a believer in ghosts.
After doing some research to reassure myself I am not crazy I found that room 421 was once a room which isolation and critically ill children where placed. Many children took their last breath in that room. I believe at least one child is still alive and well in that room pulling harmless practical jokes on the nurses and giggling about it.
They actually WORK...
...and they do it with much less complaining.
I'm sure that's painful for some of you but it's the truth.
On a different note..my mother dies at home with hospice.. they came and cleaned her and prepared her but when funeral home came.. they were so good. They even asked permission to touch her and then she had o a beautiful gown and they simply asked if I preferred they keep it on or not. I said yes as even dead my mother would be appalled at being naked.. They asked permission to cover her face also. It was very dignified and professional to me....my dad died 6 months earlier and different hospice, different state, none of the respect, they did leave gown on.
I realize patient will never know and family might never know but I think I would ask family's opinion to be respectful to them.
Years ago working High Risk L&D we had many stillbirths , genetic terminations etc..Policy was to gown the baby, take photos from best angle possible, using blankets as needed, obtain lock of hair and foot prints, make into ma keepsake package for parents (we held them for 10 yrs if parents did not want them at birth) then I was escorted by security to morgue. It was a far distance and way under ground of large hospital. Policy was to keep infant in isolette for the trip.. I did this first time and the wheels of the isolette echoing in the deep basement were awful. So next time I carried the baby and sang a prayer/luluby very quietly. Guard thought I was nuts first time( they never would actually speak to nurses) but after the first time I found they would smile. Did anyone else ever know.. not till now. But I found it was my way to honor and respect this infant, and it hurt no one. No financial cost.. nothing else involved.
I cleaned yellow and brown when I was an aide.
I cleaned yellow, brown, green and red when I was BSN, at the least.
I am currently MSN, bedside/ED, and clean everything that comes from every orifice possible. And teach students what to assess for in all of it. Oh, and I mop when I need to, clean the room and bed, change out the suction canisters and clean the bedside commodes and transport patients. Yes we have aides, techs and housekeeping. Doesn't mean they're always available when I need something done.
In short, I am a nurse.
My program starts in Jan 2008. I need advise from SRNAs like what things to do and don't to be a successful SRNA like How much time I should spend to study every day. tips to balance study and clinicals. Any advice will be highly appereciated.
thanks for your interest in this subject.
having lived through an "unable to intubate" personal experience with 8 intubation attempts on or record (remembering most of them) still have periodic flashbacks 4 yrs later as 2 anesthesiologists unprepared....so stated the chief who apologized and took corrective action after my 4 page complaint....and easily intubated me one month later so the !!!xxxx???!!! gallbladder finally came out!
articles of interest:
american society of anesthesiologists practice guidelines for management of the difficult airway
asa airway management algorithm
practice guidelines for management of the difficult airway
pitt-modification of asa difficult airway algorithm
algosim®: the difficult airway algorithm tutorial/simulator
the asa difficult airway algorithm with lma
virtual anaesthesia textbook - intubation
I've never said anything to a patient I've regretted. All those "you're an idiot" and "shut the F up, you stupid druggie" were entirely justifieid.
In homage to an Allnurses member who wrote a wonderful article entitled "Nurses Are So Mean", I'd like to provide excerpts from my personal blog which I wrote not to long ago. I give enormous kudos and applause to the writer of this article, and I sincerely agree. It seriously is about taking the time to evaluate your self and your actions, and the rationales for your reactions. It is about looking inward..it is ultimately about personal growth and fulfillment.
Typically, when mammals eat their young, it is an instinct which satisfies dominance. There is a clear lack of emotional bond and attachment, so what creates their desire to dominate? The young are simply perceived as a threat, that's what. A threat to what, you ask? To the natural progression of things. To safety. To the way things 'should' be. Naturally, when referring to nurses who eat their young, they don't take a young-wet-behind-the-ears-new-graduate into the break room, season 'em up with condiments and literally ingest them. Or, shall I say, I hope not. Besides, this most probably requires the taking of a full lunch break, and who the heck has time for that.
Let's be rationale. For us human type mammals, it's safe to say that in this case, the word "eat" implies a sense of "control over", "I'll tell you a thing or two", and "who do you think you are bouncing in here all bright eyed and bushy tailed on my territory".
Guess what it really means?
In case this is your first experience reading my writing, I like to utilize the analogy of pretending we live in the stone age to get points such as these across with humor and candor.
Say you go to work your shift, and your manager indicates that perhaps they forgot to mention this to you, uh..but you are such a strong nurse that you are a new graduate's preceptor for the next 6 weeks. You are wearing a uni-shouldered Betty Rubble frock, and are armed with a club. You have a bone in your hair. You are introduced to Penelope Perky, R.N. Good grief, even her club is new and fancy. (Go figure, yours has been used a lot more). A Littman drapes around her delicate swan-like neck, worn much like the Queen's sash, having just been coronated. Her clogs, a pair of shiny white virgins never knowing the warm pleasures of vomit, MRSA, liquid stool and urine. Her new name tag doesn't even have one lousy drop of blood on it, yet. Penelope is eager, full of fresh ideas, channeling her inner Florence Nightingale, ready to change the world. HA! What does she know! Your eyes narrow into slits, your pupils are pinpoint. You raise your club in the middle of morning report, ready to pounce on the threat to all that Is.
Hold it right there. Here is the time to evaluate. Because you are a cave-person, you only speak in grunts, only experience feelings viscerally. If you were to only have one word available to you to describe your reaction, what would it be? What color is it? 'Where' do you feel it?
Why is it that you feel the need to strike? You are evolved, intelligent and insightful. Go beyond the primal instinct to devour. What the heck is the problem here?
That evening when you are in Wilma's kitchen ready to make a pot of pterodactyl soup, boil this down also:
From my loving heart space to yours, I share this with you, clubs down. Fear is the basis of all outward emotion. Yes, Ms. Thang, Ms. I-can-catheterize-a-nun-in-the-dark, Ms. Go-to for all of your unit's tough blood draws, Ms. I am on first name basis with every physician who has practicing privileges within 500 miles. You are fearful. But, of what, and why?
I started as a new grad in a CVICU almost two years ago now. I was absolutely terrified! But I hope you will find what I did, and that's a fantastic support system. The learning curve going into ICU is tremendous, but you will be okay. Know who you can go to for questions, glean as much information as you can from your preceptor, and work on putting it all together. The tunnel vision we are all guilty of as resident RNs will fade with time and experience. I by no means consider myself a highly experienced ICU RN. Believe me, I ask for help as soon as I get a feeling that things aren't going as they should. I recently started taking IABP pt's, and this has allowed me to reflect on how far I have come in a relatively short period.
You guys are going to do great. Just remember, no matter where you find yourself as a new grad, none of it is like nursing school. The real world is much different! Take the criticism and use it positively, be open minded and motivated to grow. It's going to be hard, the first year was challenging, but you'll be amazed at the person you can become. Then, you'll get comfortable, and they'll gently shove you to the next level, and the anxiety will return. But it will fade quickly as your knowledge base grows and so does your confidence.
Good luck and keep us updated! Great choice in career path!
I feel terrible right now and im in a Surgical Ortho unit. Nurses usually get 7-8 patients. Im week 4 now into my 6 week orientation. we also get post cardiac cath patients on the floor too. i tell people that i have a 6 week orientation and my friends telling me that its too short. I think it is!. im a fresh new graduate also. I made 2 mistakes so far. One patient went down to surgery and didnt have no allergy band, and the 2nd one was that a post cardiac cath patient had a foley in and didnt see it, and i only had the patient for 3 hours. My preceptor thinks that its those mistakes are enough for the unit to let me go . Is 6 weeks too short for an ortho unit? i didnt get an orientation in the unit just in the class, and even on the first day my preceptor didnt know she had a preceptee! So im scared right now that my strict unit will let me go anytime soon. I got told by the director week 3 that i need to beef it up or else shell give my spot to another new grad. The hospital seems backward. Everything falls on the nurse and we have to kiss everyones behind. btw i work at a tenet hospital, and we have to kiss the behind of MDs who are stockholders at Tenet. Im scared that ill be jobless and be unemployed for a while and having a short employment at Tenet would leave a bad mark in my resume . I just feel terrible right now and didnt sleep all night
Long time ago I made a sketch for me, to learn how ABG interpretation works.
I hope, I translated everything correct.
Perhaps you can use it ...
I do not consider myself an expert, but am willing to tell you what I know. And, no...you are not a "pain"...that's what this site is here for...for all of us to share information and experiences. I thank you for taking the time to share with us.
Burns patients OFTEN experience PTSD both in the hospital and/or later. Nightmares are common, and sometimes a fear of being alone. PTSD can also occur or intensify from the daily painful treatments (wound care, debridement, surgery). Also, ICU psychosis, or some variant of that, can occur. Depression and/or anxiety often develop. Psychiatric care and monitoring, during and after hospitalization are very important.
I have not seen problems weaning from the MSO4 drip, as it is gradually withdrawn. I have seen, however, patients who ask for PRN morphine around the clock. I even had a patient tell me he really wasn't in pain but "enjoyed the buzz". Lying in that bed day after day, month after month can be very boring. Generally, all patients receive app. 5mg MSO4 prior to dressing changes, whether on a continuous drip or not. (If on a continuous drip, we bolus them the 5 mg.).
Yes, bucking the vent means resisting it, and/or trying to breathe over it. ABG's become crappy and the vent is constantly alarming when this happens.
Re: the seizure activity. Yes, physical and emotional trauma such as this can increase or even initiate seizure activity where there previously was none. Oftentimes, Dylantin will need to be monitored and titrated. Every patient is unique.
Emotional support can be provided in many ways. Cards and letters of encouragement are always appropriate, both to the patient and the family. Longterm patient's walls are often covered with cards and letters, pictures and children's artwork. Pictures taped to the tv are comforting. While the patient is "family only", it would most likely be helpful to contact the family simply expressing concern and more importantly, giving them a chance to vent their fears and feelings to an objective person. Being a good listener, and "therapeutic communication" is so helpful. When the patient is able to receive visitors, ask the family to check with the patient whether he is ready to receive them. Family and friends at the bedside keeps the patient feeling connected and cared for. With our longterm patients, family and friends often just " hang out" in the patient's room, even while they sleep, and they find it very comforting. Again, this is all up to the individual patient and family.
Please let us know how it goes. Take care...
Have been an ICU nurse for about 7 years now. The 1st time i went to work there was literally terrified. I thought this was the wrong job for me. Worked in a 24 bed combined ICU with all the cases neuro, card,surg everything! But pray and hope you get a patience preceptor you will get used to it. If for some reason you do not go along with your preceptor ask your manager to give you another preceptor some of them can be mean and mind its a new environment for you so somebody needs to be patience.
We all learn at different pace. Some are fast others are slow. Always have a small note book with you to jote a few important reminders. But do not feel threatened or scared to ask any questions however stupid it can be. You will love working in critical care after sometime, it might be challenging intially but you guys will get there. All the best in your new positions, and welcome to Critical care.
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