Indy 6,532 Views
Joined Apr 27, '04.
Posts: 1,485 (26% Liked)
Oh my gosh. Yeah, there hasn't been a night since I started orienting that I haven't had work show up in my dreams somehow. Night before last, I had Santa Claus as my patient. He was in fluid overload and was busy having a pulmonary embolism. Oh yes, hx of diabetes, HTN, CAD, the works.
This AM before waking up it was some kid... some important kid at his high society birthday party, and me and some doctor were there just in case his monitor went off. (he was turning 18 months old. Not one, not two.) Sure enough, he starts having pvc's a little too frequently. The monitor is this fancy thing I've never seen before that will DIAL 911 and call a code for ya, and it kept trying to do this. The doc kept reaching over and cancelling it. Until the kid has some other funky rythym, and he starts barking out orders for ... I don't remember what. I woke up sweating.
Saturday night I dreamed I had a patient named Tom Brady. No, not kidding. I helped him to the bathroom and he coded on me. I woke up asking my hubby who the heck is this guy... well at least I'm done with the nightmares about the drunk pulling his chest tube out.
You know the trick where you put your hair in a ponytail, but the last turn you don't pull it all the way through? That's my current favorite, makes a sort of sloppy bun that winds up as a loose ponytail by morning. Quite a few nurses that I graduated with did this in school. They didn't want us to have a lot of clips, etc. in our hair, have it off the shoulders, out of the face, natural hair colors (no pink or blue), etc.
I've tried to wear my hair cute like I would when off work but it just drives me bananas. It's nice to just not have it in my way at all.
Sending the contents of the foley baloon down to the lab for a UA.
Get a Kathy White's Fast Facts for ICU book. Get a Gayhart IV drug book. If you have a smartphone, epocrates is pretty good to have for fast lookup of drugs. While you are at it, explore their drip calculator and know how to use it, just in case you wind up with a drip that's not programmed into the IV pumps.
Get a good size lunch box, pack lots of snacks and liquids. If you want them to like you, bring good coffee from home once in a while. Step back and realize that the vent patients you saw in home health are stable. You will see a lot of unstable ones in the ICU so things will be a bit different. While you are there, if you happen on a buddy who will be blunt with you and give good advice, nurture that relationship. And then just work your booty off. :-)
ADN here, 60K/year income range, I work ICU and have no desire to go back to school. However, I do sort of feel like I am in a race against time to get my house paid off before my body quits on me. I like bedside better than I like the idea of taking organic chemistry.
I have learned to ask people to differentiate by saying, ok so does it make you itch, get a rash, or does your throat swell up and give you trouble breathing? If yes, allergy and that's that. If the answer is no, say ok what do you not like about this drug? Sometimes they dislike the effect for a good reason, example I dislike taking muscle relaxers with my blood pressure meds because well, they're too strong in combination. Or, they don't seem to work. Sometimes the patient dislikes an effect that turns out to be an atypical adverse reaction, and I put it down as allergy with explanation, because the pharmacy doesn't allow us room in the computer for "atypical adverse reaction," only allergy.
I'm sorry the response isn't cut and dried and easy, but people aren't easy, they are pretty complex sometimes.
Edit: I have to tell you the funniest allergy I have EVER seen. The allergy tape on the chart read: (long list of drugs, blah blah blah, THE COLOR PURPLE.) We were all like WHAT?! Do they mean purple nitrile gloves?? Then we read the History and Physical, and it's there in print, patient is allergic to blah blah blah and the color purple. We asked the doc in the morning and she was quite annoyed, crossed that out and initialed it, and said some people were talking too loud while she was dictating and no, the patient was not allergic to purple.
"Pt family pureed foot and fed it to him and he ate it all"
The handwriting on it was very neat, it was clearly f-o-o-t not f-o-o-d.
I think last year I would have said that I don't mind the term "vet nurse" at all. This year I've changed my mind. The reason is that my husband is in year two of his associate degree program as an RVT. Holy cow. No pun intended! There is a LOT more to an RVT than I would have guessed, even with an idea in mind previously that they were similar to nurses in the animal world.
Nurses, how many of you can do a manual differential under a microscope? How many of us do fecal exams and are able to identify what parasites the patient has? How many of us learned anatomy on more than one species?
There aren't too many of us who trained to close surgical incisions either. (There are some, I know, but it isn't part of our general nursing education.) Any nurses out there learn how to take, develop and read x-rays during nursing school?
I'm impressed with the variety and scope of an RVT's education, even at the associate degree level. It's really not nursing, it's not comparable to nursing. I vote for RVT as a title over "vet nurse" and I also recommend that RVT's take steps to make that a protected title, and to educate the public about just what it is they do and how valuable they are. You guys don't make much money, but you are worth every cent.
I do think other professions know what they can make and where they can get it. People are going to talk, whether it's voice, internet, conferences or whatnot.
I bought the "inappropriate" line of BS when I worked in a doc's office, long ago, doing the neverending paperwork for insurance billing. Then I found out I was the least paid because I didn't discuss the issue. Oh, how professional of me to save my boss money and eat 30 cent macaroni and cheese for supper most nights. To heck with that. Salary discussions are both appropriate and necessary to assure that people don't get run over by those facilities that are too cheap to pay for good patient care.
I usually get out my penlight and look, regular clean gloves on, before setting up my sterile field. I like to know where I'm going before I try.
Kan (and everyone else),
Thank you for your kind words of support. I would be lying to you if I didn't say that, at times, I wonder if these incidents are "much ado about nothing." I left a career in the performing arts to join the Peace Corps because of my sincere interest in helping others. That experience lead me to nursing school. If I were to pursue getting out of my contract in order to move back to New York, my classmate, in some regards, would have "won." At the same time, I have fought the good fight before and, well, it doesn't seem to matter. Interestingly, the head of security at the hospital was at my meeting with the director and he decided to remind me, without taking sides, that my classmate represents a cross-section of the community which I will serve. Need I say more?
Thanks to the microwave the thing is a lot easier to make nowadays. I had to do this without supplies other than a retention bag, a patient fridge, and an old OB nurse to tell me the process. So basically I got like six little cartons of milk (maybe it was 3, I'm not sure)- any kind of milk since we only had 2 of whole milk, and every single packet of pancake syrup I could find that did NOT say "sugar free" on it. Put pancake syrup in a disposable, clean, suction container. We have the kind that don't have a liner, resembles a flowerpot in shape, and it's the right size to fit in a small microwave, plus it doesn't melt in the microwave. Respiratory isn't happy that I used them, but they really didn't want them back either. Put container with syrup only in it, in the microwave for one minute. Then put milk in, stir, put in microwave for another minute. (About the amount of milk: basically you would like approximately one liter of liquid.) Stir until you have brownish gooey milk and you think it's melted, may have to microwave it a little more. Stir, let cool until it's tepid. Hang enema set on IV pole and clamp off. Put mixture in bag, carefully- you may have to have someone hold the bag open so it doesn't make a mess.
Unhook your patient from telemetry and any other "wires" if you are able. Otherwise it's easy to choke the patient in the following process. Lube the end of the enema set (it's rather large), keep it clamped, lie patient on left side, insert enema. Instruct patient to do deep, slow breathing while you slowly, over about 5 minutes, let 250cc or so of the enema flow into patient. Keep it there for another minute. Instruct patient to roll over to their tummy. Repeat the breathing and the 250 cc flow thing, slowly. A minute or so after they have done this and are as relaxed as is possible, have the patient roll to the right side. This is why the tele wires, IV lines, etc. would be a problem (and I haven't even thought to try it on a vent patient). Repeat the whole thing on the right side. Slowly let the rest of the enema flow in and do nothing (else) to make the patient anxious. Remove the enema when it's all been in for a minute and make sure that the patient has a bedside commode immediately next to the bed, like at a right angle. If you have to hook any wires, IV lines, etc. back up, go ahead and do that. Put towels on the floor, anti-slip socks on patient's feet, and have baby wipes nearby. Stay close and open a window if you can, because the unholy smell will knock you down if you don't.
I have given this with success to elderly constipated ladies who sing halelujah at the end of the poop fest, and one old fella with colon cancer whose impactions were in the small bowel near the appendix. It works. The turning over slowly, helps slosh the mixture up in the large intestine and can reach the lowest parts of the small bowel if done right. The cramping from the large bowel does help encourage the small bowel to move along as well. It's safe for CHF and dialysis patients, and I've not seen it adversely affect either blood sugar or fluid balance.
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