The Stumblebutt Chronicles
Ever have a day when everything you touch seems to break, fall over, or end up on the floor? Yep, me too. In fact, making a mess is one of the things I do best, and it never fails to happen when I'm in a hurry. Today was that kind of day.
To say that I loathe the 0900 med pass at my SNF would be the understatement of the year.
First of all, being able to concentrate on the pass itself is impossible in the face of almost constant interruptions, and with my challenges in that arena I'm always nervous. Secondly, the census changes from weekend to weekend so I never get comfortable with the patients, and the few that are long-termers on that unit are legendary for being difficult about meds. And since all of them have about a dozen vitamins and supplements in addition to their actual meds, the pass takes two solid hours.....IF I'm lucky.
Today, we had a brand-new tube feeder on the SNF side who gets roughly twenty pills in the mornings, most of them OTCs, before his bolus feeding and flush. I was already behind as it was, because it seemed that nobody had been medicated for pain since the middle of the night and they all needed narcotics. Plus, people kept mistaking me for the housekeeper and asked me to take out newspapers and empty garbages, and one patient couldn't understand why I looked so harried and wanted to ask me detailed questions about it.
I should've known the tube feed wasn't going to go well when I squirted myself with the contents of a fish-oil capsule after pricking one end of it with a needle, instantly causing me to smell like a seal (and people walking past to wrinkle their noses). Then I had to pour and crush all the meds that could be crushed, and my heart almost stopped for a moment because the 3-11 nurse had signed off on the extended-release potassium capsules last night.....after the patient returned from the hospital with the tube and his new NPO status.
I'd just put everything into a disposable cup and stirred well when another patient called to me from a nearby room. I looked away for only an instant, but that was all the time required for the swamp cooler to come on full blast and blow the cup over, spilling the contents all over the top of the cart.
Now the entire HALL reeked, the med book was sopping wet with the odoriferous liquid, and I had fish oil plus multivitamins and iron all over my shirt, my pants, even my shoes. I ran into the bathroom, grabbed a batch of paper towels---you know, the kind you have to get out of the motion-sensor machine one. at. a. time.---and unhappily began to mop up the mess, knowing I was going to be even later finishing this pass than I already was.
Then I picked up the pill crusher to wipe off the bottom, and about half of the little plastic sleeves slid out of the top of it and went everywhere. If any of you have used the Silent Knight crusher, you know exactly what I'm talking about---those tiny bags are slicker than owl poop, and when you drop a bunch of 'em in eau de fish, retrieving them is a pretty slippery business.
Down the hall, a CNA hollered to her co-worker: "Holy God, what is that STENCH??!"
And......I broke up. For some reason the absurdity of it all struck me as absolutely hilarious, and I laughed so hard that heads started popping out of rooms all up and down the hall. Finally I got hold of myself and went in to do the meds and the tube feeding, and my bad luck continued; it'd been so long since I last performed this basic nursing skill that I forgot the most basic part of it: kink the tube before you open it up. I didn't, and about 30 ml of residual splooshed all over the patient's gown and bed linens.
After getting HIM cleaned up, I turned to get a can of Jevity off the bedside table and knocked over not one, but two half-full sippy cups of unidentifiable fluids (which had sat there for who-knows-how-long). Needless to say, I had by now lost my happy thoughts entirely, and begun to wish I could cancel the day for lack of interest. No, it wouldn't have been enough just to go home, crawl back into bed, and start over---I wanted today to be over, and it wasn't even noon yet.
Thankfully, the CMA rescued me before I had to do the really hard ones, like the fellow with a grand total of 23 pills that have to be crushed and given in ice cream, and even then he'd refuse them and harangue you for twenty minutes about how his doctor is trying to kill him with all those pills. I have never been happier to see a med aide in all my life; there were still five residents who hadn't yet gotten their 0900s, two Lovenox shots and a breathing treatment to give, and Heaven knows what kind of trouble I'd have gotten into while trying to wheedle Mr. Fussmaker into taking his meds.
You know, when I worked 7P-7A in acute care, I was so notorious for being a klutz that my co-workers called me the Nocturnal Stumblebutt. And while I'm no longer quite so nocturnal, I haven't become any more graceful with the passage of the years, and today proved that. Again.
Oh well......tomorrow is another day!Last edit by Joe V on Sep 15, '13
About VivaLasViejas, ASN, RN Guide
Joined: Sep '02; Posts: 26,737; Likes: 43,532
RN and blogger extraordinaire; from OR , US
Specialty: 20 year(s) of experience in LTC, assisted living, geriatrics, psychSep 15, '13(((Viva))) I don't know how you LTC nurses do it, I simply cannot imagine being responsible for so many patients! I have the utmost respect for you all!!!Sep 15, '13Yep, there's nothing quite like smelling of gastric contents and iron for the balance of the shift. I've had many days like that Viva. Many, many, oh-so-very-LOOOOONG days...Sep 15, '13Love how you infuse humor in your writing to make light of a situation that was obviously long and difficult for you. You can draw strength from that :PSep 15, '13I'm doing LTC now....I regularly have about 30 patients.... I do a heavy 6/7am pass its nearly impossible....I have 4 tube feeders Every morning I'm rushing can't spend enough time with my patients...Smh...everyone always has saved all their questions for me in the morning...I'm going back to school to get my bsn so I will have more employment opportunities but until then I'm here managing....Sep 15, '13VivaLasViejas -- long live your sense of humor and writing skills, too! I can absolutely picture myself in your shoes. Thanks for the totally relatable story, and may you be imbued with unlimited gracefulness from here on out!Sep 15, '13If it makes you feel better, I once had a vial of mucomyst explode on me (no one told me not to put air in it!). At 8am. Luckily, I was able to get ORto wear so I only minimally smelled like rotten eggs. Ugh.Sep 15, '13The terrible part is for me that the more stressed/frustrated I become, the more things I drop and spill which in turn makes me more stressed and frustrated!Sep 15, '13Quote from twins4paigesAmen.The terrible part is for me that the more stressed/frustrated I become, the more things I drop and spill which in turn makes me more stressed and frustrated!Sep 15, '13And the dropsies continue......today I knocked over a half-full can of Diet Mountain Dew at the nurses' desk, and dropped an entire cup of pills during the 0900 med pass. ~sigh~ At least it wasn't fish oil! By the time I got to work this morning, everyone had heard the story and poked fun at me all day....and yes, the MAR book still smells like a cannery. SMH.Sep 15, '13My day wasn't quite as bad, though I often get covered in fish oil after I've pricked the capsule. Today I spilled a full cup of water right in front of my cart, spilled a carton of fingerstick stickers and I seriously just had the "dropsies"!Sep 16, '13Oh my! I can so relate. I was returning residual on my tube fed resident and something happened, syringe slipped and I sprayed residual all over the wall, CD player, TV screen and there was only 15 cc of it......how does so little go so far???
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