The Stumblebutt Chronicles

**VivaLasViejas**, ASN, RN

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!

The Stumblebutt Chronicles

About VivaLasViejas, ASN, RN

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