This is for all the new grads out there thinking they are the only ones running around like a crazy person...
07:00: Getting report, pulling tele strips as we go.
Me: Hmm, has her heart rate been 120?
Nightshift nurse: no, it was 80 when I did her 04:00 strip, and I think she has been about 80 during this whole admission.
Me: Ms. L, how are you feeling this morning? (Writes name on board)
Ms.L: Oh I feel fine, just a little sleepy.
Me: (Checks morning vitals) Okay well I am going to be back in here in a little bit with your morning meds, use your call light if you need anything.
NN: Here's the report on the new admit that came from ED at 05:50, admission paperwork is done but I haven't done an assessment.
Baby nurse (AKA Me): I'll go see him first ? (07:30)
08:00: In new admit's room, charting, listening to nephrologist map out plan of care.
PCA: Ms. L wants something for nausea
Baby nurse: okay, I'll see if she has anything.
08:10: pulling Ms. L's meds
Charge nurse: Ms. L wants something for nausea, I'd give her something, she's vomitting.
Baby nurse: okay. She doesn't have anything on her MAR but I'll get an order.
08:13: Walks into Ms. L's room
Ms L: (sweating bullets, breathing 30/min, clutching chest)
Baby nurse: *oh crap* charge nurse said you are nauseas, tell me what else is going on...
Ms. L: my chest hurts
Baby nurse: can you describe it for me?
Ms. L: It just hurts, it's like a 10, OOHHHHH, *pants*
Baby nurse: (begins typing page to Dr.) can you tell me how long this has been going on? Have you ever had pain like this before? Does it hurt anywhere else?
Ms. L: it started about ten minutes ago, right after I started vomiting. I've never had pain like this before! My shoulder hurts, my right shoulder, and up here into my jaw...
Baby nurse: *looks around for grown-up nurse* *puts 2L O2 NC on Ms. L* *checks frantically to see if Dr. has responded* "I will be right back!" *Asks pharmacist if it is possible to override nitro tabs from the Pyxis, tells charge nurse why nitro is needed* Goes to check if Dr. has responded, again*
Dr. (via computer): nitro, stat labs, chest x-ray, call cardiology
Baby nurse: *starts putting in orders* *looks around* how do you call cardiology? *pulls nitro from the Pyxis, brings vitals cart into room, asks the PCA for a STAT EKG, administers nitro*
Dr. (via computer): call cardiology now!
Baby nurse: (to anyone at nurse's station) do I just call the paging center for cardiology?
Random nurse: yeah...
Baby nurse: *calls paging center, goes back to Ms. L* *gives more nitro*
Phone rings; "cardiology is on the line for you"
Baby nurse: *rushes out to nurse's station, gives cardiology an update* *rushes back to Ms. L, re-checks vitals*
Cardio: *arrives at bedside* *asks questions, looks at the EKG, leaves the room*
Baby nurse: how's your chest pain? A 6 now? That's good... *cycles BP again* 204/97, here's another nitro...
Cardio: *walks back in* what was her last BP? Has she had nitro? How many? We need to get her on a BiPAP, where's the hospitalist? Give 40mg lasix IVP now.
Baby nurse: 3 nitro, chest pain went from 10 to 6, BP unresponsive, I'll tell the hospitalist to come... *pages hospitalist again, pulls lasix, calls respiratory*
Ms. L: I need to pee!
Baby nurse: *searches for bedpan, sees that she is wearing depends* it's okay, you can pee in that, we will get you cleaned up later
Cardio: did you give the lasix? We are going to need a catheter put in, are they bringing a BiPAP?
Hospitalist: *comes in room* why are there fluids running?
Cardio: what was the last BP? Start a nitro drip. Let's get a STAT echo
Baby nurse: *looks up policy for nitro drip* *triumphantly remembers that meds in bottles need vented tubing* drops/breaks a bottle of nitro while pulling from Pyxis*
RT: *brings BiPAP* she is doing really well but she is very anxious, can we give her something?
Cardio: Ativan 1mg IVP now
Baby nurse: starts to put order in and leave room at same time
Hospitalist: actually do 20mg morphine IVP now
Baby nurse: *nods calmly, walks calmly to Pyxis room, frantically overrides morphine from the Pyxis* *double, quadruple checks that 1 ml is 20mg, administers*
Cardio: give another 40 of lasix, we're transferring to ICU as soon as they finish this echo.
Everyone except me, echo tech, and Ms. L's grandson (when did he get here?!): leaves room
Baby nurse: *calls report to ICU, titrates nitro up to 10, starts writing note*
Ms. L's grandson: *hands baby nurse cell phone* can you tell my aunt what is happening? *hands baby nurse a 2nd cell phone* now can you tell my mom what is happening?
Baby nurse's phone rings, unit secretary: Ms. L's son is on the phone and wants to know what's going on...
Baby nurse: *delegates communication to current family member* *continues writing note* *gives 40mg lasix* *takes Ms. L to ICU, gives updated report* *returns to unit, looks around, feels like taking a nap* *Thanks charge nurse for completing morning med pass on other patients* *completes morning assessments/charting*
2 days later
Baby nurse: *wonders why I didn't call a Rapid Response*
Insert about 10x more silent panic and frantic eyes and you've seen the whole thing!
