gsu8696

gsu8696 has 19 years experience and specializes in Hospice. Also home health and oncology..

gsu8696's Latest Activity

1. 

   Patches: My Non-Compliance Patient

   gsu8696 posted a topic in Nursing

   Pain management is a very tedious part of the hospice nurses' lives. It takes a lot of time to titrate medications, figure out which adjuvant meds will work best for each patient and provided continual assessments for each patient to ensure you're ahead of the pain (or whatever symptom you are palliating)! In hospice, pain has multiple definitions. We've all been taught, or at least I hope we have, that pain is what the patient says it is. Which is why Mr. H was such a challenge. His descriptions of his pain were very nondescript which meant that I had to pretty much try to figure out on my own what Mr. H was feeling. With his diagnosis of COPD, but multiple co-morbid disease processes going on, Mr. H's physician and I were working hard to come up with a plan we thought we provide Mr. H the best pain control. The second part of the equation was Mr. H-he was very noncompliant. Every time I made a visit I was educating him on his medications and how to take them and why he should take them the way I told him. Mr. H was in his 70s. He was a retired veteran. And he was always in control, no matter what. So I was reluctant to ask the physician to start him on long-acting pain medications because I was certain that Mr. H would not be compliant and it would be that much harder to try to tackle his pain issues. I talked at length with his doctor on several occasions. We were surprised that it wasn't so much the COPD that was his biggest issue, but his pain from all of the other abuse his body had endured over the past years. Mr. H would call his doctor several times a week about his pain as well, so the physician was eager to try something different. Taking into consideration Mr. H's long history of non-compliance, we discussed the option of starting the patient on fentanyl patches to try to get his pain under control. We decided that the patches would be the most effective way to control pain while keeping the patient compliant. I obtained the prescription for the patches at the beginning of the week so we could see how the patient was responding toward the middle to late week. I made a visit to the patient on Monday, assisted him in applying the patch, I explained to him and his wife what it was for, how it was used, the potential side effects and everything else I could think of that the patient would need to know. He was one that needed to know everything. On Tuesday I received a message that Mr. H had called to let me know he needed a refill on his patches. Knowing I had visited the patient the day before and what had occurred, I was sure the person who had taken the message had gotten the message confused. So I called Mr. H. And sure enough, he told me he was out of patches and needed a refill. Not completely understanding what was happening, I decided I better make a visit again that day. When I arrived at the patient's home, I asked him for the box the patches had come in and he gave it to me. It was empty. I began questioning Mr. H as to what had happened to the rest of the patches that had been in the box. He replied I was still hurting so I put one on each of the places I was hurting. I asked Mr. H to show me where he had placed the patches and sure enough, he had the one I had placed on his chest, two on different areas of his back and one on his abdomen and one on his knee. I quickly removed the patches which I can tell you, did not go over well with Mr. H. I finally got him to understand how to use the patches and why he needed to give them time to begin working, I never in a million years would have guessed that instead of worrying about non-compliance I should have been concerned about over-compliance! Mr. H and I had several months together after that. He always listened to what I told him and I always made sure to follow up with him. He was more than happy to adopt my nickname for him. Patches.
2. 

   The Case of the Missing Spoon

   gsu8696 posted a topic in Nursing

   This particular evening started off like most others, busy and unpredictable. As charge nurse for the unit on that shift I never knew what to expect, but learned to take whatever surfaced in stride and tried to remember that 11 pm (or whatever time I would get out of there) would eventually arrive. So when one of my regular staff members skirted past me at the nurse's station and informed me she was taking her dinner break early, must have been about 5 pm, I didn't give it an extra thought...until one of my other nurses informed me that she was going with Vivian. That's when something must have tugged at my brain and said, "Hello, this is weird, Kristen doesn't usually go to dinner until around 8 pm and never with Vivian." I spun around to make a comment to the two deserters who had headed toward the elevator just in time to see Vivian with one of our patient's in tow and Kristen looking extremely frazzled and concerned. It took a second to process the scene, but the patient had one of his arms around Vivian's neck with a spoon at her chin. When I realized that one of my nurses was being 'kidnapped' and another was volunteering to accompany her, I waited until the elevator doors closed so as not to upset the patient further, then I quickly reached over the desk at the nurse's station and asked the operator to call the appropriate code for kidnapping (I don't think we had one until that incident!). Within minutes the hospital's finest security flew up to the unit to get the details of what had happened. The nursing supervisor had beat them to the floor by at least five minutes...I was certain by this time that the patient was at least to the airport in his hospital gown with an IV in one arm and a spoon at a nurse's neck with the other and a second nurse in tow just to make thing more interesting. There was conversation via walkie-talkie between security officers on our floor and on the main floor stating that all exits to the hospital had been blocked and that they were certain they would have the perpetrator subdued within minutes. And they would have. If they had not nearly knocked the patient and the two nurses down as they flew down the hall on the main floor, eagerly working on the most exciting case they had come in contact with since their employment! By the time the officers had blocked the main entrance, the two nurses were re-entering the hospital via the main entrance (without the patient, but don't ask how!). Not long after, the patient came back to the unit, escorted by two city police officers who picked him up as he walked down one of the main roads in the city which ran past the hospital. By process of elimination, they were able to determine that since the patient was less than a couple of blocks from the hospital, dressed in hospital attire, dragging an IV pole behind, that he most probably belonged somewhere in our humble abode. Oh yeah, and he had his hospital ID bracelet on. Thankfully, the hospital's security guards were standing strong at the front entrance when the police officers brought the patient back and were able to point the police officers in the right direction. Once the patient was safely back in bed and well medicated, physician and family notified, we were able to ascertain why he felt the need to kidnap my nurse. His response, "I told you I wanted to go home!" Every time a patient said that to me after that incident, I took it a little more seriously than most nurses probably would.
3. 

   Nursing Home Follies

   gsu8696 posted a topic in Nursing

   Making rounds one weekend, I walked into check on a patient who was sitting in her wheelchair laughing hysterically. Her roommate was sitting in the middle of her bed with her legs tucked up under chin rocking back and forth. Since I had been working there for a few weeks, I was starting to know the patients and their habits. The behaviors being exhibited by these two were out of sorts. I should probably mention that the patient in the wheelchair was nearing her hundredth birthday and she was sharp as a tack. Her daughter-in-law and great-granddaughter had just arrived for a visit. The patient's great-granddaughter was pleased to see her grandmother in such a good mood. She was questioning her grandmother as to why she was so happy. I stood in the doorway and continued to listen and observe. The patient responded to her granddaughter's questions by stating that she was having a "very good day". Her granddaughter asked what had happened to make it so good. The grandmother replied, "you know they give me those water pills to make me go to the bathroom, but once they give them to me, no one wants to come back to help me to the bathroom. So today they gave me the water pills. I called for over an hour for someone to come help me." The granddaughter was obviously becoming a little concerned. She had just come for a visit from out of town and was also a nurse. The granddaughter asked her grandmother if anyone had come to help her. The patient replied, "yes, Honey, they finally came. But the reason I was calling them was to let them know the commode was overflowing. They assumed I needed to go to the bathroom. By the time they got in here to help, there were at least two inches of water covering the floor of our room!" She further stated, "I was calling to try to help them by letting them know about the mess before it got out of hand, but they wouldn't come. It took two of them an hour to clean this room!" She went on to say as she smiled, "it serves them right. If they don't want to help us, they shouldn't be working here. But I have to say, it made it my day!" It was then the granddaughter turned to see me standing in the doorway. I asked if there was anything they needed, but they declined for the moment and went on to visit the patient. Once they finished their visit, the daughter-in-law and granddaughter came to find me. We talked about the patient and I answered the questions the granddaughter had. I apologized for the incident on the previous shift, but the granddaughter stated she understood the staffing issues, etc (I think she knew the patient had gotten her point across). The granddaughter had brought the patient a special lunch that was her favorite and the patient had eaten every bite of it. The granddaughter was pleased to see how well her grandmother looked, ate and acted. I commented that she did indeed look much better that day. The next day I came to work only to discover that during the night shift, the staff on duty was making rounds and discovered the patient had died. The patient's daughter-in-law and granddaughter came that afternoon to retrieve the patient's belongings. As I was expressing my condolences to them, the granddaughter replied, "My grandmother looked better than I had seen her in years. She was so happy, even if it was at the expense of the staff. She ate what she loved and she was laughing. She obviously died happily, and if that's what it took to make her happy, it's ok." I thought a lot about my conversation with the granddaughter. It made me realize a couple of things: 1. Enjoy every minute no matter how you have to do it, 2. The patient's comment about the staff not needing to be there if they didn't want to help hit me like a bomb. It was then I realized that it doesn't matter where I work, my patients depend on me and they need me. And that's why I became a nurse. Now every time I have the privilege to visit a nursing facility, I enter those doors with a different attitude, no matter what my business there.
4. 

   Death Denying Acts

   gsu8696 posted a topic in Nursing

   So when my patient died, I felt prepared. I felt sad. She was an elderly woman. But she was somebody's mom, somebody's daughter, somebody's wife. She had a long life, but I wondered what it was like, Had she been happy? Where was she from? What were her dreams? What were her stories, her life experiences? How had she come to this place? She was unable to speak, so the staff didn't spend much time in her room. She had been in our unit for several weeks. She was a typical geriatric patient from the nursing home with a feeding tube, a catheter, and bedsore for just about every year she had been on this earth. Not surprisingly, the patient had died from sepsis. She was on a beaded Clinitron bed (I'm probably dating myself). The nursing assistants went in to provide AM and PM care, empty the catheter, etc. Other than that, interactions with the patient were limited. The nursing assistant, another nurse coworker and I provided the patient's post-mortem care. Since the patient had been a 'no code' we called the physician, called the family then made sure the patient and the room were presentable for the family when they arrived. We turned the bed off so the mattress would harden and make the patient look more natural in her bed until the family arrived. Then we left to finish paperwork, etc. I failed to mention that when my attentive colleagues were giving me instructions on postmortem care, pronouncements, preparations, and paperwork, they were also providing me with extraneous information...like all of the weird and eerie experiences they had had with deceased patients. Not believing all of the 'ghost' stories or experiences they so wanted me to believe were extraordinary, I went back into the patient's room to retrieve something. The bed was back on. Thinking one of the other staff went in once we were finished and thought it needed to be on, I reached down and turned it back off and left the room. A few moments later I needed to return to the patient's room for something else. I walked in to find the bed back on. Again, I turned the bed off as I exited the room. The patient looked innocent enough, so there was no way I was going to mention the bed thing to my coworkers when I returned to them. Third time there was a need for me to return to the patient's room. A third time I walked in to find the patient floating in her Clinitron bed that I knew I had turned off...twice. For the third time, I turned the bed back off. I battled with whether I should share this information with my coworkers thinking that they would surely either think I'd was crazy or that I'd been 'touched' by the dead. I couldn't keep the information to myself. I wasn't quite sure how to tell them that I thought my patient, who had been pronounced dead a short time earlier, was turning her Clinitron bed back on. But I did tell them. And to my surprise, they agreed with me...there had to be something very eerie happening. They refused to go back into the patient's room with me. I was convinced that I was observing my first supernatural experience. Until I found my coworkers laughing hysterically at me in the next nursing pod. That's when they told me that the bed was on a timer. It was designed to automatically come back on at intervals in case it had been left off inadvertently. I'm sure they thought that experience marred me for life. In actuality, it made me stronger in my beliefs and in my conviction to find more compassionate coworkers!
5. 

   Pediatric Hospice Humor

   gsu8696 posted a topic in Nursing

   I had been the manager of our hospice inpatient unit for a couple of years. I had a fantastic nursing staff! I absolutely loved everything about that job with the exception of one thing; okay, maybe two, but the primary exception would have to be admitting pediatric patients to our inpatient facility. Unfortunately the little ones needed our services, fortunately, they needed us. And as difficult as it was for us, we delivered; but, however difficult it was for us, there was no way it could compare to the difficulties the parents and the patients were experiencing. While it was not a common occurrence, the admission of pediatric patients to the inpatient facility did happen. And so it was that we got the chance to meet T. She was four years old, but oh, so wise beyond her years. T's little body was being ravaged by AIDS. The ugly disease had stolen what we adults would consider everything, including her eyesight from CMV. Funny thing was, someone forgot to tell T how horrible she should be feeling. Her mom had recently died in our program as well. T was being cared for by other family members. T loved life and everything about it, but one of her favorites was oatmeal. Our cook made it for her every morning. T quickly stole all of our hearts. On this particular morning, our male nurse, Chris was working and was assigned to T's care. As she did every morning, T wanted oatmeal for breakfast. We had all been a little concerned because this particular morning, T just did not seem herself. Nothing we could put a finger on, she just appeared out of sorts, although she denied pain as well as all other symptoms that morning. As she did every morning, our cook prepared T's oatmeal and Chris took it to her. Because she could not see, T had to be fed. Chris took the oatmeal in and began to feed her. All of a sudden we heard T scream. It was a scream that brought the entire staff, including me, running from all directions to see what had happened. When we entered her room, T had begun crying (or so it seemed!) and yelled "it's hot! You burned my mouth!" Chris was devastated. He began apologizing profusely to T and blowing on the oatmeal to cool it off. Chris kept saying to us "I thought I had it cooled enough." The look on his face showed nothing but devastation and horror. Two other staff members had already reached the sides of T's bed and were attentively assuring that she was not badly burned, and I turned to the charge nurse and reminded her to fill out an incident report. Suddenly, as Chris was still apologizing to her, without provocation T yelled, "April Fool's!!" and she started laughing hysterically. It took a few seconds for the rest of us to process what was happening before we realized that we had all just been had by a 4-year-old more full of life than any of us could have given her credit for! I will never forget the look on Chris' face, but even more, I will never forget the lessons I learned that day from that child. I often wonder how long she had been plotting and planning her April Fool's Day ploy and how she was able to execute it to precision!
6. 

   Communication Chaos!

   gsu8696 posted a topic in Nursing

   I had been assured by my colleagues who had recruited me to the unit as well as the head nurse on our unit that the fact that I had no oncology experience and that I was not chemotherapy certified were only minor issues...unless I had the unfortunate opportunity of coming into contact with one of two primary oncologists who had reputations for being extremely demanding to the point of being able to throw some fairly impressive fits when they wanted something. These 'fits' were generally a result of them wanting their patients to have the best care, but also because they were 'typical' oncologists and wanted what they wanted when they wanted, where they wanted. I was reassured that it was extremely unlikely that either of these physicians would be causing me any issues on the evening shift because they rounded early in the mornings and again in the afternoon. My head nurse further reassured me that she had spoken with both physicians to let them know I was coming on board and that while I was not yet chemo certified, we had our IV therapy team that could provide the chemo until I was up and running. With all of these words of encouragement and phone numbers for every single person I knew (both home and beepers...I'm dating myself!), I felt like I was armed with enough knowledge and tools to handle whatever situation might arise in these first few evenings of uncertainty. While I had never met either oncologist that I was incessantly being warned about, I was certain that between my nursing courses and minor in psychology with my English degree, that I could no doubt handle whatever issues might come my way. Until that second night. Life had been going so well. Things were flowing smoothly. Then our unit secretary called me to the nurse's station to take a call from Dr. B (one of the notorious oncologists). As I approached the nurse's station, the unit secretary grabbed my hand before I could pick up the phone. Her words cut through me like a knife "he's admitting a patient to the floor. Tonight. And she needs chemotherapy." This wasn't supposed to happen--I didn't want to do this--I was just kidding when I said I would--I want my Momma!! Wait a minute. I could do this. Even if there was no empty bed on the floor. I picked up the phone and in my sweet, naive voice, said, "Good evening, Dr. B, how can I help you?" At that moment my brain went into one of those modes where it's trying to process something that's being thrown at it but it just can't process it and it can't figure out why until it hits you that perhaps someone neglected to tell you that one of those oncologists that demands perfection is from Pakistan and might have a thick Pakistani accent which might make it extremely difficult for you to understand over the phone especially if he's barking orders one after the other at you. Breathe! Oops! The physician had just rattled off a list of orders that I had not even begun to understand (although I was writing furiously). With every ounce of courage in my body, I finally said, "Excuse me, Dr. B. Could you please repeat what you just said?" Again the physician began to rattle off the admission and chemotherapy orders (which I had no clue about, although he would never know it!!). Still, I couldn't understand him. I was trying. And praying...hard, extremely hard. But it wasn't happening to me. Again I stopped the physician in mid-sentence, "Dr. B, I am so very sorry. Could you please repeat what you just said?" My brain was trying so hard to process the orders being thrown at me like darts through the phone. I contemplated either handing the phone to the unit secretary or just hanging up and leaving the unit--it was obvious my career here was over, but then I realized I couldn't do either. One more time I squeaked, "I am so sorry, Dr. B. I just do not understand what it is you are saying to me. I cannot tell you how sorry I am." Then it happened. Without warning, Dr. B began speaking loudly and so fast that I could only understand about every third word he said. Unfortunately this time, I did understand, "I can't believe you cannot understand what I'm saying! I don't know why you cannot understand me, no one else has a problem understanding me..." He continued. For an eternity. In a time that would have put an Olympic trial to shame, my ego had been deflated, my feelings had been annihilated and I had most certainly lost my job. I stood with the phone in my hand but away from the ear, although not far enough from my ear that I couldn't hear the laughter that began permeating through the phone line. There was a language I could understand! I put the phone to my ear in time for Dr. B to say, "It's ok. You'll learn how to understand me in time. But don't think I'll let you off the hook for very long!" At that point, he began to slowly repeat the orders to me. We then discussed the fact that I didn't have any empty beds on the unit, but I assured him I would work that out, even if I had to single-handedly build a room on myself! A couple of hours later Dr. B appeared on the floor to see the patient we had discussed...she was in her room, her IV accessed and her chemotherapy being administered by the IV therapist (I'm still paying all off all those people who helped make that happen, and it's been 20 years ago!). Dr. B and I had a great talk that night...it was the beginning of a long, strong relationship. He was right, it didn't take long at all for me to learn to understand him and what he wanted for his patients. And I delivered every time!
7. 

   Patriots' Act! How Could I Turn Down Her Request Now?

   gsu8696 posted a topic in Nursing

   Most of the patients on our floor were oncology patients either there to receive inpatient chemotherapy or continuing their ongoing battle with the dreaded disease. The other major portion of our census was our general post-op patients...the appys, the cholys and the like. And then there was the third portion of our census: the general nursing home patients who were admitted for any variety of reasons, but essentially because they were just too 'sick' to be in the nursing facilities...you know the ones with too many wounds, too many tubes, almost always with diabetes and surgeons just itching to find something to amputate or an organ to remove for the heck of it. There were two surgeons who frequented our unit with these type of patients. Everyone knew that when either of those surgeons had a patient on our floor it was never good. Their reputations were not ones that necessarily endeared them to any of the nurses because of their opportunistic attitudes. As a matter of fact, it was often stated (and unfortunately true) that the longer one of these surgeons had a patient, the shorter that patient got. These two surgeons would repeatedly admit these older bedbound patients for surgical amputations beginning with the toes and working their way up until most of their patients eventually received an above the knee amputation, and for those even more unlucky, bilateral AKAs. When I found out I was assigned to the fourth nursing pod on this evening, I cringed. Mostly because of Mrs. C in room 435. God bless her, she was the typical nursing home patient with all of the diagnoses listed above and then some, including Alzheimer's. The problem with Mrs. C was not so much her care as it was that she couldn't remember. Anything. Ever. No matter who was assigned to that pod, those clinicians had to have, and I mean it was essential, that they have the patience of Job. Mrs. C constantly, and I mean constantly, in every breath, for every second of every minute of every shift was calling for help. As a nursing staff, we were constantly in her room just to ensure that she really didn't need whatever it was she was calling for at that particular moment. Weeks passed and Mrs. C was still in room 435, still calling out to us all. It became so bad, that we would offer each other incentives (candy, money, PTO time) to go in and check on Mrs. C. Eventually it got to the point that none of us would take each other's bribes, not very often anyway! While I was the lucky one assigned to the pod on this particular evening, several of my coworkers happened to be visiting that pod during that evening. As usual, Mrs. C. was calling out. We were trying to discuss something (I can't remember what, but I'm sure it was extremely important!). The nursing assistant finally went over and pulled the door to the room closed, but left it open just enough that we could see Mrs. C to ensure her safety. Unfortunately, I didn't have enough money with me that night to bribe any of my coworkers to enter Mrs. C's room. Because Mrs. C just always called out "Nurse! Nurse!" we felt like her request was generic enough that she could have been talking to any one of us. Which meant that we could push her repeated requests off on each other. Except for one small problem on this otherwise beautiful night on our otherwise chaotic unit. When none of us responded to Mrs. C's repeated cries for help she changed her call. Instead of yelling "Nurse! Nurse!" she began yelling, "Miss Red, White, and Blue! Miss Red, White, and Blue!" All of my coworkers began laughing hysterically. Being a virtually new nurse and wanting to fit in, I began laughing with them thinking they were taking advantage of Mrs. C and enjoying a laugh at her expense. It was then that I realized that they were actually laughing at me. Suddenly I realized, adorned with my white uniform that evening, I was wearing my navy cardigan sweater and had my red stethoscope wrapped around my neck...for the first time, Mrs. C was able to single one of us out, and it happened to be me. How could I turn down her request now?? I couldn't...but as soon as I gave her some reassurance, made sure she was clean and comfortable and that everything was ok, I left her room and promptly removed my sweater, my stethoscope, and all other articles that might assist her in singling me out again. However, in that brief moment, the damage was done: Mrs. C had successfully identified with me and instilled in me an overwhelming sense of guilt after if I didn't run to her bedside whenever she beckoned. I never in a million years would have thought I'd miss Mrs. C and her incessant need for attention, but the fact that she was the first thing that popped into my mind when I was trying to remember my most humorous nursing moments, made me realize what an impact she has had made on me as a nurse.