HDNurse

Pamilina - My, aren't we Miss Judgemental today? You must think I'm stupid if you think I voiced those feelings to my patient. I calmly explained to her that such large fluid gains are extremely harmful to her and that it is making her heart have to work extremely hard and that at some point her heart won't be able to take it anymore. Truth? You don't know me or this patient. You don't know about the dozens (hundreds?) of times we have had this conversation about her fluid restrictions and day after day after day when she comes in with over 6 kg of fluid on. You don't know about the numerous times she has been in the hospital for fluid overload (last week she was in the hospital on a vent!)because we can't get it all during her regular dialysis treatments, or how she is now getting treatments more than 3 days a week because she is non-compliant with her fluid restrictions. You don't know how every day her blood sugars run over 500 because she doesn't like taking her insulin. I feel like I am beating my head against a wall with this patient. No amount of EDUCATION over the course of her treatment has made one damn bit of difference. It is because she did not control her diabetes that she is in kidney failure. She has a BKA as well with more certainly to follow. I CARE about this patient and that she is killing herself with this fluid just as easily as if she takes a gun to her head. I don't want her to die, I want her to be in better control of her disease and treatment. It is her actions that will determine her outcome and it makes me incredibly sad to know that no matter what I do, how much I care or how much I try to teach her it will not make one hill of beans of difference in the end. Her death will come sooner rather than later because she chose to ignore what I have taught her. I must reiterate: I did not say one inappropriate thing to this patient, or treat her with anything but total respect. Nowhere in my origianal post did I say that I had done otherwise. I have treated that patient with total professionalism, just as I treat all my patients. I just wish she would treat me with the same amount of respect, and quit lying to me and admit that she can not control the amount of fluid she drinks. As long as she lives in denial, we will not be able to get her to change her behavior. You mention contemptous behavior on my part. What contemptous behavior?Venting my frustration to a bunch of strangers who don't know me or my patient? Verbalizing frustration to an anonymous audience is a far cry from verbally abusing a patient. That did not happen, and I never said that it did. If I had, then you would be right to get indignant. Yeah, I use this site to vent. So what? I LOVE my patients, have an incredible relationship with all of them and they LOVE me. I feel incredibly proud to be able to be a part of their care and they appreciate all that I do for them. They tell me that they look forward to seeing me on their dialysis days. Finally, I finish with your own words. "Do not deminish any human." Well, didn't you do exactly that to me?

Too many times the patient is just looking for someone to be responsible for the awful situation they are in. Anybody, but themselves. My dialysis patients hate that they have to give up a huge part of their lives to come in for 3 hour treatments, 3 days a week. They have no control left in their life. So they blame their health care provider when they can't remove the 6 kg of fluid during their dialysis treatment, that they have put on over the last 2 days. Heaven forbid they should take responsibility for having put on that much fluid in the first place or for not controlling their diabetes so they are thirsty all the time. It is not my fault that you have CRF. It is not my fault that you are fluid overloaded. It is not my fault that you can't breathe and your legs look like giant tree stumps. But, it is my duty to explain to you what this is doing to your body, and give you all the information you need to make an informed decision about your care. I will continue to provide the best care I can, if you will let me. You can choose to continue drinking fluid like a fish. That is your right. Just stop blaming me for how bad you feel. (ooooh, that rant felt good...)

One of my patients came in today - Monday- having gained 11.6 kg over the weekend! When I talked to her about it, she adamantly insisted that she "doesn't drink very much and doesn't know how she could have gained that much." When I did the math and told her that was over 25 lbs, she still denied drinking very much over the weekend. Arrrrrrrgggggghhhhhh!!!! Why doesn't she just quit wasting our time and take a gun to her head? It would be just as effective at killing herself, just much quicker. She must think I'm stupid.

I had a male post-op patient that had his foley removed. He had apparently learned that if he did not pee in 8 hours he got catheterized again. Over the next week, I had to catheterize him repeatedly, because he would hold his pee. I knew he was doing it on purpose. He enjoyed being catheterized way too much.

I work with a very sweet asian nurse who always charts that the patient has 4+ pitty edema. Having that much fluid in their legs, I feel sorry for them too.

If I received a nickle for everytime I heard this complaint, I would be able to retire! I have turned up the temp in the room, turned up the temp of the dialysate, turned on the heat in the heated chair, covered them with their multiple blankets and still hear "it is too cold in here." I don't know what more I can do. I am going to suggest to my patients that they bring their own hot water bottles or those microwavable buckwheat pillows. Any other ideas?

Either way it sucks. $25/hr or $25/tx. I'm just trying to figure out if it is in my best interest to go from getting $35/hour or $187/tx. Still seems to me if I am doing the 1:1 txs for the day doing 2-3 tx/day while the other nurse does 6-8 in the treatment room/day, and we both work 12 hour days, she makes out like a bandit and I get a lot less. I'm not sure I want to go to a per tx pay.

Along the same lines. I am currently working at an hourly rate of $35/hour and there is talk of going to a per treatment pay of $187. Can I really make more this way. Seems to me if I am stuck doing 1:1 in CCU, ICU etc, that I would actually get less. I did 5 patients yesterday in the unit, while my co-worker did two 1:1 pts. See what I mean?

This particular patient was found clutching his chest and trembling. When the tech was not able to get him to answer her she called me. Within seconds, I had ascertained that he was not breathing and there was no pulse. You are right that they could look like they are sleeping and be in more trouble than is apparent. I am much more aware of their breathing patterns now. On a good note... This patient is now alive and "well" and back at his regular treatment time at our clinic. He returned to the clinic two days before his 79th birthday. He got a pacemaker and his BP is so much better now than it was prior to his arrest. He usually had a BP with a systolic in the 90's. Now he runs in the 120's. He is still having a lot of pain in his chest wall due to the separation of cartilage during the CPR-sure wish there was a way to avoid that, but the alternative isn't acceptable is it? He doesn't remember any of it and asks me repeatedly about details of that day.

He is 78 years old and one of my favorite patients. A very sweet, gentle and pleasant man. He is never any problem to care for. He is totally compliant with his diet and fluid restrictions. We never have to take more than 2 kg off of him at a time. He is the perfect patient. He has never given me any indication of being acutely ill. His history shows having a CABG in 1987 and no problems since then. Monday, he drove himself to treatment, walked into the clinic by himself, had no complaints of feeling ill. His heart and lungs sounded great. 57 minutes into his treatment and after removing only 0.8 kg, he arrested. Just like that. One minute he is fine, the next minute he is technically dead. We started CPR and put on the AED until the paramedics arrived (10 minutes later!). The AED said no shockable rhythm, continue CPR. For 10 minutes I did compressions on that man. The paramedics arrive and someone says, "Lori, Mr. so-and-so is here and needs to be put on." So I'm right back into the dialysis "dance" for the rest of the day. We had no idea if he made it or not. I stopped by the hospital after my shift to see if he had made it. He did make it, and more importantly, he is alert, following directions and recognizes me. He is neurologically intact! He is expected to make a full recovery. I once was a firefighter/EMT and I've performed CPR before. Usually on people who have been down who knows how long. They never made it. They were strangers to me. This man: I have a relationship with. This was different. I have been a nurse for almost 19 years and I have never had a patient code right in front of me. I've taken CPR classes year after year to make sure I was prepared, and to be honest, the last few times I didn't take them too seriously 'cuz "I've been there, done that." Those "mock codes", that I once thought of as rediculously a waste of time are no longer going to be looked on with disdain. Today I'm glad I was prepared. I saved a man's life. God, it feels great to be a nurse! I've made a differnce. Of all my dialysis patients, this man was not the one I expected to code. He was "stable". It can happen to anyone, at anytime. It pays to be prepared.

One of our techs mentioned possibly working in the prison dialysis clinic and said that nurses are VERY WELL paid there and that it might be possible to pick up some extra shifts. I asked him to get me the information, but then he bailed on me and told me he doesn't know who to contact. Now I am really curious, and it sounds like something I would like to do. Does anyone know how I would find out who to contact for the Carson City, NV Corrections Facility Dialysis Unit?

No joke. The dietician is about ready to pull out her hair. The protein popsicles are ok, I guess, as there is some benefit for the pt. But the popcorn and sno-cones are strictly entertainment. Give me a break....

Our Medical Director wants to get a popcorn machine so the pts can have popcorn while watching the Netflix movies he brought in. He also wants us to give them sno-cones! We give them protein popsicles too. What next? Like I don't have enough to do than to add fetch and carrying food to my list of chores.

Will someone please explain to me the rationale behind this new rule. I mean why is it suddenly a no-no to pull saline from the patient's own NS bag? Using ETOH, sterile syringes. We have been doing it this way for years and then suddenly it isn't acceptable. They keep thinking of ways to increase our costs, but do they reimburse us for this? Once we institue pre-filled syringes, they will just come up with some other stupid rule.

It is not uncommon at all for a dialysis patient to use a double lumen tunneled catheter for dialysis. Ideally, we would like to eventually progress to using a fistula or graft but there are some patients, where, for one reason or another, those types of accesses are not appropriate and the patient become catheter dependent. I could see this happening in a 600 lb pt like you describe. The pts do face increased risk of infection and catheters that become clotted, and many patients have to have catheters replaced repeatedly due to these complications. But, we do see these catheter dependent patients all the time.