dragonsfancy

I work in a pediatric burn unit (or did, until this past Friday. Heading for the ER on Monday!) and we had this 8 year old in with pretty serious scald burns. His mom was unable to stay with him, so we all pretty much took turns going in to hang out with him and keep him company. He'd had surgery and ended up having some sort of psychotic reaction to the heavy amounts of meds that he'd been given, so he'd have delusions and such about his brothers and other things. One night, he kept ringing his call light and when the nurse that was assigned to him went in there, the kiddo would say that he didn't need anything and that he didn't ring the call light. A few hours passed and the phone at the nurses station rang and it turns out it was the police. They questioned the nurse about the kid's care and after a few minutes, both the nurse and the police realized what had happened. It seems that the kiddo picked up his phone, dialed 8 for an outside line, dialed 911 and told the dispatcher that his nurse wouldn't change his diaper and that they had him tied down to the bed and wouldn't let his mom come to stay with him. Needless to say, even though the kiddo recovered and went home, we still tease this particular nurse about that night.

My most memorable patient has to be a 99 year old lady with very advanced Alzheimer's/dementia. I had just completed my training as a CNA, certified and just off of orientation. The patient was this little bitty tiny woman. 42 lbs., around 4 foot something and MEAN! I would go into her room to do a.m. care and she would look up at me with this horribly mean look on her face and holler at the top of her lungs "Sh*tfire, you're the devil!" and then proceed to hit or bite me. There would be times when I'd go in and she would have had a bowel movement. Let's just say that she could have easily been a major league pitcher, as some of her poop balls more than once found their target. I carry a scar on the back of my ear where this lovely lady bit the crap out of me and drew blood while I was bathing her. She would cuss out the chaplain. Then there was the time that she stopped eating and drinking and it took four nurses and CNA's to hold her down while the fifth RN put an IV in. She held perfectly still right at the end only for the RN to get the line secured with tape and for us to let go of her. Then she reached up and gave herself an 8 cm. skin tear by pulling the IV out by the tubing. After all this, you might wonder why she was my most memorable patient. Well, the day she passed, I was holding her hand and she reached up and caressed my cheek and said, "I'm not always clear of mind, but just know that I love you." and she closed her eyes and passed about twenty minutes later. It's patients like this that make me happy to be in the field that I'm in.

I'm a tech in a pediatric burn unit and March will be a year since I started working there. I've seen quite a few things that make mad/sad/frustrated all at the same time. *Eight year old with 82% TBSA 3rd degree burns sustained from accidentally dribbling charcoal starter fluid on his clothing while lighting a grill. *Four year old with 4th degree burn to his foot after mom got drunk and decided to let her kids sit on the hood of the car while she was driving. He fell off and was ran over, foot contacting the muffler. Foot was amputated at the ankle. *Developmentally delayed 14 month old whose mom decided that "she just wasn't right in the head" and poured boiling water on her and left her in the floor, burned, for several hours until the dad came home and found her. *Two year old that was scalded by being dipped in the tub by a familial foster parent's son for pooping on himself. These are the ones that hurt me the most, I think. The child abuse cases.

My official title is "burn tech", but I'm also referred to quite often as a CA/Clinical Assistant. (Our hospital's version of PCTs.) I work as a tech in the burn unit of a pediatric hospital. My duties are varied, as our unit is small and I'm the only burn tech for our unit, period. I mainly do v/s, pass out meal trays, make beds, run errands (to the blood bank, lab, etc.) and stock supplies. We have six rooms for inpatients and we also see kids on an outpatient basis daily in the burn unit and then we have an official "burn clinic" in the surgery clinic on Wednesdays. I do simple to moderately difficult dressing changes on our outpatients, along with "soft wound debridement" (usually gauze and tap water used in a wiping motion to rid the wound of old cream/ointment and eschar). Sometimes, I'll assist with inpatient dressing changes, but generally the RNs do that. All of this is done under direct supervision of an RN. i.e. The outpatient is placed in the outpatient room. I go in and greet them, undress the wound and clean it. I then get an RN to come in and assess it and then we decide if it needs to be redressed in the same manner or changed over to a different dressing. I do some patient/parent education regarding wound care/dressing changes/scar massage/aftercare. I do not do labs, d/c saline locks, insert or d/c foleys, I/Os or anything of that nature as Alabama's board of nursing does not allow a tech to mess with IV's at all, nor do they allow labs or foleys to be done on pedi patients by the tech. Our nurses take care of the I/Os because of how strictly they keep up with them. Usual staffing if our six rooms are full is a Unit Clerk, Burn Tech (Me), and 3-4 RNs. However, we might have as high as 5-6 RNs if we have high acuity patients (vents or critically ill kids on a monitor.). We are classified as a critical care unit. Our unit also serves as the regional pediatric burn unit in the southeast, so we usually have out-of-state patients. Pardon my rambling. My point is, we each have our own jobs to do, but if we don't work together as a cohesive team, then our patient's care tends to suffer. 've never been told, nor have I told anyone "that's not my job".

After nearly eight years of working in LTC as a CNA, I finally managed to break free from working with adults as I now work totally with peds. However, I take with me many "code brown" stories, a few of which I'll share here with you. 1) There was a gentleman on my assignment one night who had acquired a random stomach bug that caused him to have to run to the potty several times within an hour. If that wasn't bad enough, compounding that was that he had to be assisted to transfer from w/c to commode, as he'd had a stroke and had total left side paralysis. He was also non-verbal, well that's not entirely true. He could get your attention and convey his thoughts through gestures and such. Anyhow, he caught me coming down the hall one night and began frantically pointing towards his bathroom and pulling at my scrub top while crying out "G*d**n!" (He couldn't really speak coherently, but that was the one word that came out loud and clear when he was frustrated.) I wheeled him into the bathroom and he pulled himself up on the handrail while I pulled his pants down so he could sit on the commode. The minute the air hit his buttcheeks, the most foul spray of stool shot out of him and consequently all over me. So, here we are...a stroke patient who is relieved and horrified both at the same time and a CNA who is grossed out, covered in stool and is at the moment, holding the poor man up and puking in the toilet behind him. I managed to get a coworker's attention and she came and cleaned my resident up while I went to the shower and stripped down. My charge nurse called my husband who brought me a clean change of clothes and a pair of clean shoes. 2) Another resident was infamous for not pooping for three or four days and then on that fifth day, would pass a large mass of poop roughly nine inches long and seven inches across. She never complained or anything. She would simply say, "I just had my baby." 3) Then there was the great C. diff. epidemic of 2003. Everyone on our hall seemed to have it. Slimy, egg-white consistency poop that smelled like rotting death. I think I lost fifty pounds in a month from not having an appetite. There you have it, some of my more memorable "code brown" stories.

When I worked in this one particular nursing home around two years ago, I took care of a lady with rheumatoid arthritis. She couldn't really do much for herself in the way of personal hygiene due to her hands and arms hurting her, so whenever she was incontinent or if we were giving her a bed bath, she would look you dead in the eye and with all seriousness, exclaim: Girls, make sure you wash that moosie good, now, you hear?

eat candy bars to excess and then visit the ED c/o abdominal pain and projectile vomiting...

...go skydiving with my buddies after we put down a couple of six-packs of beer. After that, I'll...

...and fell flat on my rear, requiring a trip to X-ray where they also found...

Try Dermaid. You can usually get it at any pharmacy. Pricey, but worth it's weight in gold.

I've worked in several nursing homes since 1997, so I've had plenty of run-ins with restless spirits. At this one nursing home, there were three different wings. North, East and West. West wing was the "heavy" hall. Mostly tube-feeders and total care. East was the Medicare/short-term rehab wing. Then there was North. North had a pretty ecclectic mix of patients of differing levels of acuity. There was a short hall and a long hall. However, to the back of North wing, there was a long hall that had about ten private rooms, a day room on one end and a small dining room on the other end. The residents back on this hall (called 400 hall) were all ambulatory and even a few "wanderers". Now, I generally worked from 3-11, but on this particular night, the 11-7 girl was sick so I was asked to stay. As I was off the next night, I agreed. Since I was working a double, I was given the assignment on 400 hall. It was an easy assignment as most of the residents were continent and the few that weren't were really light weight. Anyhow, I was sitting in the dining room with the lights off, charting by the dimmed hall lights when I caught something out of the corner of my eye moving down the hall. Thinking it was one of my "wanderers", I looked up and saw what to this day I still believe was a toddler on a tricycle. Let me tell you now, I lost it. The ADL book went flying and I skittered up the short hallway to the nurse's station. I relayed my story to the charge nurse and she just sort of chuckled at my expression and explained that one of the residents that had passed away years ago had a grandson that was killed by the back tires of her car. He was in the driveway and she didn't see him and backed right over him. The night the lady died, she was calling out "Tyler, oh my baby Tyler. Nana's coming.". Then she passed. Everyone has come to the conclusion that the toddler on the tricycle still haunts that hall, looking for his grandma. Either way, I never worked another 11-7 on 400 hall.

Not a nurse yet, but a burn tech in a pediatric burn unit. However, before this, I worked as a nurse's aid for eight years in LTC and dear Jeebus did I ever see/smell some things that turned my belly upside down. In no particular order: 1. Crusty, fungus-y toenails. 2. C-diff poop 3. Sputum (I still run away from the patient who has the unfortunate luck of being suctioned while I'm in the room. 4. Necrotic tissue. (Had a patient whose pit bull bit a chunk out of the antecubital area of his right arm. Long story made short, a chunk of the tissue turned necrotic and was being dressed in 1/4 strength Dakin's and FMG as a wet-to-dry dressing. The smell of bleach and necrosis is NASTY!!) 5. Purulent drainage from a stage 4 decub. UGH!! Those are things that will make me toss my cookies in a heartbeat!!

:chuckle :rotfl: Birmingham, AL Dr. Fix/Plastics and Specialized Ortho and Dr. Job/Physician Recruiting. :chuckle :rotfl: