Alright, friends. I'm keeping this one short and sweet because my brain is sore and my dog is annoying.
This week, I have learned....
1. There should be a time limit hospitals should have to fix a problem. If things aren't better after, say, 15 days, let someone else try.
2. I'm in the mid Atlantic of the US with spring travel plans to Florida, and I'm actually feeling nervous about Zika. I had a guillian barre syndrome patient in nursing school. On his way driving home from work, his chest felt off, so he course corrected to the ED. When he pulled up and walked to the doors, he struggled with leg weakness. After he was done in triage, he couldn't stand. He was intubated, and completely paralyzed, before he left the ED for ICU.
3. A patient on neuroleptics will still have detectable epileptiform patterns on an EEG.
4. A good neurologist knows no matter how crazy the patient sounds describing symptoms, what they say is legit and will stay the course for diagnosis.
5. My favorite doctors to work with are the ones who will sit and talk patho with a nurse and enjoy that the nurse legitimately loves to learn.
6. Sliding scale coverage alone for inpatient management is not currently supported by research.
7. If working day shift doesn't eventually make me check into a psych ward, nothing will.
8. The GI doc who left me scrambling to save a guy's life (what felt like) single-handedly by doing no intervention before he got dumped on us (actively bleeding out 2 points of hemoglobin over 8 hours and maintaining a BP that won't leave 70s-80s) has suddenly become cautious enough to send a perfectly stable (hemodynamically, symptomatically, and on CBC) rectal bleed to ICU before meeting or scoping her after I've literally done all the work needed on her for the shift. And of course, I was rewarded with an end of the shift admission.
9. The Florida Man Collective has evolved to include its latest - Wrinkles the Clown. He is a scary-looking clown who is for hire to scare anyone you want, for any reason.
10. The more you annoy the doctor about the same thing, over and over and over, the more likely it is they will listen and maybe put in an order.
I have nothing else right now. My broken brain is feeble!
Life is short and fleeting, and you truly can be in the wrong place at the wrong time.
I started a CRRT for the first time on Friday and it actually ran smooth till today! One of my co-workers had to restart it (pt had to go to the OR) and it clotted twice in 2 hours...not that its anyone's fault, but I was sorta proud of the fact it ran for 20 hours...
Life is short and fleeting, and you truly can be in the wrong place at the wrong time.
I started a CRRT for the first time on Friday and it actually ran smooth till today! One of my co-workers had to restart it (pt had to go to the OR) and it clotted twice in 2 hours...not that its anyone's fault, but I was sorta proud of the fact it ran for 20 hours...
Good for you - a lot of people do not like CRRT.
I do think that NxStage is a great machine - of course the alarms can be "unsettling"....
Specializes in Mental Health, Gerontology, Palliative.
- Apparently its possible for someone to go from being "fine" at 0650 handover and when I check their temperature at 0730 they have a temp of 39.5 C and their o2 sats are 68%
- I've also learnt that some doctors have a serious issue with letting patients die. Same patient from yesterday who is not for resus, not for treatment that would prolong life and does not want to go to hospital for an acute admission. Doctor bent over backwards trying to get this patient to agree to a transfer and asked me "why doesnt he want to go to hospital?"
Same doctor looked very pissed when I said "Because he doesnt want to go, while he is very sick he is fully competent. He is also a former nurse with extensive experience in long term care facilities and knows exactly how his illness will progress"
- Its jolly rewarding when I manage to stand up against said doctor, advocate for my patient and get a treatment plan in place that makes the patient and their NOK feel happy.
- Its also a struggle when you know that in one respect a hospital admission may help, but know that the status quo without treatment will hasten the patients death considerably and have to have that conversation with the patient and their family
This week I learned to never speak anything into the universe you don't want to become a reality. Sitting at the nurse's station speaking with a fellow RN about the type of patients we prefer and our interests, I mention how I don't enjoy cardiac cases. I've never gotten a good handle on it and it's just not my cup of tea. No exaggeration - two minutes later, I get handed a new admit: Multiple MI's, CVA x 6, angiogram +/- stent placement, and premed for iodine allergy.
Twinmom06, ASN, APN
1,171 Posts
Life is short and fleeting, and you truly can be in the wrong place at the wrong time.
I started a CRRT for the first time on Friday and it actually ran smooth till today! One of my co-workers had to restart it (pt had to go to the OR) and it clotted twice in 2 hours...not that its anyone's fault, but I was sorta proud of the fact it ran for 20 hours...