Tuesday, September 28, 2010

Frustration and Gratitude

Some days I come off of a nursing shift feeling like a total moron. I guess that is what happens when you try a new specialty. Hopefully my coworkers and managers will not judge me to be an idiot and will understand that I am teachable. I just need to learn how to do things that I have not done before and as a result, sometimes look stupid to others. So, some shifts are a challenge. However, I must say that the patients make everything worthwhile. The names fade, but the characters drift in and out of my memory:
The risque joke making, 60 something year old gentleman who joked that he wanted me to bring him a rum and coke with his percocet. He was in for terrible COPD and was a major smart ass with an obvious glimmer of intelligence, who turned out to be a former police chief of a nearby major city…
The occasionally confused woman with a broken hip who told me about her childhood during World War II. She had been visiting her relatives in Germany when the war broke out and and was stuck in Germany for the duration. She painted an incredibly colorful picture of the bombings and destruction that she witnessed. When she finally got home to the US, she had not seen her Dad in several years. She described their reunion with tears in her eyes…
The 75 year old woman with congestive heart failure who talked about her 40 years as an ER nurse. She said she wore a huge white cap and was required to stand when a physician entered the room. I was secretly thrilled when I overheard her tell a friend that she had a “brilliant nurse”.  She told me she raised 4 children, 3 of whom turned out to be nurses as well.
The elderly gentleman in for dehydration related to nausea and vomiting from chemotherapy. He talked about being a prisoner of war in Italy in World War II. Then he came home to Florida and started a successful dairy farm in what is now an urban area. I asked him how he felt about selling his land, and with a twinkle in his eye, he told me that it was worth it when he was able to buy his wife her first diamond ring after 35 years of marriage…
I may have to look stupid and ask some dumb questions sometimes, but really...it is quite a job.

Friday, September 24, 2010

Wednesday, September 22, 2010

Scrubs, Caps, and Aprons

I was so envious of the students in the other local nursing programs. Some wore white scrub pants and blue polo shirts. Some wore burgundy scrubs. Students in my program were stuck in a time warp. White polyester high waisted pants with the seams down the front of the legs. A polyester white shirt with a zipper down the front and a peter pan collar. The finishing touch was a blue and white striped "pinafore", apparently a fancy name for an apron. The whole thing came together into an unflattering package.We did have white caps, but were not required to wear them. They did not have the black stripe. Is the black stripe an indicator of graduation? Does it indicate your school? I don't know.
The women in this picture gave me a smile. the two in dark colors are apparently students.  I love the cap of the one in the middle with the Jackie O hair. It looks like it could easily kick the asses of the other two caps.
Thank goodness we don't have to wear whites now. Giving one patient charcoal would ruin the look.  At our hopital we just went to one uniform color for all RN's and LPN's. Respiratory, PT and CNA's, etc have their own colors.What do you think of uniforms?

Tuesday, September 21, 2010

Had a Bad Day?

Medical Terminology

Sometimes nurses get sent to work on unfamiliar units due to staffing problems. I know little about Gynecology, but apparently they just needed someone with a nurse's license who had a pulse. So, while floating to the Gynecology floor a few weeks ago, I met a sweet as can be twenty something CNA/Tech. She came out of a patient’s room and asked me in an exasperated tone “We don’t have sanitary napkins, do we ?”
I replied “Yes, I'm sure we do. They're probably in the Supply Pyxis”
“Really?” she said ” I’ve never seen those here.”
Wondering how a Gynecology floor could possibly stay running without an ample supply of sanitary napkins, I asked  “Are you sure you know what sanitary napkins are?”
She looked at me in disbelief “Of course I do. They are the little square wet wipes like you get at a barbeque place.”
We had a quick lesson on feminine hygiene products that evening.

Monday, September 20, 2010

How to End a Life

These are the words of Dr. Atul Gawande, a general surgeon and writer.
“Recently, while seeing a patient in an intensive-care unit at my hospital, I stopped to talk with the critical-care physician on duty, someone I’d known since college. “I’m running a warehouse for the dying,” she said bleakly. Out of the ten patients in her unit, she said, only two were likely to leave the hospital for any length of time. More typical was an almost eighty-year-old woman at the end of her life, with irreversible congestive heart failure, who was in the I.C.U. for the second time in three weeks, drugged to oblivion and tubed in most natural orifices and a few artificial ones. Or the seventy-year-old with a cancer that had metastasized to her lungs and bone, and a fungal pneumonia that arises only in the final phase of the illness. She had chosen to forgo treatment, but her oncologist pushed her to change her mind, and she was put on a ventilator and antibiotics. Another woman, in her eighties, with end-stage respiratory and kidney failure, had been in the unit for two weeks. Her husband had died after a long illness, with a feeding tube and a tracheotomy, and she had mentioned that she didn’t want to die that way. But her children couldn’t let her go, and asked to proceed with the placement of various devices: a permanent tracheotomy, a feeding tube, and a dialysis catheter. So now she just lay there tethered to her pumps, drifting in and out of consciousness.”

Read more http://www.newyorker.com/reporting/2010/08/02/100802fa_fact_gawande?currentPage=2#ixzz0yxLtNH1R
This is an excellent article that I would encourage anyone to read. Most nurses are confronted with dying patients and their families. Every day we see patients come into our operating rooms at the last part of their lives. I was very saddened last week to see a 95 year old patient no longer able to take food by mouth, with advanced Alzheimer’s, come in for debridement of pressure ulcers on the backs of both ankles and on her tailbone area. She is in constant pain due to osteoarthritis and has emphysema. Her family has kept her at a full code rather than DNR status and insisted on feeding tube placement. The pressure ulcers are from not being able to move herself in the bed. Even with excellent nursing care, pressure ulcers can eventually occur. Now don’t freak out. I am not advocating euthanizing the elderly. We give our end of life patients loving and respectful care no matter their code status or the attitudes of their family. But where do you stop adding treatments? I don’t know what the answer is.
Dr. Gawande advocates early hospice care in his article as well as educating the patient and family on end of life care EARLY in the disease process. He questions the excessive costs of extraordinary measures to keep terminal patients alive. I would be interested to hear the opinions of those not in the medical field, so I can understand some different perspectives. After years in the ER and surgical areas, jaded is a kind adjective to describe us sometimes. What do you think???

Sunday, September 19, 2010

Not So Silent Killer
I had an absolutely lovely patient who was getting ready for surgery. However, I noticed her blood pressure was extremely elevated, 176/109. Considering it should be under 140/80, this is an issue. Anesthesia is hard on the body even without the strain of high blood pressure (hypertension) on the heart and other organs. The anesthesiologist ordered multiple doses of IV blood pressure lowering drugs, drugs that dilate the blood vessels, pain medications, antianxiety medications. We gave this woman a ton of medication, and her bp was now up to 192/116, possible stroke territory. Her surgery was cancelled and she was admitted to the hospital for cardiac workup and to get that bp under control. I brought her a turkey sandwich and ginger ale, as she had been fasting for surgery and quite hungry . She was very appreciative and ate it all. I gave her the lecture on how she needed to watch her diet and take her prescribed medications and how hypertension is the silent killer causing irreversible damage to the heart and kidneys before people even take notice. She nodded and said all the right things. She gave me a big hug and thanked me for her care. I went and gave her nurse on the floor a detailed report about the patient and her orders from the physician. When I came back to the bedside, my sweet patient was eating a ginormous Whopper with cheese and large fries. Now I am the first to admit my diet is not perfect, but really. Does anything we ever say make a difference? I hope she will get better.