Tuesday, March 31, 2009
My first code. Of sorts. (part I)
Okay, I'm sorry about that teaser from yesterday. I was so beat when I got home that I was incapable of much more than becoming a bump on the couch. I pretty much vegged out with some Intervention and Project Runway Canada. And then I went to bed at 21:00. So here's a synopsis of my mind-numbing day:
We arrived on the unit for 0700 report and I was again assigned 2 patients, both of which I've been assigned to before. You may remember my friend Mr. Willie (as in Groundskeeper Willie), of "Ach! Stop pulling me family crest!" fame. There was also Mrs. S who was about the sweetest old lady on the planet. She had arrived on the unit about 8 weeks prior, all skin and bones due to severe malnutrition. She was quite the success story as she worked her 78 year old ass off in order to get out of incontinent products and to self-transfer to the commode and wheelchair so she could get off the unit. She did a great job of building her strength up and she was going to be discharged off the unit into the nearby rehabilitation hospital. She still looked like a skeleton but you could see that she was gaining some weight. Seriously - any people with body image issues reading today? Starvation is NOT attractive. Go eat something while you still can!
So my first task was to go in and get vitals from Mr. Willie, who was sound asleep so I tried to be quick and non-annoying about it. Unfortunately he wasn't in an especially chipper mood so I attempted to be jokesy yet subdued and hooked him up to the vitals machine. I put the cuff on his arm and he yelled "Godammit woman, didja put your hands in the icebox this morning??"
Yikes. Apologies ensued. I didn't think my hands were particularly cold!
So I hooked him up and pressed 'Go' and waited for the vitals machine to do its magic. Unfortunately it couldn't find the BP so it kept inflating/deflating the cuff. Finally I just killed it and attempted a manual. Shit! Mr. Willie has Parkinson's disease complete with hand tremors. I was trying to palpate his radial pulse but I couldn't tell whether it was a pulse I was feeling or if it was just his wrist flexing. Yarg. By now I've spent 20 minutes trying to get a noninvasive set of vitals and he is thoroughly awake and not in the best mood. Finally I just estimate and inflate the cuff to 160. As it's coming back down, past 120, past 110, past 100, I'm thinking - crap. I can't get his BP manually either. Nurse FAIL.
Then I hear it and see the mercury jump around 97. Hooray! As I was charting it I realized that he has chronically low BP. I PROBABLY should have checked his baseline first! lol!
So I let my instructor know that I couldn't get Mr. Willie's pulse because of his Parkinson's tremors. She suggested I go for it and find an apical pulse for the first time. I went back into his room, ready to attempt it, and There. He. Was.
Nurse McDreamy.
Approximately 700 feet tall with sparkling eyes, dimples, and a great smile. Then he said hello in a rich Aussie accent. I felt MY apical pulse flutter. Swoon.
I introduced myself and said I was going to attempt to find Mr. Willie's apical pulse. Nurse McDreamy had Mr. W's G-tube out and was going to aspirate it and started explaining everything he was doing to me. In that luscious accent. Double swoon. Did I mention Aussies are third on my list of automatically-doable-men? That's my list of, regardless how ugly they may be, men that I would go out with if their accents were svelte enough. Irishmen are first. I really don't know what it is about them. Maybe I'll just blame Colin Farrell on that one. So after Nurse McDreamy was done his G-tube assessment, he started helping me find Mr. Willie's apical pulse. Poor Mr. Willie, being my guinea pig all morning. Lest you think I was neglecting him in the testosterone-laden presence of McDreamy, RN, actually the opposite was true. I actually made more of an effort to involve Mr. W because I felt so embarrassed from swooning over a fellow nurse at the bedside! I started with the 5th intercostal space and I couldn't hear anything. Just Mr. W talking. I jovially told him to zip it and kept listening. He continued making small noises and I realized it was his Parkinson's, so that was really distracting. Then McDreamy started pointing to different areas to listen to. Still nothing. Nothing, nothing, and nothing. I could hear him breathing but no heart sounds. McDreamy took my scope and tried. He couldn't hear anything either. Later he showed me the chart where it said that Mr. W had some kind of cardiac pathophysiology where his S3 and S4 sounds were muffled. If the cardiac specialist couldn't hear his heart sounds either, then I felt justified.
Mr. W is not one to beat around the bush, as it were. So he was washing his face and axillae, and suddenly said - "I believe that I peed."
Okay, said I, no problem. We'll get that cleaned up as part of your bath.
"Well, good thing, because now I have to shit!"
Blink, blink.
"Uh, okay, Mr. W. Would you like me to draw the curtain for you? We'll give you some privacy." He nodded and I went to draw the curtain closed. Suddenly, McDreamy stopped me and rhetorically questioned what kind of rational human being would want to have a bowel movement in bed. Only, the language he used was slightly more crass.
So he started getting Mr. W up from the bed! Let me remind you that a few short weeks ago, Mr. W was entirely bed bound. Yes, he is technically CAPABLE of walking, but not very far, and not to the toilet, and definitely NOT while trying to maintain bowel control, you know?
I should have said something.
I SHOULD have said that Mr. W was better off just using his incontinent product in the bed because I didn't think he would be strong enough to make it to the bathroom, much less in a hurry, much less while squeezing his sphincter shut. And that sacral ulcer would make it very uncomfortable if not downright damaging to use a bedpan.
McDreamy RN was becoming a whole lot more like McAsshole RN while he insisted that Mr. W stand up and walk to the bathroom. His patient care went right out the window. His manner was short, somewhat condescending, and I was mortified for poor Mr. W who was just doing what he was told. That accent of his wasn't doing anything for me now except make me even more pissed off.
Except, he was not. With a splatter I saw that exactly what I expected had come to pass. My first Code Brown, ladies and gentlemen, and for a man on G-tube feed - well, you can imagine the scene.
Mr. Willie's Parkinsons tremors had gotten worse and worse to the point that I was afraid he was going to keel over. The nurse had him over by the bathroom so I let them go the rest of the way while I started cleaning up. He was sooo agitated, and so I was I. How awful. What a terrible loss of dignity. McA RN finally got him on the toilet and we got to work cleaning it up. He was cursing under his breath and rolling his eyes at the whole scene. I could have smoked him in the nose. Bahhh, I was so angry! Luckily one of my clinical buddies seemed to pick up on my agitation via peer ESP and came into the room bearing deodorizers. She sprayed it everywhere and that seemed to help. Unfortunately there was BM on my scrubs, on my shoes, on my arm (eww.) and just about everywhere.
So that's the first part of my, ahem, shitty day. There's more to the story but I am heading home from work now. I shall continue the story at a future time.
We arrived on the unit for 0700 report and I was again assigned 2 patients, both of which I've been assigned to before. You may remember my friend Mr. Willie (as in Groundskeeper Willie), of "Ach! Stop pulling me family crest!" fame. There was also Mrs. S who was about the sweetest old lady on the planet. She had arrived on the unit about 8 weeks prior, all skin and bones due to severe malnutrition. She was quite the success story as she worked her 78 year old ass off in order to get out of incontinent products and to self-transfer to the commode and wheelchair so she could get off the unit. She did a great job of building her strength up and she was going to be discharged off the unit into the nearby rehabilitation hospital. She still looked like a skeleton but you could see that she was gaining some weight. Seriously - any people with body image issues reading today? Starvation is NOT attractive. Go eat something while you still can!
So my first task was to go in and get vitals from Mr. Willie, who was sound asleep so I tried to be quick and non-annoying about it. Unfortunately he wasn't in an especially chipper mood so I attempted to be jokesy yet subdued and hooked him up to the vitals machine. I put the cuff on his arm and he yelled "Godammit woman, didja put your hands in the icebox this morning??"
Yikes. Apologies ensued. I didn't think my hands were particularly cold!
So I hooked him up and pressed 'Go' and waited for the vitals machine to do its magic. Unfortunately it couldn't find the BP so it kept inflating/deflating the cuff. Finally I just killed it and attempted a manual. Shit! Mr. Willie has Parkinson's disease complete with hand tremors. I was trying to palpate his radial pulse but I couldn't tell whether it was a pulse I was feeling or if it was just his wrist flexing. Yarg. By now I've spent 20 minutes trying to get a noninvasive set of vitals and he is thoroughly awake and not in the best mood. Finally I just estimate and inflate the cuff to 160. As it's coming back down, past 120, past 110, past 100, I'm thinking - crap. I can't get his BP manually either. Nurse FAIL.
Then I hear it and see the mercury jump around 97. Hooray! As I was charting it I realized that he has chronically low BP. I PROBABLY should have checked his baseline first! lol!
So I let my instructor know that I couldn't get Mr. Willie's pulse because of his Parkinson's tremors. She suggested I go for it and find an apical pulse for the first time. I went back into his room, ready to attempt it, and There. He. Was.
Nurse McDreamy.
Approximately 700 feet tall with sparkling eyes, dimples, and a great smile. Then he said hello in a rich Aussie accent. I felt MY apical pulse flutter. Swoon.
I introduced myself and said I was going to attempt to find Mr. Willie's apical pulse. Nurse McDreamy had Mr. W's G-tube out and was going to aspirate it and started explaining everything he was doing to me. In that luscious accent. Double swoon. Did I mention Aussies are third on my list of automatically-doable-men? That's my list of, regardless how ugly they may be, men that I would go out with if their accents were svelte enough. Irishmen are first. I really don't know what it is about them. Maybe I'll just blame Colin Farrell on that one. So after Nurse McDreamy was done his G-tube assessment, he started helping me find Mr. Willie's apical pulse. Poor Mr. Willie, being my guinea pig all morning. Lest you think I was neglecting him in the testosterone-laden presence of McDreamy, RN, actually the opposite was true. I actually made more of an effort to involve Mr. W because I felt so embarrassed from swooning over a fellow nurse at the bedside! I started with the 5th intercostal space and I couldn't hear anything. Just Mr. W talking. I jovially told him to zip it and kept listening. He continued making small noises and I realized it was his Parkinson's, so that was really distracting. Then McDreamy started pointing to different areas to listen to. Still nothing. Nothing, nothing, and nothing. I could hear him breathing but no heart sounds. McDreamy took my scope and tried. He couldn't hear anything either. Later he showed me the chart where it said that Mr. W had some kind of cardiac pathophysiology where his S3 and S4 sounds were muffled. If the cardiac specialist couldn't hear his heart sounds either, then I felt justified.
Once complete with Mr. Willie, I scampered off to giggle with my clinical group for a few minutes over McDreamy. Another RN overheard us and, sadly, informed us about Mrs. McDreamy. Bummer! Anyway, totally unbecoming nonprofessional behavior aside, I went back to Mr. W to see if he needed repositioning or anything (he has a sacral ulcer) before I went to see my other patient Mrs. S. Mr. W, still not in the best mood, insisted that I get his bed bath going ASAP as he was expecting a visit from a physician and wanted to be clean before that. So I agreed and got his basin all ready, got all the towels primed, and who shows up again but McDreamy RN. Hooray, thought I, someone to help me roll Mr. W around this big bed.
My impression of this McDreamy fellow was about to do a complete 180.
Mr. W is not one to beat around the bush, as it were. So he was washing his face and axillae, and suddenly said - "I believe that I peed."
Okay, said I, no problem. We'll get that cleaned up as part of your bath.
"Well, good thing, because now I have to shit!"
Blink, blink.
"Uh, okay, Mr. W. Would you like me to draw the curtain for you? We'll give you some privacy." He nodded and I went to draw the curtain closed. Suddenly, McDreamy stopped me and rhetorically questioned what kind of rational human being would want to have a bowel movement in bed. Only, the language he used was slightly more crass.
So he started getting Mr. W up from the bed! Let me remind you that a few short weeks ago, Mr. W was entirely bed bound. Yes, he is technically CAPABLE of walking, but not very far, and not to the toilet, and definitely NOT while trying to maintain bowel control, you know?
I should have said something.
I SHOULD have said that Mr. W was better off just using his incontinent product in the bed because I didn't think he would be strong enough to make it to the bathroom, much less in a hurry, much less while squeezing his sphincter shut. And that sacral ulcer would make it very uncomfortable if not downright damaging to use a bedpan.
McDreamy RN was becoming a whole lot more like McAsshole RN while he insisted that Mr. W stand up and walk to the bathroom. His patient care went right out the window. His manner was short, somewhat condescending, and I was mortified for poor Mr. W who was just doing what he was told. That accent of his wasn't doing anything for me now except make me even more pissed off.
Unfortunately, and I'm going to chalk this one up to plain old newbie-ness, I didn't stand up for Mr. W. I thought that McAsshole the registered nurse would know better than a first year student. I hadn't worked with Mr. W for a few weeks and, who knows, perhaps he really was able to walk to the bathroom....
Except, he was not. With a splatter I saw that exactly what I expected had come to pass. My first Code Brown, ladies and gentlemen, and for a man on G-tube feed - well, you can imagine the scene.
Mr. Willie's Parkinsons tremors had gotten worse and worse to the point that I was afraid he was going to keel over. The nurse had him over by the bathroom so I let them go the rest of the way while I started cleaning up. He was sooo agitated, and so I was I. How awful. What a terrible loss of dignity. McA RN finally got him on the toilet and we got to work cleaning it up. He was cursing under his breath and rolling his eyes at the whole scene. I could have smoked him in the nose. Bahhh, I was so angry! Luckily one of my clinical buddies seemed to pick up on my agitation via peer ESP and came into the room bearing deodorizers. She sprayed it everywhere and that seemed to help. Unfortunately there was BM on my scrubs, on my shoes, on my arm (eww.) and just about everywhere.
So that's the first part of my, ahem, shitty day. There's more to the story but I am heading home from work now. I shall continue the story at a future time.
Have any of you ever been faced with this? Someone who should know better but doesn't, and who you should speak up to but are afraid to?
Monday, March 30, 2009
A difficult day
at clinical today...
Suffice it to say, for now, that it wasn't the patients - it was the nurses.
Thursday, March 26, 2009
Back'n'action
Well, in case you're wondering, my post from last week is still unresolved. But I am being open and honest with myself for the first time in probably a while and I can feel change in the air. To be honest I've been steering clear of blogging for a bit because I have been doing a whole lot of partying to get my mind off things. However, judging by my traffic counter, not many people are interested in my emoting, so it's back to your regularly scheduled program of UgRN!
P.S. Thanks to everyone who sent their well wishes. It was totally appreciated and I know I've got a whole lot of life left in me and a lot of experience to gain, so it helps a lot to get the experience and wisdom of other people :)
Anyway - clinical! OMG, there's only 2 weeks left of this semester. Two weeks proper, anyway. Then there's a gap while we celebrate Easter with the fam and then it's back to finals. Then after finals there's another mini semester in May. But I'm not thinking about that! I'm thinking about 2 weeks left in classes!
I'm soooo ready to be done this semester. I think I've said this before but I love nursing and nursing school. Really, I do. I just haaate the freakin' wringer they put me through! I'm sick of going to classes every day and learning a million new things, all the while thinking, 'shit, I've got to memorize all of this stuff for the final!'. It's really insane how much the human brain can store. Add to the mix my current life stressors and lack of sleep, and it makes for a pretty explosive college girl!
This week in clinical I had TWO patients! One was a stepdown from ICU (is that the right word? coming from ICU to a medical unit?) with a previous tracheotomy and a whole lot of tubing, and the other was just about the sweetest nonagenarian that I've ever met. My assignment wasn't supposed to be quite so crazy but my previous patient was discharged and replaced with the ICU patient. So I totally had my hands full. I did vitals for the first time on a real patient (with my Littmann Master Cardiology scope, which I heart!). My instructor, who seems to love me now that I wrote such a good reflection journal, watched and said that my technique was great so she wasn't even going to double check my results on a manual BP. I insisted that she did and she got the same BP as me! So that was very exciting for me.
The thing with vitals is that people are counting on you to come up with accurate numbers. It's not like a bed bath where you can just do it your way and no one complains. If the numbers are off, it could screw with someone's meds or tests, and ultimately life. So I took it as a pretty big deal. My biggest obstacle is actually finding the brachial pulse on someone. I didn't even KNOW there was a brachial pulse except on a baby arm. So a few of us spent hours on that just palpating each others arms. It's pretty funny, any nursing student can approach another nursing student and start poking their elbows for a brachial pulse, and we all instantly understand! We don't even need to ask permission any more. That's peer support for you.
So just to be sure, I checked my stepdown patient's vitals manually and then with a vitals machine, and I was totally thrilled to see they matched exactly for BP and pulse. SpO2 was at 95% on 5L (?) of oxygen which was good. The sneaky part about measuring someone's respirations is that they will change their respiratory rate when they know that's what you're counting for. So we are taught to palpate the radial pulse, count off 30 sec and take the reading x2, and then to keep our hands on their wrists for another 30 sec while we count off their respirations while ostensibly still checking the pulse. It was a lot of fun. I felt kind of sneaky in a good way. But then I got all over confident and forgot my HR count while I was counting off respirations. So clearly I have some work to do there, haha!
The sphygmomanometer that we have on the unit is really super ancient. I might have mentioned this already, but it's about 3 feet tall on casters, with for-real mercury in it, and you need to push it around the unit to get to a patient's room. Compare that to the portable cuffs we used in lab that is essentially just the cuff, a dial, and the pump part. Totally can fit in your pocket. The nurses on the unit laugh at us for taking BPs manually, but oh well! I'm so thrilled that I can do it at all! :)
Anyway, I just wanted to check in with you all. I haven't forgotten about you! <3
Meme: What does your stethoscope look like?
I've been tagged by Student RN Tiffany!
1) Post a picture of your stethoscope
Here are the rules:
2) Tell what you love about it
3) Tell what you hate about it
4) Tell me what your dream stethoscope would be
5) Does it have a name?
6) Tag all your nursing friends (Including the one that tagged you) and dont forget to leave a comment on their blog telling them that you tagged them!
4) Tell me what your dream stethoscope would be
5) Does it have a name?
6) Tag all your nursing friends (Including the one that tagged you) and dont forget to leave a comment on their blog telling them that you tagged them!
______
1) I already posted a picture of it :) I love my engravings. They're so me!
2) Mostly, I love the fact that it's got the horse engraving and my name/school/grad year. It keeps me connected to the idea that some day I will graduate from this chaos! I also love how loud it is as I can sometimes be a bit hard of hearing. Probably due to my extensive telephone work and the iPod usage that I enjoy whenever possible :) I also love how heavy it is. Shocking, I know, but when things feel flimsy in my hands I just don't feel as confident with them. This guy is NOT flimsy!
3) Bah, the only thing I hate is being the only person in my whole freakin school who doesn't have a bell AND a diaphragm. Everybody's like dude, wtf is wrong with your scope?
4) LOL, I don't have enough experience with them to know what I would change. I like mine. I would REALLY like one that could magically shrink down into my back pocket when I didn't need it!
5) Not yet, but I'm sure it will. We've only had them on the unit twice now! I've called it "My Little Pony" a couple of times. Maybe that will stick. Or how about, "Damn this thing in my pocket digging into my leg!"
6) Oooh I totally tag back Tiffany, little d, Lou, Somnambulant (if you're still blogging these days!), and Wardbunny. I'll comment on your blogs tomorrow to let you know. But for now... I am off to bed!
Tuesday, March 17, 2009
Dear Drofen
It's been a rough few days...
Thank you for posting that review of Fireproof. I decided to rent it on iTunes and it really struck a chord with me. Yes, it appears that men really are capable of being real men all on their own and shouldn't require careful prodding from a woman to do the right thing.
I started to realize that I'm a bit of a pushover and I shouldn't have to take the B.S. that I have been, but I keep taking it hoping that everything will be smoothed over in the end. I need to put a stop to that and start demanding the respect I deserve otherwise I may never get it. Well, I don't know if it will work out or not, but I have to trust that Someone has my best interests in mind.
"A real man needs to be a hero to his wife before he can be to anybody else"
You may have started something big in me. Thanks, I think ;)
Thank you for posting that review of Fireproof. I decided to rent it on iTunes and it really struck a chord with me. Yes, it appears that men really are capable of being real men all on their own and shouldn't require careful prodding from a woman to do the right thing.
I started to realize that I'm a bit of a pushover and I shouldn't have to take the B.S. that I have been, but I keep taking it hoping that everything will be smoothed over in the end. I need to put a stop to that and start demanding the respect I deserve otherwise I may never get it. Well, I don't know if it will work out or not, but I have to trust that Someone has my best interests in mind.
"A real man needs to be a hero to his wife before he can be to anybody else"
You may have started something big in me. Thanks, I think ;)
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