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Then she was screaming that the pt was on Hospice and shouldn't be having all this stuff done.  Okay, #1 - it's midnight, we're changing rooms, it's not a change in the pt's condition, it's not an emergency; we're not going to wake up a family member in the middle of the night to say, "oh by the way, we're moving your mother-in-law to a different room."  Imagine how she would have reacted to that.  #2 - after they put in the NG tube they got 1200 cc's out of her stomach, that's a lot!  You don't sit around when the pt has an ileus or bowel obstruction and is vomiting stuff up, you want to empty the stomach and keep it empty.  #3 - the pt had undergone a Hospice eval, she was not a Hospice pt at that point; even if she was, the purpose of Hospice is comfort at the end of life.  But, the main thing about all of this - the pt is alert & oriented and able to make her own decisions.  The daughter-in-law has absolutely NO SAY in the pt's medical care!

It was hot again Sunday and difficult to sleep when you have to go back to work.  It was Melodee, Liz, and me and I told LIz I was sorry but I was not going to take that one pt back (the rude, non-compliant jerk!).  So I had 3 of the same pts and my 4th was wonderful, no problems except for one episode of pain which was taken care of easily.  My gentleman with the trach/mist collar continued needing dressing changes and pain meds.  My one lady had pulled out her catheter (the one we'd left unrestrained as she was doing so well) and I had to put that back in, plus she was getting blood, plus I was supposed to remove her central line after starting a peripheral line.  I got her catheter in on the first try and believe it or not, this was the first female catheter I've done so I was quite happy!  She was a difficult stick so Lee (charge) got one in.  In the meantime I was dealing with the pt next door, the one on the ventilator and was running back & forth between the two.  I had gathered up my supplies to remove the central line and send the tip to the lab but had to go back into the vent room.

When I went back to take out the PICC (central line) there was blood all over her gown & bed.  She'd pullled out the new IV and was waving it around in her hand.  Got her cleaned up and Lee said to go ahead & run the 2nd unit of blood thru the PICC, contact the doctor in the morning and ask for an order for a new PICC.

I also spent a lot of time with my lady on the vent.  At one point she had a lot of fluid coming out of her mouth & nose, needed suctioning.  The RT said she had sinusitis.  I checked and the towel he put down had orange coloration in the fluids - her Dilantin is orange.  She was having reflux from her stomach, tube feeding was done thru the G-tube but was now coming out of her mouth, nose and around her trach.  I flushed it and discontinuted the tube feeding.  Also, at one point her oxygen saturation dropped, even tho she was on the vent, so that was a concern.

It was just a very busy night and it was almost 0300 before I had a chance to even start charting.  Luckily 3 of them were from the previous night so I had less to look thru, but once again it was about 0815 before I got out of there, plus I never got a break.  Melodee was busy too, one of her pts was different and he was a handful.  Liz was busy, but I don't think she was as busy as we were.  But it was a good group, both nights.  My only complaint about Melodee is that she doesn't tape report, she gives a verbal report and that takes a lot longer.  You can tape a report in 5-10 minutes, depending upon how much extra you put in; both nights she took 20-25 minutes to give her report.  You just can't help but add comments and stuff when you're giving verbal; stuff that isn't necessary. 
7/27/03  Sun  (0853):   Today is Take Plants For A Walk Day.  Now I know you're supposed to talk to them, didn't know you were supposed to exercise them also!

Word of the Day:  luftmensch \LOOFT-mensh ("OO" as in "foot")\ noun.  an impractical contemplative person having no definite business or income.  (luftmentsh breaks down into "luft" (a Germanic root that can be tied linguistically to the English words "loft" and "lofty"), meaning "air," plus "mentsh," meaning "human being.")

My horoscope:  'Yesterday's bathtub mystery will be explained today. Still, you'll have no idea what to feed the penguin. Pizza might work, I'd think.'

Worked on 2east Thurs/Fri.  Thursday it was just Melodee and I to start, I started with 3 but got an admit right away.  We both thought it was time for it to be a quiet night without a lot of admits and with 4 pts each we couldn't get any more.  Wishful thinking!  At 2300 we got another nurse which meant we could get 4 admits.  I gave up one of my pts and Melodee gave up one of hers, then the new nurse got an admit.  I got a 4th pt eventually. 

It was a very busy night for me, as usual!  It was after 0300 before I got a chance to look at my charts.  One of my pts had taken a turn for the worse during the day, after discussion with the wife he was made a no-code and we were giving him comfort care.  Melodee helped by calling the doctor and asking for a morphine drip so I wouldn't have to keep going in every hour or so and giving him an IV push of morphine, giving him ups & downs in pain control.  He was a lot of work with other stuff to do for/to him also.

When I went in Friday night he had expired around 1630 that day.  I had 2 of my same pts, picked up the pt I gave away the night before, who was a pain in the ass, and a new pt who still needed to have all the admit paperwork done.  I say he was a pain, which I probably shouldn't, only because he was a clock watcher for pain meds.  He knew he could get Dilaudid every 2 hours and Demerol every 6 hours.  Dilauded is stronger than morphine, the 2mg I gave him every 2 hours was the equivalent of 10mg of morphine.  I had given him the Demerol and 40 minutes later he asked for Dialudid.  He was told it was too soon and that would be too much in that time frame. 

Had to start a new IV in a pt, got it the first time, yay.  I'm still not 100% on getting them started so everytime I get one I'm happy.  I had to start a new one on the clock-watcher.  He told me he was a difficult one to get and said I had to do it in one particular place.  It happened to be on the back of his right forearm.  That's a difficult place, especially when his shoulder wouldn't move fully.  So there I was, upside down, using my left hand to start the IV, and doing it by feel as I couldn't see the vein.  I actually got a blood return and saw the blood come up the cannula when I advanced it, but when I tried to draw back I didn't get any blood return, darn!  I looked elsewhere but didn't find any place.  I ended up calling down to ICU and the charge nurse came up and did it, just about the same area I had tried.

Got a ride home by Sandy (monitor tech).  It's not far to walk, but sometimes after a long night it's hell climbing up the long flight of steps from the hospital parking lot, then I have more to climb to my apt.  She's so nice, she always gives me a ride when we work the same nights.

Had an appt Sat for the ultrasound I had to cancel earlier.  Had to drink 1/2 gallon of water and not pee!  Then during the ultrasound he had to push down, ooooooooh!  I was actually grimacing by the end as I had to go so bad!  Took a quick look at the picture, would have loved to have seen more, but had to
run to the bathroom.  I went to the grocery store afterwards and thank goodness they have a bathroom as I had to go again!

Had my review, both unit managers were there.  I did well.  You're rated 1-5; 1 is not good, 5 is almost impossible.  You also do a self-eval before and I'd given myself mostly 3's (consistently performs to expectations) with one or two 4's.  They gave me more 4's than I gave myself!  Not only did I get an increase from my review, there was another market adjustment.  That will be just about $27.00 an hour; see, it pays to go to college and get more education!  Of course I had to sit down & calculate, with the night differential added in I should get about $2100 before taxes.  Pretty good!  And that's just working 3 nights a week!
7/28/03  Mon  0303:   Today is National Drive-Thru Day, so put away the pots & pans & go!  In & Out sounds like a good idea, too bad they're not open right now, a cheesburger with grilled onions sounds pretty good right now.  Antonio Vivaldi died this day in 1741.  I just love his work, I've listened to The Four Seasons over & over!

Word of the Day:  quietus \kwye-EE-tus\ noun.  1: final settlement (as of a debt).  2: removal from activity; especially : death.  3  something that quiets or represses.  (In the early 1500s, English speakers adopted the Medieval Latin phrase "quietus est" (literally "he is quit") as the name for the writ of discharge exempting a baron or knight from payment of a knight's fee to the king. The expression was later shortened to "quietus" and applied to the termination of any debt.)

My horoscope:  'Today you will have to take someone aside and gently explain that a "briefcase" is not actually for undergarments. Remember, you probably made a few silly mistakes yourself when you were just starting out.'

Another
very productive day!  Finished a book; read a magazine; started another book; watched TV; slept.  Oh, and perused a multitude of wonderful pictures on Fotolog!  So far 3 people have added me as a Friend/Favorite, how cool is that!
7/30/03  Wed  (0908):   Ohhhhh YUM!  Today is Maine Lobster Festival, I could go for one right now, I'm starving!

Word of the Day:  cantankerous \kan-TANG-kruss\ adjective.  difficult or irritating to deal with.  (Merriam-Webster says, "It's irritating, but we're not absolutely sure where "cantankerous" comes from. Most etymologists think it probably derived from the Middle English word "contack" (or "contek"), which meant "contention" or "strife." Their idea is that "cantankerous" may have started out as "contackerous," but it was later modified as a result of association or confusion with "rancorous" (meaning "spiteful") and "cankerous" (which refers to something that spreads corruption of the mind or spirit). Considering that a cantankerous person generally has the spite associated with "contack" and "rancor," and the noxious and sometimes painful effects of a "canker," that theory seems plausible. What we can say with conviction is that "cantankerous" has been used in English since the late 1700s.")

My horoscope:  'Money will come from an unexpected source. If you put it in a mesh bag and run it throught the washer, you'll get most of the smell out.'

Wow!  What legs!  I'm watching
Singing In The Rain with Gene Kelly, Debbie Reynolds, and  Donald O'Connor.  Right now Cyd Charisse is doing her thing with Gene Kelly.  She's from Amarillo, Texas, same place I'm from!  Believe it or not, her real name is Tula Ellice Finklea.  I think I prefer Cyd Charisse much more!
Cyd Charisse & Gene Kelly
Turns out Charisse is her married name, Sid was her nickname and she spiced it up for Hollywood.  Which reminds me, if you ever think "I should do such & such right now," DO IT!  I saw a picture of Hedy Lamarr years ago that looked just like my Mom.  It was in a magazine; I should have torn it out as I've never seen it since and I can't remember the magazine.
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