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In an effort to keep it to one place, the school said they'd allow cigarette smoking on campus, but only in the parking lot.  It would never happen today, and I was surprised even then as this was in Texas, not California where you'd expect a more relaxed attitude.  So anyway, it was fun to see that car.  I really liked it, even though it was huge.  It was the one with the fins on the back too.  I think it would be fun to have one of them.  Well, actually I'd like to get a car, soup it up, jack up the back, paint it, etc., like the cool ones when I was in high school.  I'm not sure exactly which one, but I think a Chevy Nova was one of them.  That's another thing to add to my list to get when I win the lottery :)
6/11/03  Tues  (1052):   Today is King Kamehameha I Day and that reminds me of a good trivia question.  I forget exactly how it was worded, but the question asked where would you find a royal palace on American soil or territory, or posessions, something like that.  Most people think of foreign countries having palaces and forget that there's one in Hawaii.  Don't forget that Sunday is Father's Day!

King Henry VIII is back; on this day in 1509 he married Catherine of Aragon.  You can go
here to read about her.  She was his first wife.

Word of the Day:  gambol \GAM-bul\ verb.  1: to skip about in play: frisk, frolic.

My Horoscope:  'Several extremely hungry creatures will look at you strangely today. Throw them a raisin cookie.'

OH  MY  GOD!  I worked on 4West Sunday night and when I say worked, I mean worked!  We all started with 3 pts (I was working with Camille & Kelly).  I looked in on the first one, she was sleeping so decided to go see the other two first. 

One gentleman had had a CABG and I guess the night before he was pretty confused and had a problem with the Asian nurses & aides.  Apparently he had been in Vietnam for 3 years and during his confusion thought he was back there.  So I was told to take him, can't get much more Caucasian than me! He was fine, almost completely normal.  There were a couple of episodes where he seemed a little strange, but he was alert & oriented.  He was surly a couple of times, then stopped.  Luckily he slept all night.

My other pt was alert & oriented, breathing was better and he was doing fine.  He slept all night also.

I went in to check the first one, she was lethargic, but knew who she was and where she was.  I was keeping an eye on her as her BP was low, 70's & 80's for the systolic (upper number).  When I went back in around 2200 she was unresponsive, cool, and clammy.  Checked her blood sugar, it was okay.  She didn't have a temperature.  Couldn't get a blood pressure.  I was trying to rouse her with a sternal rub - try it on yourself.  Take your knuckles and rub really hard over your sternum, it hurts!  No response. 

Camille came in about this time and she tried to get a blood pressure, nothing.  While she was trying again I called Marcy, who was Charge.  No one could get a blood pressure on her.  I called her doctor and we started her on Dopamine, which should also help her urine production, she'd had none all day.

We finally got a blood pressure, starting with a systolic in the 50's, then 60's.  Finally got her up to 90/55, then her heart rate jumped to 190!  So this is going on and suddenly Camille's pt, who was on a trach and had just come up from ICU that day, had oxygen sats in the 70's, chest pain, arrhythmias on the monitor. 

I'm thinking, "oh no, we're going to have two Codes at the same time!"  Got back on the phone with the doctor and we dropped the rate of the Dopamine.  It worked, her heart rate dropped back to the upper 90's to 100.  By this time the family had come in as the doctor had called to verify the pt's wishes as a "no code."

Daughter was upset and crying, but was following her mother's wishes not to be placed on any life support or undergo CPR.  Her sister called and I told her she was on the phone, felt it was better to have family talk to each other.  The other sister hung up on her and called back to talk only to me.  Seems the sister calling wanted everything done for her mother & was mad at her sister who was there, but the one at the hospital was the pt's designated agent.  She didn't want to lose her mom, but was going with what mom wanted.

Anyway, Camille's pt is fine, stats are back up and she's sleeping.  My pt is finally alert & talking.  Then I get an admit, GI bleed, and she's a little confused at times.

It was run, run, run all night long!  Never got a break and I was there until about 0815 finishing paperwork.  And I had to go back Monday night!

Oh, and there was a message on my machine when I got home, Kathi's water broke early Monday morning & Rachael was on her way to the hospital.  Unfortunately I couldn't go, needed to sleep!

Monday night was better, I had 3 of the same pts and picked up another one that was there Sunday night so I knew a little about him.  Worked with PJ & Sally and we managed pretty well, no emergencies; the night was
much smoother!

Now to last night!  Now that I'm away from there I finally feel better.  I was sooooo ticked, pissed, irritated!  If I hadn't had to do the Day nurse's work, things would have been
much better.  If you're reading this, it certainly won't instill confidence in your care if you have to go to the hospital! 

I had 4 pts, 3 were the same from the previous night and two I'd had for the 3rd night in a row, thank goodness as it made things a
little easier.  I was doing chart checks, checking the doctor's orders from the day to make sure they'd been entered, transcribed & done correctly.  Fixed a couple on a couple of pts, then discovered an order for potassium to be given IV to my pt I'd had the previous two nights.  She had been alert & oriented, with occasional episodes of confusion, but re-oriented quickly.  She was unresponsive now, due to a high amonia level.  Her potassium level was also low.  The doctor ordered lactulose every 4 hours (for the amonia level) and 3 K-riders (for the potassium).  I looked at the medication sheet and the order for the potassium had been written there, but then x'ed out.  I checked the Pyxis (where the meds are) and they were never removed.  There was no order cancelling the potassium.  I called Lee, Charge nurse, to come & verify what I was looking at and he agreed they should have been given.  By the way, the order was written at 0930 in the morning.

By this time she'd had another lab draw and her potassium was a little lower, plus her blood count was down so now I also had to give her blood.  He wrote up the medication error and while he was doing that I told him she also didn't get another med that was scheduled for 1800; I discovered it at 2230 and that's when I gave it.  Also had another pt who didn't get a heart medication at 0900, she gave it at 1500.  Then there were some other medication errors on some other pts (I was working with Jill & Marge) and turns out it was the same nurse.

Then, while Lee's writing the potassium error up, Kay calls (monitor tech) and asks us to put a pt back on the monitor.  Sometimes when they turn they'll pull a lead off.  Anyway Marge gets up, goes into the room then hollers for help.  Lee & I go running (Jill is off on a break).  The pt was on the floor.  One of the lift team guys happened to be down the hall and I told him we need him now!  The pt was okay, thankfully.  Oh, this is the same pt I mentioned above with the trach.  And that reminds me - Monday night I went in to help reposition her and the inner cannula of her trach was sitting on her chest!  She'd managed to pull it out, thank goodness she didn't pull out the whole trach.  The other nurse picked it up and was about to put it back in and I said "stop!"  Told her to get a new one (sterile) from the box and replace it.  I'm glad I was there.

I had all that catch-up work to do, my charting, answering call bells, covering Marge (she's an LVN so I was responsible for two of her pts), and cleaning up/changing the pt who was getting the lactulose.  Lactulose causes loose stools and since she had a GI bleed that also added to it.

These three nights are a prime example of why I don't like 3 in a row!  With two in a row if you have one bad night you know you only have to come back one more night.

It is also time for annual employee TB tests so I stopped by Monday on my way home so I could have it read this morning.  When I woke up Monday to go back to work I almost had a heart attack.  I have
never reacted to the PPD test before (PPD = purified protein derivative); this time there was a red area about the size of a dime.  I thought "oh no, I've got TB!"  Then I calmed down & felt it.  For a positive test the area has to be raised and it was smooth.  Turns out everyone else who had gotten the test that day had the same reaction, even when they'd not reacted before.  It was basically gone by last night; I had it read this morning and it was negative. 

Also got the results of the mammogram, it was negative.  So I don't have TB and I don't breast cancer.  Two positives after all the hard work of the past 3 nights  :)
6/18/03  Wed  (1124):   Oh Boy, today is National Splurge Day!  Whatever you've been waiting to do, see, get, today's the day!  On this day in 1928 Amelia Earhart became the first woman to fly over the Atlantic.  And for you Beatles fans, today is Paul McCartney's birthday.

Word of the Day:  vexillologist \vek-suh-LAH-luh-jist\ noun.  1:  one who studies flags.  It comes from 'vexillum,' the Latin term for a square flag or banner of the ancient Roman cavalry.

My horoscope:  'You will finally get the television exposure you've been wanting by organizing a group of protesters to block the entrance to a physics lab, holding crudely-lettered signs saying "Down With Gravity!".'

Wow, a whole week has gone by; you ask yourself, "where has she been?"  I been bakin' in the desert!  Went to Phoenix last Thursday to visit Mom and Dad, oh, and Dog too.  Rachael was kind enough to pick me up and take me down to the airport.  Things have changed, even with an E-ticket (ohhhh, memories of Disneyland!) you have to stop at the main counter & get a boarding pass.  You can't go thru the security check-point without a boarding pass now.

I see a line of people in front of the ticket counter so I go get in line.  Then I realize it's the counter for Frontier.  I glanced over and right next to it is the counter for AmericaWest.....no people in line!  Got my boarding pass and proceeded thru the security checkpoint.  I beeped when I went thru the metal detector.  At this point they herd you into a roped off area and you are not allowed to touch your things that have just gone thru the x-ray machine.  So I stood there, eyes glued to my carry-on and my purse.  A lady came over, gathered up my things & escorted me to a table & chair a few feet away.  I got patted down!  Then I had to take off my shoes so they could be x-rayed.  They were quite busy patting people down & checking them with the wand.  Don't know why I was chosen for the honor of a hand search!  
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