My Day

Today was sort of a bummer. I had to leave extra early to drive out to a hospital way north of DFW. Today I get to follow the floor nurse around.

First time around the ward, we take all the diabetic patient's blood glucose levels. Test strip in glucometer, wash hands, glove up, alcohol wipe to finger, puncture, dip strip in blood, drop cotton ball on finger, unglove, wash hands, record measurement. Wash rinse, and repeat about 12 times.

Second time around the floor, we give insulin on a sliding scale basis to everyone whose blood sugar is over 120, this has to be timed pretty well, because if you give insulin too early, the diabetics will pass out or maybe even die before they get their breakfasts.

Intermission I - draw four tubes of blood from a patient for STAT labs, neither one of us can get a vein in his arm, so I do my first butterfly stick on the back of someone's hand. Doing things for the first time is always cool.

Third time around the floor. Vital Signs time. Ho-hum. Oh wait, got a guy who has pulse of 160!!!! TACHY! Not good for him, but pretty exciting for me. People jump into action as I am sent to get the rest of the vital signs :sigh: Take and record vital signs on 15 patients.

Fourth time around the floor, time to push meds. You have to check back to the vital signs frequently because you don't want to give digoxin to a person who has a heart rate of 60. Nor do you want to give a medicine for high blood pressure to a patient that has a B/P of 80/60 (lol that person's meds are working TOO well) You have to check meds three times each before you give them and you have to identify the patient two different ways.

Now when a patient is getting meds through a tube placed directly in their stomach, the RIGHT way to do it is to crush each pill (we are talking 5-10 pills here) into it's own little plastic envelope. You put a big syringe without it's plunger on the end of the tube that is implanted into the stomach, put a bit of water in the tube, then empty one of the little envelopes of pill into the tube, then more water and so on and so on. The really hard part about the process is that you only have two hands. The syringe needs to be held in one hand while you pour meds, then water with the other hand. The flaw in the system is that if you don't hang on to where the tube goes into the syringe somehow, then it breaks apart and you have water and meds all over the bed. If you stretch your right hand out really far and stick your tongue out and squint one eye, it sometimes works out ok. That was the "right" way. The way it's really done is that all of the meds are crushed into one envelope, dumped into some water, then poured down the tube, with more water poured in until the tube is clear. The problem that if this is done day after day, the tube will eventually clog up. It's a no-win situation.

Well after telling you about 1/3 of my day I find I am tired of typing and you are probably tired of reading, so how about we call it a day? LOL
 
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You did good, Barbie.
 
Did you go to Denton, or more north? Not much up there besides that...
 
I'll have more of these later

To: All Nursing Personnel From: Director of Nursing
Subject: Proper Narrative Descriptions

It has come to our attention from several emergency rooms that many nursing narratives have taken a decidedly creative direction lately. Effective immediately, all members are to refrain from using slang and abbreviations to describe patients, such as the following.

Cardiac patients should not be referred to as suffering from MUH (messed up heart), PBS (pretty bad shape), PCL (pre-code looking) or HIBGIA (had it before, got it again).

Stroke patients are NOT "Charlie Carrots." Nor are rescuers to use CCFCCP(Coo Coo for Cocoa Puffs) to describe their mental state.

Trauma patients are not CATS (cut all to shit), FDGB (fall down, go boom), TBC (total body crunch) or "hamburger helper." Similarly, descriptions of a car crash do not have to include phrases like "negative vehicle to vehicle interface" or "terminal deceleration syndrome."

HAZMAT teams are highly trained professionals, not "glow worms."

Persons with altered mental states as a result of drug use are not considered "pharmaceutically gifted."

Gunshot wounds to the head are not "trans-occipital implants."

The homeless are not "urban outdoorsmen," nor is endotracheal intubation referred to as a "PVC Challenge."

And finally, do not refer to recently deceased persons as being "paws up," ART (assuming room temperature), CC (Cancel Christmas), CTD (circling the drain), DRT (dead right there) or NLPR (no long playing records).
 
Ccfccp! Ccfccp!
 
Kinkkerbelle said:
To: All Nursing Personnel From: Director of Nursing
Subject: Proper Narrative Descriptions

It has come to our attention from several emergency rooms that many nursing narratives have taken a decidedly creative direction lately. Effective immediately, all members are to refrain from using slang and abbreviations to describe patients, such as the following.

Cardiac patients should not be referred to as suffering from MUH (messed up heart), PBS (pretty bad shape), PCL (pre-code looking) or HIBGIA (had it before, got it again).

Stroke patients are NOT "Charlie Carrots." Nor are rescuers to use CCFCCP(Coo Coo for Cocoa Puffs) to describe their mental state.

Trauma patients are not CATS (cut all to shit), FDGB (fall down, go boom), TBC (total body crunch) or "hamburger helper." Similarly, descriptions of a car crash do not have to include phrases like "negative vehicle to vehicle interface" or "terminal deceleration syndrome."

HAZMAT teams are highly trained professionals, not "glow worms."

Persons with altered mental states as a result of drug use are not considered "pharmaceutically gifted."

Gunshot wounds to the head are not "trans-occipital implants."

The homeless are not "urban outdoorsmen," nor is endotracheal intubation referred to as a "PVC Challenge."

And finally, do not refer to recently deceased persons as being "paws up," ART (assuming room temperature), CC (Cancel Christmas), CTD (circling the drain), DRT (dead right there) or NLPR (no long playing records).
Click to expand...
omfg can't stop laffin!

Note: Quote is ON TOP of comment! Eat yer hearts out!!! :D

All the best,
Fire
 
I'm ca-ca for coo coo puffs. Does that mean I've had a stroke?
 
This One Was a Doozy

Hi, sorry I haven't written in awhile, I've been pretty busy, and with spring break, I had nothing nursish to report. I'm taking a day off today, yesterday was something out of a horror film.

Kindred Hospital. I have been assigned to give meds to two patients, one of which has a hole in her stomach with a feeding tube that goes directly into the stomach.

I'm looking up each drug individually(about 25 total), and I have to know absolutely everything about each drug, it's classification, what it does, what side effects that sort of thing. I had many ACE inhibitors, calcium channel blockers and beta blockers, which can be really confusing. Then I am checking what nursing action is important BEFORE the drug is given, checking the labs (making sure that the guy getting potassium doesn't have a high level, stuff like that)

Enter my instructor asking me if I'm ready, I tell her I'm not quite ready yet, she looks at me and says that while I'm amazing at theory, my hands on clinical skills need work. Never one to mince words I tell her that her hurry-up, hovering, and very critical attitude makes me nervous. Yesterday she watched me do an in-and-out cath to empty a guys bladder, and she really stressed me out. To her credit, after that she became calmer when I had a procedure to do, (cleaning, packing and dressing a 5 inch long pressure sore on a guy's calf in which you could see the bone.) but that was later.

Right now I had meds to pass. We go to the feeding tube lady first. Then my teacher did something amazing (I was so shocked!) She taught me how to hang an IV piggyback, something we aren't supposed to learn until we are seniors. Yipeeeeeee.

Okay back to meds. First you check placement of the feeding tube by injecting 10 cc's of air while listening with a stethoscope for bubbling noises. Then you asiprate the stomach contents into your 50 cc syringe. If they have more that 50cc's in there, something is wrong.

I couldn't pull anything out of her stomach into the syringe, so I get a new syringe filled with water and try to flush the line. No go, her feeding tube is blocked. My instructor takes over forcing water into the line, then pulling it back out, in hopes of breaking up the clog. No go. We are at the end of what we can do with the patient now, because of increased risk of liability.

We find the patient's assigned RN, who now has a problem to deal with. I am by instructor to watch her try to unclog the feeding tube. I could tell the RN was frustrated and stressed and didn't want to be there. She starts doing what my instructor was doing, then she sent me to get a coke, which for some reason can unclog lines sort of like draino. We squirt some coke into the line, but there is still resistance in the line. So the RN, in a hurry, first "milks" the line, which is like massaging the length of the line. It doesn't work, so she begins something that the textbooks stay NEVER to do.

She begins "stripping" the line, which is holding the line taut and pinching it and then sliding the pinch all the way down the tube. After four or five tries, she does it too hard and she PULLS OUT THE WOMAN'S STOMACH TUBE.

Okay now the woman is squirting stomach contents (mostly water and coke) up into the air like a fountain, hitting me directly in the face. I was wearing glasses so none of it got in my eyes, thank god. Now that the lady is leaking everywhere, we have to do something quick, this has just become urgent, because the hole will begin to close immediately after the tube is removed. She will still have to have surgery to replace the tube, but we don't want it closing because that would make the surgery more complicated and cause the patient pain.

The nurse runs and grabs a foley catheter (which is a tube that sits in the bladder and drains urine) while I hold a towel over the hole. She inserts the foley cath into the woman's stomach and fills a little balloon at the end of it with water, so it stays in place. Then she goes to call the doctor and gets to tell him how she fucked up.

The ER provides me with a clean scrub top but I couldn't wait to go home and get a shower. Yeech!

After that I felt like a day off was due, and fuck them if they don't like it.
 
D: eeeeee
 
Kinkkerbelle said:
To: All Nursing Personnel From: Director of Nursing
Subject: Proper Narrative Descriptions

It has come to our attention from several emergency rooms that many nursing narratives have taken a decidedly creative direction lately. Effective immediately, all members are to refrain from using slang and abbreviations to describe patients, such as the following.

Cardiac patients should not be referred to as suffering from MUH (messed up heart), PBS (pretty bad shape), PCL (pre-code looking) or HIBGIA (had it before, got it again).

Stroke patients are NOT "Charlie Carrots." Nor are rescuers to use CCFCCP(Coo Coo for Cocoa Puffs) to describe their mental state.

Trauma patients are not CATS (cut all to shit), FDGB (fall down, go boom), TBC (total body crunch) or "hamburger helper." Similarly, descriptions of a car crash do not have to include phrases like "negative vehicle to vehicle interface" or "terminal deceleration syndrome."

HAZMAT teams are highly trained professionals, not "glow worms."

Persons with altered mental states as a result of drug use are not considered "pharmaceutically gifted."

Gunshot wounds to the head are not "trans-occipital implants."

The homeless are not "urban outdoorsmen," nor is endotracheal intubation referred to as a "PVC Challenge."

And finally, do not refer to recently deceased persons as being "paws up," ART (assuming room temperature), CC (Cancel Christmas), CTD (circling the drain), DRT (dead right there) or NLPR (no long playing records).
Click to expand...

Just wanted to say that made my day. I haven't laughed that hard in ages lol.
 
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