nurse at small

Hard to Say Goodbye

noreply@blogger.com (Betsy B.) — Sat, 12 Jul 2008 14:37:00 +0000

Every now and then a patient touches you so much that you are sad to see them go. Recently I was taking care of someone that was going through such hardship, as he had ALS. He was on the steady decline, yet always had a smile, always had a thank you. I was shocked at how well he and his supportive family were handling everything. Such life was there, such love and support.

I was sorry to see him go, even more sorry a special man like that has such limited time left on Earth.

Bon Voyage!

noreply@blogger.com (Betsy B.) — Thu, 10 Jan 2008 14:58:00 +0000

I am leaving for Zambia to complete my fellowship. I hope you will come over to the new site to check out what I'm up to as I'll be gone for the next 6 months.

Betsy In Zambia

Pain Management

noreply@blogger.com (Betsy B.) — Tue, 18 Dec 2007 15:56:00 +0000

I recently was not pleased with an encounter with a covering resident who was there for the night shift. I was just finishing my last 12-hour shift of 3 days in a row, and I had been fortunate enough to have the same patients for all 3 days. That is always very helpful for a nurse as you REALLY get to know the patients and can understand them better which leads to better treatment. You really understand when they are describing their pain, and you get a good grip on how to treat it.

At the end of my shift one of my patients informed me he was in a ton of pain. Now, he was receiving 4 mg of Dilaudid by mouth every 4 hours, and I had noticed that he was never drowsy, and would smile and get out of bed and walk around when pain was under control. However, he was also quite the stoic and wouldn't always tell you right away how much pain he was in. He most certainly had a high tolerance for both pain and the medication. I immediately paged the doctor on call to come check him out when his wife called me into the room because he was in too much pain. I walked in the room to see him breathing rapidly, tears in his eyes, and refusing to move from the chair he was in. (It had taken 3 days to get him to be comfortable showing me how he was feeling.) Something didn't seem right to me, and even if everything was okay I needed an order for some IV Dilaudid fast.

The doctor came up within 15 minutes (thank-you) but then argued with me over how much pain he was in. I had managed to get a verbal order for 1 mg of IV Dilaudid, but I wanted to give him 1 more mg as he was still very uncomfortable 15 minutes later. The doctor fought me tooth and nail. He said the patient was comfortable (even though 1 minute prior I had seen for myself he wasn't) and he wasn't going to write it, that he was fine. Instead he wanted to just give a new order of up to 6 mg by mouth.

I understand his concern of not wanting to over-medicate the patient, but I don't understand the need to make a patient in that shape wait another 30 minutes for pain relief when we have the means to stop it in 2. I also was furious over the doctor feeling like he knew the situation better than I did when he has known the patient for all of 3 minutes and I've been taking care of him for the past 3 days.

I wish he would have listened. I'm sorry the patient was in pain 25 minutes longer than he needed to be.

Why Would A Patient Lie?

noreply@blogger.com (Betsy B.) — Mon, 10 Dec 2007 17:46:00 +0000

Recently one of the nurses I work with caught her patient lying. It seemed so ridiculous as to why she would do it. It made no sense to her care, and she had no idea that we had caught her in her deceit.

Sometimes patients who are diabetics hate testing their blood sugars. I can't blame them as I don't think I would particularly enjoy it myself. But, to keep themselves healthy they are required to check it multiple times a day. When a patient is admitted to the hospital they put away their own testing equipment and the nurses will use the hospitals equipment to do it for them. Sometimes a patient will prefer their own equipment and to check it themselves, so we are happy to let the patients do that. The nurse will simply ask the patient to report their blood sugar at the appropriate times. Patients will often have better control of their blood sugars when managing it themselves in the hospital because they know what works for them.

For this patient we were sending off a chem panel everyday which included her glucose level. She didn't know that we were checking her glucose when we drew her blood every day as it was done in the laboratory. Well, after a couple of days it became clear that she was lying when reporting her blood sugars to us. The lab would show us a value >250, and she would say it was 90. No, it wasn't a glucometer problem, she was choosing to lie. When reporting her own numbers as normal she wasn't receiving the insulin that would correct the hyperglycemia.

I have no idea why a patient would want to lie about their blood sugar, especially since it can have immediate harmful effects and long term can do serious harm to the body.

Not A Pleasure Palace

noreply@blogger.com (Betsy B.) — Tue, 04 Dec 2007 03:04:00 +0000

On our unit we seem to see a lot of the same people over and over again as their illness is chronic. We have one patient that we don't always look forward to seeing, as he will often leave AMA, refuses to listen to doctors, and lastly has gotten more than a little fresh with the nurses. It has been a while since his last admission, but the stories still get told on a regular basis.

On his last admission he stipped down completely naked in the bed. When the nurse came in he asked her to perform oral sex in very crude language. Of course, the nurse wasn't going to put up with it and immediately went and got the resident. After a chat with the resident the patient seemed to shape up for a bit. What is funny about this whole story is that when talking to the patient the resident was overheard to say, "Sir, this isn't a pleasure palace. This is a hospital."

Pants?

noreply@blogger.com (Betsy B.) — Fri, 30 Nov 2007 13:38:00 +0000

Overheard on the unit:

The nurse says to patient walking around on the unit "Darling, are you a little cold? Because you forgot to put on your pants."

noreply@blogger.com (Betsy B.) — Tue, 27 Nov 2007 22:02:00 +0000

One of my patients recently told me how their aunt is blind, and her aunt's husband has Alzheimer's. They are totally dependent upon each other and times are starting to get tough due to his slow decline. He is the only one who can drive, and twice during the past 6 months he has been found by the police in his car with his wife--totally lost. He'll be driving down the same roads he has for the past 50 years and will suddenly forget how to get somewhere. The problem with this is that he refuses to admit he's lost, and since his wife is blind she can't help them out.

It's a terrible situation. The family is wrestling with the idea of taking the car and license away from him for the safety of them both. But by doing that they will be taking away their ability to leave their house independently.

It is a tough decision to decide when is time to intervene.

Travel Clinic

noreply@blogger.com (Betsy B.) — Wed, 21 Nov 2007 16:21:00 +0000

I just went to the travel clinic to prepare myself for the upcoming departure, and I must say I was very impressed. They had charts, maps, books, etc. on what I should take with me in order to prepare for this trip. I left with shots, the promise for more shots, and appropriate prescriptions to take along with me.

I know a lot of people go traveling, and I hope people are aware that such clinics exist to prepare and protect you for healthy travel.

One Laptop Per Child

noreply@blogger.com (Betsy B.) — Wed, 14 Nov 2007 02:47:00 +0000

For those who haven't heard about the quest some brilliant people at MIT are on to make a $100 laptop this is a site worth checking out: One Laptop Per Child

They are trying to insure that every school aged child in the world has their very own laptop. Imagine the educational offerings! Imagine the instant messaging.

Right now they are having a promotion where you and I are able to purchase one of these laptops. The cost is twice as much, and for your extra money you actually purchase another laptop that will be given away to a child in a developing nation. It's a win-win situation. The organization gets more exposure and gets to donate more laptops, and the purchaser/donor gets the latest tech gadget.

Vacuum Assisted Closure of Primary Wounds

noreply@blogger.com (Betsy B.) — Wed, 14 Nov 2007 02:28:00 +0000

We had an inservice today about vac dressings. For those not in the know it's a great way to cut healing time. Studies have shown that it can cut healing time by a third. It also lets people have less frequent dressing changes, which reduces the pain and discomfort patients often feel with the standard twice daily wet to dry dressing.

Often times these vacs are only used on wounds that have failed to close primarily. An example would be a surgical incision that has become infected and needs to be re-opened to allow to close secondarily.

I was surprised to hear today that there is talk about using vacuum assisted closure on primary closures from the beginning--before they become infected. This would be done by placing the vac right over the suture line.

I tried to do a quick google search to see what I could find about this with no luck. Does anybody have experience with it?

Sick Calls

noreply@blogger.com (Betsy B.) — Fri, 09 Nov 2007 14:34:00 +0000

Sick calls can be a killer on a unit.

I work in the kind of environment that is greatly affected by somebody being absent in the immediate time frame. If somebody isn't there when scheduled, it means that those who are there need to take on extra patients and responsibilities. If there is more than one sick call it can lead to the need to close beds on the unit as we don't have the nursing staff to take care of them, which will then affect the whole hospital and most importantly the OR and ED. One of the worst days I've had at work was when we had sick calls. I was in charge, and I had to tell admitting and the OR we didn't have the beds they desperately needed. This prompted one phone call from an occupied OR, "You mean to tell me that you honestly don't have a bed available? I have the patient on the table prepped and shaved! What am I supposed to do now! Send him home?" I told them I had no idea what to do. All I could tell them was that there was no room at the inn.

So how do you manage sick calls? People become ill, it's part of nature. How do you tell people that being ill too often is unacceptable? It's a tricky situation as people can't manage when their body becomes ill. But what do you do about the people who take advantage of calling in sick when they aren't? Or when they just don't want to put in the effort of finding alternate child care when the regular sitter falls through? Suggest using Parents In A Pinch for emergency childcare. Put out unit expectations for sick calls.

There has been some complaints about sick calls on my unit, and it has recently prompted a posting of unit expectations on sick calls with actual numbers as to how many times in a time period it is allowed. Now, they are not saying come to work when sick. They are just saying they are going to talk to you if it is looking suspicious or if you are excessively calling out. We'll see if it helps.

Map Of Doctors Of The World

noreply@blogger.com (Betsy B.) — Sat, 03 Nov 2007 01:39:00 +0000

I thought I'd share this interesting map of the world that shows the number of inhabitants per doctor. I wonder what the number is for the city of Boston.

http://thewvsr.com/doctors.htm

Blood Group O and Malaria

noreply@blogger.com (Betsy B.) — Sat, 03 Nov 2007 01:26:00 +0000

I'm starting to get prepared for my upcoming trip to Africa, and I must say I found this article quite interesting, especially since I fear Malaria and I have group O blood.

That leads me to pass on that my fellowship placement is finally all set! I'll be leaving for Zambia in January to spend 6 months there working on the Maternal Child Health Initiative being sponsored by the Massachusetts General Hospital Center for Global Health.

I will continue to keep posting on this blog about my experiences. I hope you will enjoy being an observer to my great adventure, and maybe even learn a thing or two.

Wish me luck!

Prisoner

noreply@blogger.com (Betsy B.) — Thu, 01 Nov 2007 13:12:00 +0000

I took care of a prisoner. It was strange closing the door on the room expecting complete privacy for the patient so you could care for her, but uncomfortable that this time two guards were watching your every move and not allowing any privacy. It was awkward waiting for the handcuffs to be removed and replaced anytime you wanted to help her walk or go to the bathroom. I couldn't help but feel she was a nice person, or at least polite and cooperative with me, even though she was a criminal that had landed herself in jail. I felt stupid when the guards stopped me from handing her the phone as her husband had called; I didn't realize that even the right to talk to loved ones was taken away in some respect.

I hope she felt that I cared for her as a human being who needed my aid, and not as a criminal.

Embarrassing Dressing

noreply@blogger.com (Betsy B.) — Mon, 29 Oct 2007 00:42:00 +0000

A couple of months ago I cut my leg open on some broken glass while taking the trash out to the curb. It was completely my own fault as I knew there was broken glass in the trash, and even though I was very careful I managed to fillet my leg open about 3 inches.

I quickly washed it out, called for a ride to the hospital, and while I waited I went through whatever dressing supplies I had to quickly cover it up. It was in an awkward place on my leg so I only could use one hand to do the dressing. It wasn't exactly a professional looking job, but hey, it was covered.

I got to the ER and who else is going to put in my stitches? My past nursing instructor of course! In typical instructor fashion, she took one look at me and said, "Did YOU do that dressing?" As I tried to explain she cut me off by saying "That is terrible! You call that a dressing?" Of course she couldn't hide the smirk on her face and I couldn't stop laughing.

Note to self: Always keep real dressing supplies on hand for emergencies.

Singing Sensation

noreply@blogger.com (Betsy B.) — Fri, 26 Oct 2007 14:15:00 +0000

Yesterday I was doing a procedure on a patient, and their husband was at the bedside with them. They had been married for almost twice as long as I've been alive, and I always love asking how these love affairs began. I love to see people look at each other as that twinkle comes back into their eyes while they remember and wonder how much of the story to tell.

This couple met in college, she was in a singing group that used to practice at one of the other member's house, and he was the brother of that other member and would turn the pages for them.

I took this as an opportunity to ask them if I could hear them sing, and I was delighted as the two of them broke out into a duet. Definitely something you don't hear often on our unit!

Friends

noreply@blogger.com (Betsy B.) — Tue, 23 Oct 2007 14:41:00 +0000

One of my patients today was GREATLY cheered up when his friends came by to visit. Family just hasn't been doing the trick, it took his 3 golfing buddies to travel more than an hour to make him smile and act like the man I'm sure he was before his illness.

I hope people reading this take time to visit friends in the hospital, not just family members. It's friends who often become our new family, as they are the family you get to choose. Don't forget them.

Touched

noreply@blogger.com (Betsy B.) — Sat, 13 Oct 2007 01:26:00 +0000

Recently I took care of a women who was faced with the recurrence of an illness she thought she had beat 14 years ago. It was an incredibly emotional time for her as she had several recent admissions leading up to the big problem. I knew she was a bit depressed and emotional. When working with her I decided I'd take the approach to treat her like a person and not somebody who was ill. She didn't seem like she wanted any more reminders about her current situation and she clearly was spending a lot of time with her thoughts about her future. I thought if I could gain her trust I might be able to help her open up a bit and get some of the emotions out on to the table.

Truthfully, I didn't spend a lot of time with the patient. I left her alone, tried to help her keep her dignity, and was there if she needed anything. That was it.

On day 2 of my care some med students needed a patient to interview so I recommended her. It worked out well for both parties as the students got to see a patient in this situation and what they were dealing with mentally and emotionally, and the patient got a chance to tell her story again in a thorough and complete manner. The results were better than I had hoped. She opened up to the point of tears and sobbing while telling her story for their H&P. It was a magical teaching moment for the med students, and it was a positive experience for the patient as she got the chance to let out and explore some emotions she was trying to deal with.

The surprising part was how the patient repeatedly told the students how pleased she was with my care. I was very flattered by this as I wasn't sure if my plan was working as she had yet to ask me about the questions I knew were on her mind.

After the students left I gave her a few minutes to recover, then I went in her room. I was met with a fresh wave of tears and a thankful hug. She told me she didn't realize she had so much pent up inside her and how it felt good not to run away from her negative thoughts. Finally, the difficult questions came out and off I went to print out information for her.

I hope she knows that she touched my life as much as I did her.

Love Marks?

noreply@blogger.com (Betsy B.) — Mon, 08 Oct 2007 23:11:00 +0000

Today I was assisting another nurse in settling her patient. I was unbuttoning the top of his johnny when I see his chest is rather scratched up, of course my mind immediately goes to the dark side as he looked like he and his Harley had rode many miles together. The patient catches my eye then decides to speak up.

Patient: "Those scratches aren't love marks. I had to give my cat a bath and he didn't like it too much."

Me: "I take it he won? Why a bath anyway?"

Patient: "He got fleas! He is a tiger kitty and he licked off all his stripes because of the fleas!! We had to bathe him, and my wife is really upset over the whole thing."

Poor thing!! That will teach me for making assumptions about one's private life.

How Many People In The Hospital Are Alcoholics?

noreply@blogger.com (Betsy B.) — Fri, 28 Sep 2007 02:14:00 +0000

That is a question I can't answer.

I can tell you that in the past two weeks I've had two patients who came in for scheduled surgery who were heavy drinkers. Both had 3-4 drinks a day, but only one suffered from DT's.

Let's see what the internet can show us.

While doing a very brief and limited search to find out if there are any studies leading me to the stats I came across this article: "Alcoholics Risk Infection After Heart Surgery" and in it states that 20-30% of people in the hospital are alcoholics. It's interesting to note that the highest prevalence is detected in the third to fifth decade of life, and also that the risk of surgical complications due to alcohol increase with simply 60 grams of alcohol a day (3 glasses of beer or wine.)

This is also an interesting abstract on, "The Alcohol Patient and Surgery." Wow. I wonder how much money they are talking about when they say the economic implications are tremendous.

Poor Hand-Off

noreply@blogger.com (Betsy B.) — Tue, 25 Sep 2007 14:11:00 +0000

I was not pleased a couple days ago when I had to transfer a patient to another floor. They had been with us for about 15 minutes when the patient informed us that they had tested positive for MRSA within the past few weeks in the doctor's office. This was not good as the patient was in a semi-private room and the roommate was free of all bugs. I had to get the patient with MRSA out of there and into a private room. After looking at the bed situation we had no private rooms available, and there were no possible bed moves to be made to alleviate the situation. So, I called admitting to see if we could find this patient a different floor to move to. We knew we'd be getting the patient post-op, but at least this would buy us another day to move some people around and hopefully have a bed available.

About 2 hours later I finally am able to make the transfer. As I'm giving report to the other nurse it's clear that they are less than thrilled about having to take this patient, and they immediately put me on edge with this comment: "He probably knows what to say to get a private room without having to pay for it." Excuse me? Does this other nurse seriously think that a patient with underlying dementia (yes, I already told her that in report) is with it enough to come up with an elaborate scheme to get a private room? The next question she posed after I explained in the kindest way possible why he was indeed MRSA positive was, "Don't you guys have any private rooms?"

At that point I wanted to go up there and speak to this nurses face-to-face. Does she really believe that I'm that stupid to have not put him in a private room or do bed changes if it was an option? I was completely taken aback and actually had to pause to put together my response. It was incredibly difficult for me to keep my composure and not respond the way I really wanted to her patronizing questions. But I did because it is important not to take things personally. This nurse was just upset that she had to take another patient and was dealing with it in her own way.

noreply@blogger.com (Betsy B.) — Tue, 25 Sep 2007 14:06:00 +0000

As charge nurse one day a mother of a patient comes out to see me, visibly upset. I ask what is wrong and what I can do to help. She informs me that her daughter is very upset as to who her nurse will be (just changed shift) for the rest of the day and wanted somebody else to have her. I immediately said I would be happy to have her as my patient and we talked further about the situation and why they didn't want the nurse originally assigned.

Not a huge deal, sometimes there are just personality conflicts or it is not a good fit. I am reminded of my days waiting tables when sometimes no matter what you did the table would not like you and you weren't going to be making any money. As waitstaff if you were in one of those situations it was always wisest to let your manager know and potentially switch waiters. But what do you do with nurses and suddenly you are the "manager"?

How do you tell another nurse that their compassionate care they gave a patient the day before was viewed as inadequate by the patient? How do you tell them that the patient wants somebody else?

Alcohol Dependence

noreply@blogger.com (Betsy B.) — Wed, 19 Sep 2007 21:20:00 +0000

My patient looked at me one morning with a questioning look in her eye and wanted to talk about what had happened during her hospitalization. I was wondering how much she really wanted to hear, so I started slowly to gauge her reactions and tread very carefully with my terminology. I avoided the term alcoholic and instead used alcohol dependence. It just has a nicer, less-pointing-finger sound do it.

She was shocked to hear that the amount of alcohol she drank each day (3-4 glasses of wine) had an effect on her that caused her to go into DT's (Delirium Tremens) after surgery when her body wasn't getting the alcohol it was used to and needed. I then went on to explain how it could be dangerous and how we treat it with a drug called Ativan. She was shocked to hear that so much had gone on as she doesn't remember much about her time in the ICU. What she does remember she described it like being part of the movie "Invasion of the Body Snatchers."

At this point it is always so tricky, because you know they are a serious alcoholic, and that they have not a clue as to how much they are hurting themselves. It's a difficult conversation to have as you want to keep them from becoming defensive but you want to be honest with them. I was more than caught off guard when the patient told me that she never wanted to go through anything like that again. I took it as a chance to tell her that the withdrawal period was awful and that we had helped her get through it. Now came the time when she had to decide how she was going to live her life once she got home.

I started on the route of the drinking in moderation talk, the one where you let them know that they have to cut down or stop without going anywhere near those judging statements. In the end it was her who called me out and said, "Wouldn't it be better if I just stopped altogether?" I was blown away. I immediately offered to get her information, and when her husband came in I explained to him all that we had just discussed. It was the closest thing to an intervention that I have ever been involved with, and I with her the best of luck in her new sobriety.

Voyeuristic Site

noreply@blogger.com (Betsy B.) — Wed, 19 Sep 2007 21:01:00 +0000

I'm not sure if anybody is aware of this, but blogger has a site that simply shows photos that are being uploaded to their public blogs in real time. Very interesting, always something different, great distraction.

http://play.blogger.com/

Can You Wait A Second?

noreply@blogger.com (Betsy B.) — Tue, 18 Sep 2007 03:14:00 +0000

This is an oh-so-common happening. I want to preface by saying that in the following I will not at all exaggerate the timing of the events. In true scientific nature I will report clean, unadulterated data.

I answered a call light today, and the patient was rather gruff sounding and needed her nurse "Urgently to get back in bed." Now, it's rather common for patients to be in a chair expanding their lungs for 2 minutes and requesting to get back in bed (and just asking for a nasty bout of pneumonia) so we learn to check with the nurse who has the patient about the situation before putting a patient back into bed for them. I hang the call light up, and immediately seek out the nurse who is taking care of the patient. Less than a minute later and I've found her and am describing what just happened and asked her what she'd like me to do. The nurse then partially smiled and told me about the patient's anxiety, and that she hasn't been up long and needed to stay longer. So, about another minute later (less than 2 minutes total from hanging up the call light) I was on the way to the patients room--which was conveniently next to the nurse's station.

I'm about 5 steps from the doorway to the room, I can see the patient at this time, and I watch her push her call button again and re-demand to see her nurse. Talk about a little trigger happy! I did as any good nurse would do, explained the reasoning for her to be in the chair and got her to agree to stay in it for "A bit longer" (always being vague in exactly how long that will be.)

As I walked away after the intervention I hear her AGAIN push the call button.

And patients wonder why we sometimes don't answer call lights. It's because we can't get to them thanks to all the other patients who have anxiety and cry wolf!!