Last night I took care of a man having the DT’s, a.k.a alcohol withdrawal. Why don’t  we just give these people a six pack of Bud, instead of pumping them full of Ativan every 15 minutes? I mean, seriously.  I’ll even drive to the packy.

Anyway, this guy is all over the bed, up on all fours, johnny WIDE-OPEN, when I see that one of the cardiac monitoring leads is stuck to the back of his scrotum! Yet the monitor showed a perfect sinus rhythm! It struck me so funny that I had to point this out to my fellow nursing professionals, who pointed and giggled, and called over more people who in turn pointed and giggled. Since we had such a good cardiac tracing, the question remained…leave the monitor attached to the family jewels or not? I wasn’t sure, since this question really doesn’t come up all that often. Well, I decided that leaving the monitor on his balls, while great fun for us nurses, probably broke some sort of ethical or professional code of conduct, so reluctantly, I started to remove the EKG lead, only now it’s stuck in the hairs around his scrotum.. He yells, “HEY! Get out of there or I’m calling your mother!”

Nursing. You just can’t make this stuff up.

Sometimes it’s hard to find amusing things to write about when you are tired and feeling so burnt from work that you can almost see the smoke. So this post won’t try to make you laugh. It will, however, try to put out the fire of burn-out that hits us all once in awhile, no matter how upbeat we may try to stay.

My ICU has been unusually busy and completely filled at all times for months now. Admitting  a patient and transferring them out 6 hours later, to receive yet another admit who is sicker than the first patient, is becoming more and more frequent. So we are all feeling the pressure and the pace, and anything that exacerbates the stress is something we try like hell to fix.

For me, it’s patient agitation. Pulling on restraints, trying to reach the ETT, and  triggering vent alarms all over the place makes me agitated. Sure, we have our propofol and Versed and fentanyl and Ativan, but it doesn’t always work when you are trying to walk the line between undersedation and oversedation, a decent BP versus one that’s in the toilet.

For the past 2 nights, I have taken care of a respiratory failure/pneumonia patient, who is elderly and has some degree of dementia. She’s been lightly sedated with a Versed drip, but has frequent breakthrough agitation, where she gets very close to extubating herself.  Now, most vented patients are scared in my opinion, but I kept getting a very strong feeling that this little lady was way beyond scared. She would refuse to open her eyes, although she was able to. PERRL @ 3mm, followed simple commands at times. She would calm somewhat with reassurance and holding her hand, but she wouldn’t open her eyes, keeping them tightly shut.  Having no other way to make contact with her other than verbal and physical reassurance, I decided she and I had to make some sort of eye contact.  I leaned over the bed and opened her eyelids, and looking into her eyes, said, “Hi there….I’m Kelley, and I’m your nurse tonight.” She kept the eye contact and stopped flailing. She tracked me with her eyes, with me still holding them open. “Do you know that you are in the hospital?” She shook her head “no”. I explained the tubes and the vent and the wrist restraints, and she would nod yes or no as I asked her questions. No, she was not in pain, and yes, she was warm enough.  I let go of her lids and asked her to open them for me, and she peered out through slightly opened eyelids. I thought to myself that this was a lady who is so afraid of what’s happening that she’d rather just shut out any visual input, and slam those eyelids closed and thrash around. And I had been considering increasing the Versed before this, truth be told. (Remember what I said about agitated patients…an agitated patient frequently equals an agitated ME!) But she was better after that–she would still thrash at times, but now she would calm down a lot quicker just with verbal reassurances. I still pulled back her lids at times to talk to her, because I need to make that kind of contact just as much as she needs to receive it. I don’t tell you all this so you think, “Wow, what a sensitive nurse! Bully for her!”  It just made me feel I had done something for this lady that she really needed. Fess up, people, we all need our warm fuzzies from time to time.  We couldn’t continue this kind of work if we didn’t get them–at least I couldn’t.

So to all my vented patients…I do know you’re in there. Next time you are trying to pull out your ETT, don’t be surprised if I peek in just to say hi.

Well, I see I haven’t blogged anything since, ummmmm…last June! Well, if you read my last entry, you know that I decided to keep on keepin’ on in the ICU/CCU, on nights, so since June, I’ve either been working or sleeping. But I’m awake now, so I thought I’d post about my shift last night.

Apparently I haven’t been sleeping quite enough, or I’d at least to be able to remember my patient’s names…if I could have done that last night, I’m sure everything would have gone much more smoothly. My poor patients! I had a head-injured patient S/P crani/evacuation of both subdural and epidural hematomas, and a newly vented septic lady, sedated/restrained, pressors, etc. Now, in report, I know that their names are Frank and Edith, respectively. Once out of report, my brain decides that Frank’s name is Bob, and Edith’s name is Mary, and I didn’t realize I had their names wrong til 0730 report. Yes, all night long, I had agitated patients who previously had been calm and quiet! Poor “Mary” is mouthing words to me that I can’t make out because of the ET tube, probably something like–”You MORON!!!! My name is Edith, and I want a new nurse!! How do I know you aren’t going to send me to OR and amputate my legs???????” And I’m oblivious to my patient’s distress, assuming she is just bucking the vent and needs more Versed. Which I gave her. Boatloads. All night long, “Mary, Mary, RELAX!” And she’s tied down to a ventilator, thinking, “You know, I knew this wasn’t gonna be a good day…”

My head-injured patient doesn’t answer or look at me when I call him. “Bob! Can you hear me?” I lean into his face, and call him again. He looks at me suspiciously, and I know now that he was thinking, “You MORON!!! My name is Frank, or at least I think it was before I fell out that window onto my head.” Now he starts getting restless, knowing he is at the mercy of a moron, and I’m thinking, “Hmmm, in report, he’s been fine…maybe we better get a stat head CT!!!” Frequent pupil checks from me, always prefaced by, “BOB, I’m going to shine a bright light in your eyes!” And he was probably thinking of where he thought I could shine that bright light, right up my heinie.

Well, the day nurse is taking care of them now. I hope she remembers their names. It will save her 8 hours of aggravation on everybody’s part, and a whole lot of Versed.

People, know your patients! Take it from a moron who’s been there.

I had my chance to escape. I didn’t take it. So, am I crazy or what?

I just turned down a 3-11 job on the psych unit, in favor of staying in the ICU/CCU on nights, where I have worked, er, labored, for the past 7 years.  Yes, folks, I turned down Yahtzee in the dayroom in favor of fecal bags. Now I am positive that I am out of my mind! 

“Save yourself!”, came the battle cry of my co-workers. “Cut me some slack!”, said my lower back. Did I listen? No. Why?

I don’t have a jolly clue.

Maybe I just like poop.