Confessions of a registered nurse (Confessions of a student nurse): RN stories

The power of gas

Fri, 30 May 2008 16:07:10 GMT

After certain abdominal surgeries, passing gas can help relieve pain. I learned yesterday that farting is such a powerful healing tool that even fake farts can make someone feel better. My patient was a grade-school aged boy recovering from a painful operation to his leg. He paged me to his room for pain medicine and as soon as I began examining his IV, he let out an extremely large fart. I looked at his face and could tell he was trying not to laugh, so I smiled and said, "Feel better now?" Both he and his sister burst out laughing. This laughter led to several more drawn-out farts, and it did not take me long to realize that there was a fart machine involved. "Where is it?" I asked with a smile. He pulled out from under his sheet a little remote-operated machine. Wow, the whoopee cushion has gone high tech! His doctor had ordered that he get up and out of bed several times each shift, but he had not been willing to walk around yet. Applying my hard-learned critical thinking skills from that awful experience I call nursing school, I said, "Want to have some fun with that?" His whole face lit up and he shouted, "Sure!" I grabbed his crutches and handed them to him. I gave his sister the fart machine and I took the remote. "Let's go for a walk by the nursing station," I casually said. His mom laughed and his dad hid his face in his hands. Peter* slowly climbed out of bed and our journey began. At first he was slowly navigating down the hall. When he passed the extremely busy nursing station, I pushed the button on my remote. A loud but quick farting noise was immediately heard, and Peter hunched over forward and put his hand on his stomach. A few nurses and doctors paused and looked up, but no one said anything. As he stood there, I pushed the button again. This time the machine picked a long, diarrhea-sounding noise. Peter took off on his crutches moving down the hall. The nurses all looked around at each other, and my coworker Donna said to him, "Are you ok?!" He replied, "Yea, I *INSERT LOUD FARTING NOISE*, uh..." His sister was laughing so hard she was almost crying. Donna was obviously trying to stay composed, but after another push of the button, she could not control herself. As she started laughing, so did Peter, followed by most people at the nursing station. "I think I should go back to my room," Peter said, and as he began going back down the hallway, I accompanied him with the appropriate sound effects. When he finally returned to his room and was filling his parents in on his performance, he could not stop smiling. "How's your leg feeling," I asked, expecting it to be pretty sore after walking around. "Oh, it's great!" he answered, surprised. Two hours (and numerous times retelling his story) later, he still was not having any pain.

Triage notes

Fri, 01 Jun 2007 10:56:54 GMT

Before entering my new patient’s room, I read his triage notes. “Diarrhea at 0300. Mucous membranes moist, patient playful, drinking Gatorade at triage. No fevers, no signs of distress.” I looked at my watch and noted that he had only had diarrhea for a few hours. This should be an easy patient, which was exactly what I needed at the end of this long shift. I walked into the room and introduced myself to the family. The boy was around two years old and was sitting on the examination table. He looked calm, but was working hard to breathe. This was not consistent with diarrhea for a few hours. The parents were Spanish-speaking only, so maybe there was a miscommunication at triage? I began examining the boy. Everything seemed fine- his breath sounds were clear, no fever, and he appeared well-hydrated. I bent down close to him to lift up his shirt to see if he was retracting (using extra muscles to breathe). That’s when it happened. “GRRRRRRRRRRRRR!!!!!!” he screamed, raising his hands up in a claw-like fashion while making a scary face. Startled, I jumped back, now fully awake. “GRRRRRRR!!” I growled back, tickling him. The triage nurse forgot to note that my patient was a little dinosaur. After he stopped giggling and doing his dinosaur breathing, he looked like a healthy little boy. Not wanting to spoil the doctor’s fun, I forgot to mention the patient’s reptile-status when she asked about him before entering the room. A few minutes later I heard another “GRRRRRRRRR!” followed by the doctor’s laughter and, “Would you please grab this dragon a popsicle?”

Is he or is he not...

Wed, 07 Mar 2007 22:18:59 GMT

The day began like a normal morning in our busy ER. I had Ben, a student nurse, working with me, and we were taking care of two patients having difficulty breathing. While we were examining one of our patients, I noticed I was getting an ambulance patient in my open room. I debated whether we should finish the exam or go right away, and decided to go check out the new kid then return to finish our exam. “Adolescent male, postictal after his fifth seizure today,” the EMS woman told me. I watched as they transferred the boy from the stretcher to the bed. He didn’t react at all. Most kids at least appear startled during the transfer. Ben and I walked over to the patient. His skin was pink but he wasn’t reacting to us or responding to painful stimuli. We placed him on monitors and they immediately started alarming. His oxygen saturation was 81%. “Is he breathing!?” I shouted. EMS quickly answered, “Don’t worry, he’s just postictal.” Ben and I stood there examining him, and Ben was the first to speak. “I really don’t think he’s breathing.” I agreed, and had the tech overhead page for help while we started grabbing the airway equipment. Within seconds we had a respiratory therapist, pharmacist, and two attending doctors at the bedside. They started shouting out what felt like hundreds of orders while the respiratory therapist was bagging the patient. Within minutes we had the patient in the critical care room for intubation. As I was giving report to the critical care nurse, I saw Ben peeking in from the hallway. I motioned for him to come stand with me. I was expecting him to be reluctant to enter the room- it’s an intimidating place with all the doctors and machines, but Ben was at my side immediately. An ER nurse is born, I thought to myself. We went back to our assignment and began deciphering my notes so we could chart on the insanity that had just occurred. While we were standing there, Ben said, “That was so cool! I definitely want to be an ER nurse!” I was still shaking slightly and had been fighting the urge to vomit. I think I prefer my patients when they are breathing!

Deep breath and.....

Fri, 09 Feb 2007 05:19:22 GMT

Ok. Blood culture, urine culture, lytes, CBC, rapid RSV for room 3. Has the baby in 2 peed yet? I still need to do his urine dip, and why won't his line flush? He still needs his Rocephin, has it been thirty minutes yet? I'll call the pharmacist again after I take care of 3. The doctor is in room 1, so hopefully I have a few minutes before I have orders. But that baby is really retracting and her oxygen sats are 94%, so I should take care of her before I worry about the baby in 2. Crap. Why is the mother for 3 standing in the hall waving me over? Ok, blood culture, urine culture, lytes, blanket, Gatorade, CBC, rapid RSV for 3. I'll get my supplies together, what size IV should I use? 24 gage will probably work. Is the doctor writing orders on 1 now? Deep suctioning, rapid RSV for 1. But I still haven't even started the workup on 3. Whose alarm is beeping? 1's sats are now 92%, I'm not comfortable with that. Why aren't there any neonatal nasal cannulas in this room? I'll get the bag and mask ready just in case. Are her lips blue? No, just my panicked imagination. 86%, is this machine reading right? I’ll wake her up and see if that helps. I wish I could find a tech to help with the workup in 3, I should be done with that by now. Is there something in my shoe? I keep feeling a sharp stabbing pain in my foot. But I can’t sit down yet. I have to take care of this baby now. It’s been fifty minutes since 2’s vital signs. I’ll be with 1 and 3 for at least twenty minutes, so I have to get 2’s vitals first, but he’s stable, should I just wait for his Rocephin and be late on his vitals? Oh yeah, I still have to call the pharmacist.....

This is what my brain goes through in just a few minutes at work. Winter in a pediatric ER is like this nonstop. By the time I get home, I don’t want to think about patients or hospitals or anything work-related. Unfortunately, as soon as I fall asleep, I am suddenly overwhelmed with patients again. I wake up panicked because I’m late on vitals and giving meds. I remind myself that I am not at work for another four hours, then close my eyes and return to my demanding patients yet again. When my alarm goes off around 5, my brain feels ready for a break, not to begin another twelve hour shift. Am I overwhelmed? All the time. Am I on the verge of a breakdown? That’s a possibility. Do I love what I do? Absolutely.

ER life

Tue, 09 Jan 2007 19:46:07 GMT

I am no longer an ER intern. I am now an ER nurse. Saying these words is exciting, yet terrifying at the same time. My first day on my own started off nicely, with most of my patients only having minor problems. I began building up my confidence- I can handle this whole nursing thing! Then a patient with DKA (diabetic ketoacidosis) was brought to my room. I dread DKA patients more than I dread any other type of patient. They require a large amount of work and monitoring from the moment they enter the room until they finally can go up to the floor. I am not sure why the charge nurse gave me this child my first day on my own, but it probably was not the wisest decision. The girl’s blood glucose was above 700 (should be around 100) and her blood pH was 7.14 (her blood was acidic). She was slurring her words, which is never a good sign. DKA puts patients at risk for cerebral edema (brain swelling), which can cause death. I took a deep breath and started working. I had a little cheat sheet I made for myself on how to handle DKA patients- what labs to draw, how to calculate the fluids, etc. I knew I needed two large IV’s, so I overhead paged my tech. No response. I overhead paged any available tech. No one was available. Crap. I tried twice to get an IV on her, but was unsuccessful. Not off to a good start! I finally got a small IV in and was able to get her blood sent to the lab. By the time I got everything organized, it was time to draw more labs. The IV would not draw back blood, a new resident had picked up her chart and was standing there reading through the protocol to see what to do next, and the mother kept demanding that we give her a meal ticket for the cafeteria. Didn't she realize how sick her daughter was? I felt like the room was spinning and that I was going to hyperventilate. I still had two other patients! Right when I was about to lose it, the resident figured out what needed to be done, my tech arrived and was able to start an IV, and the pharmacist helped me hang all the necessary fluids and insulin. Another nurse agreed to check in on my other two patients, and even helped me get that first IV to work again. As I was charting everything going on in the room, it hit me. I am nowhere near being alone! The night nurse arrived and although it took half an hour to give report and try to explain everything that had gone on, I couldn’t help but smile as I walked back to my car. I had made it through my first day “on my own.”

Gifts in the ER

Tue, 19 Dec 2006 17:07:24 GMT

Some days the ER gets hit with the "breathers"- the kids having asthma attacks. While the rest of Dallas is enjoying the sudden change from cold to beautiful weather, we are suffering from all of the asthma attacks it caused. Last week, we had so many breathers that they started changing regular rooms into asthma rooms- several "breathers" in a room where you normally only have one patient. My room was given this "honor" and I got hit hard- a two month old breathing 90 breaths a minute (try to breathe that fast for just one minute) and a toddler having an asthma attack. Just keeping up with the back-to-back albuterol treatments and epi treatments was keeping me busy. Then I saw the dreaded EMS guy strolling down my hallway. "Don't go in my room. Don't go in my room. Crap. He just went in my room." I peeked in the room and saw a cute little girl, smiling and calm. Probably an appendicitis transfer from another hospital, I thought. I told the EMS guy I had a sick kid to take care of and I'd be back as soon as I could. His expression let me know he didn't like that, but I really didn't have a choice. A few minutes later I went back to see what was going on with my new transfer. I walked in the room and the EMS guy handed me a small cup with blue water in it. Uh oh. Is this a urine sample? Is this an ingestion case? Why is her urine blue? I held the cup up and was examining it when part of a finger floated by. It caught me off guard and I got that all-too-familiar-now feeling in my stomach. After winning the battle with the contents of my stomach, I handed the cup back to the guy and said, "Door hinge?" The mother replied with a surprised, "yes" and I quickly resumed my job of taking care of my patient.
Lesson of the day: Never accept a "gift" in the ER from an EMS you made wait.

I'll be ok.... maybe

Mon, 11 Dec 2006 04:17:11 GMT

"Possible seizure at school," the EMS said to me as he wheeled his patient into my room. The patient had never been diagnosed with seizures, but this was his fifth similar episode. At school, the boy suddenly became quiet and sat there, staring straight ahead. He would not speak to anyone or move, even when directed to do so. An altered level of consciousness like this could signal many scary situations- seizures, brain tumor, blood sugar problems, drug toxicity, etc. What was wrong with my patient? The resident ordered all of the appropriate and expensive tests, and the neurologist was at the patient's bedside quickly. She was not sure what the problem was, but planned on admitting the patient after the MRI was complete. The boy's mother was begging him to respond to her, but he sat there quietly. When I was in the room doing an assessment and checking his pupils, I noticed that he had tears in his eyes and that his lower lip was quivering. I asked his mother if I could speak with her son for a minute, and brought her to a chair outside the room. I sat down next to him and said, "When I was in school, the kids made fun of me because I was so short. I came home in tears all of the time. I hated going to school." This made him start to sob. "The kids all say my mom is crazy," he replied to me. "That must really hurt," I said. This made him cry harder, which made me want to cry. "You can't tell your mom why you are upset, because this would hurt her feelings too," I asked him. He nodded his head. I asked him what he did when the kids upset him but he couldn't tell his mom. "This," he replied. I talked with him for a few more minutes, and then went to tell the resident that he was able to speak. She quickly went into the room and came out a few minutes later. He wouldn't say a word to her. I went in with the doctor and explained to the boy that I knew it was difficult, but that the doctor really needed to hear him talk. I asked him what his favorite subject was. "Math," he answered. I left the room to take care of my other patients and when I checked back a bit later, he was no longer being admitted. They performed a CT scan just to make sure things were ok, and arranged for him to follow up with a psychologist. When he was leaving with his mom, he walked up to me and gave me a huge hug. Finally, I felt like I could handle this ER job. I was making a difference. What have I been stressing about? As I stood there filling out the rest of his paperwork, smiling to myself, the housekeeper rushed in to clean the room. I looked behind me and saw another EMS guy coming towards me with a young boy. Can't I get a minute to recuperate!?! He started giving me report before the room was even clean- dog bite to the lower leg. No big deal, probably just a few stitches, I thought. They brought him in the room and as they passed me, I noticed the word "Flight" on the back of their jackets. "He was flown in?!" I asked, panicked. "Yes, it was a pit bull," the man responded. Thankfully, an attending doctor walked by as the EMS said this, and the attending followed me into the room. He took the bandage off the leg and immediately instructed me to find the other attending and bring him STAT. I looked up and immediately regretted it. There was barely anything left of his calf, and I could clearly see his exposed muscles. I found the other attending and overhead paged my preceptor immediately. Before she was there, both doctors were giving me orders - Morphine, IV fluid, sterile saline, portable x-ray, antibiotics, etc. I froze. Morphine and what else? What am I doing here? Did I really just see that boy’s calf muscle?! Was that his bone? I want to be a receptionist again.....

Lessons from the ER

Wed, 06 Dec 2006 21:48:21 GMT

Here are a few of the things I have learned from my patients over the last few months:
~ Slamming your finger in the doorknob side of the door hurts. Slamming it in the hinge side of the door will take your fingertip right off.
~ Texas football fans are insane. Our ER is dead during any big football game, college or professional. An hour after the game, we get slammed with the kids who should have been brought in several hours earlier.
~ An untreated ear infection can lead to brain surgery.
~ An untreated cavity can lead to an ICU admission.
~ Some parents will choose buying cigarettes over buying their child's asthma medications. The result? The cigarettes can trigger an asthma attack, and there will not be any rescue medication available..
~ When making up lies for how their child was injured, parents usually forget to take into consideration their child's developmental age. A one-month old is not going to roll off of the bed and break her femur.
~ ER rooms can somehow become cursed for the day. On my last shift, every patient who was sent to room #6 ended up being sent to the ICU. Ashley, another intern, had two patients in room #1 get intubated. Some days every patient in a certain room will have the same condition- seizures, vomiting, etc.
~ Partially or completely amputated fingertips do not bother me. But cuts on the fingers slightly deeper than paper cuts? They make my stomach drop.
~ I desperately need to learn Spanish.
~ Popsicles have more healing power than Bandaids.
~ Ariel is the most popular Disney character.
~ When siblings are present, it is important to let them know that their brother/sister is going to be ok. If you fail to do this, you will quickly have two screaming children to take care of.
~ The most important thing you can say to a child when you first enter the room carrying something is, "This is not a shot."
~ Unless you are actually carrying a shot.
~ When you find out that one of your patients has died, such as my little cardiac baby from a few months ago, you have to make yourself move on. This is much easier said than done.
~ The best cure for an infant with constipation? Taking a rectal temperature. It seems to unintentionally work way too often.

Triage according to Katie

Sun, 03 Dec 2006 08:47:28 GMT

Every patient who comes to the ER is triaged when they first arrive. When triaging a patient, a complicated formula is used to determine what "level" to make that patient. Here is my own version of our levels:
Level 5 - should have gone to a pediatrician's office- send down hall to First Care
Level 4 - same as level 5, but higher priority than level 5
Level 3 - stable for now, keep close eye on
Level 2 - kind of stable, requires a lot of work, could go downhill any minute, send to Katie's room
Level 1 - trauma, life or death situation

I don't know why, but for my last few shifts, all of my patient's have been level 2's. The first few days I handled things without too much difficulty, but on Wednesday, I was put in the Asthma room. The Asthma Room is a little taste of Hell. It is a small room with seven reclining chairs lined up against the wall. There is one nurse responsible for all seven patients, and unless there is a trauma in the back, there is a respiratory therapist there as well. That's right- a seven to one patient to nurse ratio for children having TROUBLE BREATHING! For those of you who are not medically inclined, a patient's airway is the most important factor in keeping patients' alive, and children are known to go from respiratory distress to cardiac arrest in just minutes. Any one of my seven patients could quit breathing. When I am in the asthma room, I feel like I am holding my breath the entire time. Just keeping up on the hourly vital signs for seven patients keeps me busy- but then there are meds and admission papers and nursing notes and PARENTS to deal with. When I find out at the beginning of the shift that I am in the Asthma room, I say a little prayer asking God to give me the strength not to cry until I get to my car at the end of the day. Wednesday I barely made it to my car before the tears started flowing. I forced myself to return to work on Thursday, and was given a normal room assignment. Thankful that I wasn't in the Asthma room, I thought I was going to have a good day. I was wrong. My first patient was supposed to be a direct admit to the floor, but they didn't have any rooms available, so I had her for six hours. She was on a ventilator and was having difficulty breathing. Then they brought me a "Level 3" who ended up being admitted to the ICU, except there were no ICU beds available, so he stayed in my room. My next wonderful surprise was an autistic child having seizures, two of which he demonstrated for me in his room. When he started seizing, all I wanted to do was leave and never look back. How can I handle these three patients at the same time? I barely made it through the day without losing my mind. I guess I was hoping that they would save the severe patients for the more experienced nurses, but that is not how things are going to work. So here I am now, nervous about going to work, but somehow loving it at the same time. I know that I will get through it and am thankful that I have found a few experienced nurses that I can turn to for help. For now, I am keeping my fingers crossed that I start getting a few more Level 3’s my way, but that I will be able to handle the Level 2’s I am somehow destined to get. At least the level 2's make for good stories, as soon as I get the energy to write them....

Prolapsed what? Where?

Mon, 13 Nov 2006 05:17:01 GMT

I dread seeing a patient being brought to my room by ambulance. Although the EMS guys are friendly, they usually bring difficult kids who are going to require a lot of attention. A few weeks ago I saw this cute little boy on a stretcher being brought to my room. "Prolapsed rectum," the EMS said to me as he walked by. I went into the room and heard the story from his parents. The boy had been constipated and was trying a little too hard to poop, and "something bad happened to his rear end." The mother was devastated and said she had never seen anything so awful in her life. I put on a pair of gloves, had the parents stand the kid up, and took off his diaper. Preparing myself for the worst, I looked at the prolapsed rectum. I didn't see anything. Uh, where else would a prolapsed rectum be? I stopped for a moment, panicked and wondering how I could miss something that should be so obvious. The EMS saw it, the doctors at the hospital he was transferred from saw it, and yet I was seeing nothing. Embarrassed and worried that I was misunderstanding the problem, I said to the dad, "Will you please show me what you are talking about?" The look he gave me screamed "you idiot" more than words ever could. "It's right here," he said, pointing at absolutely nothing. He did a quick double take and his face was quickly as red as mine. We shared an embarrassed laugh, and I left the room, relieved that the prolapsed rectum had fixed itself and that I wasn't as big of an idiot as I led myself to believe.

In an instant

Thu, 02 Nov 2006 05:37:58 GMT

The young couple entered the ER early in the evening with their brand new baby girl. She was beautiful and her parents could not keep their eyes off of her. They thought she had some kind of a virus- she had not been eating and had not had a wet diaper in over a day. They were nervous as all new parents are, but knew that we could fix their perfect baby and have her back to her happy self in no time. After the nurse and the respiratory therapist examined the girl, they decided that something was wrong and alerted the doctor. There was an immediate rush of people into the small ER room, and all the parents could do was stand back and watch. The baby was brought to the trauma room and within minutes the top cardiologists were at the baby's bedside. Pretty soon, a tube was down their girl's throat to help her breathe and they were headed towards the elevator to go up to the ICU. Their daughter would be having open heart surgery within hours. Watching them follow their daughter towards the elevator was heartbreaking- they were almost moving in slow motion. Their gazes were blank stares. This could not be happening. In the elevator, they were up close to their baby and able to see all of the medical devices she was attached to. The mother reached out her trembling hand to touch her baby, but pulled back, too afraid. After gentle reassurances from the medical team in the elevator, she again reached out her hand and had barely touched her daughter when the elevator door opened and the rush to save her daughter's life resumed. As everyone poured out of the elevator, the shocked parents stood there for a moment, the mother sobbing, the father fighting back tears. Hours ago they thought their daughter would be put on antibiotics. Now doctors were preparing her for open heart surgery. I don't remember the girl's name, and I can't remember what she looked like, but I know that I will never forget the expression on that mother's face, and how helpless I felt because I could not do anything to make her feel better.

Now what?

Thu, 26 Oct 2006 01:56:50 GMT

Starting an IV on a small child is extremely difficult. In the two months I have been an intern, I have successfully started several IV's on school-age children, but none on an infant. A few days ago I had the opportunity to try again. Nervously I gathered all of my supplies. My preceptor (a nurse I had never worked with before) was right there holding down the baby's opposite arm and ready to take over if/when I was unable to get blood. Holding the baby's hand tightly with my left hand, I poked her right hand with the needle. Nothing. I advanced it slowly and to my surprise, saw a flashback of blood. With my tongue sticking slightly out to the side (it somehow helps), I advanced the catheter into her vein. Success! I removed the needle and applied pressure to occlude the vein (to prevent blood from spilling out of the un-clamped IV port). Although I was holding her arm, the baby was still able to squirm, and the IV catheter started coming out. Quickly I held it in place with my right hand. I stood there confused, my left hand occluding and holding the arm in place, my right hand holding the catheter. I needed another hand! Embarrassed, I looked at my preceptor and had to say, "I've never made it this far, I don't know what to do now!"
Lesson of the day: Some skills are a lot like a choreographed dance. Memorize each step of the dance before the actual performance!

Blue is bad

Mon, 23 Oct 2006 14:48:41 GMT

During one of my internship classes, we were told, "At some point, you are going to have a patient who is not breathing, and you will have to do CPR." This statement definitely caught my attention, but I was comforted by the knowledge that all I would have to do is yell, "HELP!" and five nurses would come running to my aid. You are never alone as an ER nurse because all of your coworkers are right there to jump in when needed. Unless you are alone in the ambulance bay, that is.
Last night my patient's mother requested that I bring her daughter out to meet her in the ambulance bay with the car. We do not normally do this, but since I was not busy, I agreed. I wheeled the patient to the back door and waited inside. After a few minutes I heard car tires screeching and the car horn blaring, not letting up. Wow, she's in a hurry! I started wheeling my patient down the wheelchair ramp when I heard a woman scream, "He's dead!" Uh, excuse me? Who's dead? This is not where you are supposed to drop patients off. I looked up and saw the source of the scream, a woman standing by her car in the middle of the ambulance bay (pretty much resembles a dark alley). I looked at the car and didn't see any passengers, so I assumed that the "dead" person was a young child. My training kicked in and I knew what to do: run to the car, grab the patient and run him to the trauma room. I put my patient's wheelchair in park and ran up to the car (I know, probably not the safest move). I opened the door to save the child's life and was shocked to see an adult man slumped over in the front seat. He was blue and not breathing. This is when my entire body froze and all I could hear was my heart beating. I had no idea what to do. He was too big for me to move by myself, there was no one in screaming distance, and the driver of the car was too panicked to do anything. All she could say is that he had overdosed on heroin, and she had no idea how long he hadn't been breathing. Thankfully, my patient's mother showed up and I yelled to her to take her daughter away. She quickly obeyed. That's when I took off running inside for help. I didn't know what else to do- my first code and there was no "code blue" button to push. My gut told me to never abandon a patient but my brain told me I couldn't handle this on my own. Thankfully the trauma team responded to my plea and came running to the bay area where they pulled him out of the car and onto the street. Even though we are a pediatric ER they were able to bring him to the trauma room and save his life. My preceptor Susan, after lecturing me about never going to the ambulance bay alone, told me that I should be proud about how I handled the situation. To be honest, I'm most proud of the fact that I somehow avoided peeing my pants! Hopefully, my next code will take place in the comfort of a well-lit, warm, code-blue-button-nearby, ER room.

Isis, my little angel

Wed, 18 Oct 2006 22:22:46 GMT

One important lesson I have learned so far about children is that even the sweetest and cutest child can turn into a little monster when they don't want to do something. Whether they are scared and don't want an IV started or they don't want to take their medicine, I have been shocked by how quickly they can flip their switch and go from talking about Ariel to kicking, screaming and spitting. The parents are usually embarrassed and upset when their child starts behaving this way. I never understood what they were going through until I took my little angel Isis to the vet last week. I knew she had a UTI, so after a lot of drama collecting a urine sample from her, I called around to find a vet to do a urinary analysis on it. None of them would do the simple test without seeing Isis first. I made an appointment and brought her in. Trips to the vet are never fun, especially for the vet. I put Isis up on the table and the vet tech walked in the room. Isis immediately warmed up to her, rubbing up against her and purring like crazy. "I need to take her to the back to weigh her and take her temperature," the tech told me. I replied that I was ok with that, but that Isis was just putting on an act and that she has a quick left hook. The tech smiled and said, "No, she's a sweetheart, aren't you Isis?" She picked Isis up and the moment the door closed behind her, I heard that awful high-pitched ear-shattering cry that cats can only do when they are extremely ticked off. This screaming and crying went on for at least five minutes. I sat there in the room embarrassed and wanting to cry. My poor baby was being tortured by that mean tech who was trying to take her temperature, and everyone in that office could hear her screaming. When the tech finally returned with Isis, she said, "Well, I don't need her temperature that badly... " I think I'll try that sometime at work- "Sorry doc, I didn't give Tommy his shot because he started crying and made a nasty face at me." I bet that will go over smoothly!

Would you like regular or decaf?

Tue, 10 Oct 2006 22:12:23 GMT

Some patients and their families think that nurses are waitresses in scrubs. They think that their request for a blanket should be their nurse's number one priority, because she couldn't possibly have any other patients with real problems, right? I had one of these patients the other day. The worst part was that she should not have even been in the ER, she should have gone to a walk-in clinic or her primary care doctor. But she showed up at the ER and was brought to my room, so I got to wait on her. Every few minutes the mother would signal me from the door. They needed a blanket, so I went and got a blanket. As I handed her the blanket, she said that they also needed towels. Why couldn't she have told me that before!? She wanted me to call the doctor at least every half hour to ask her questions. I can't bug the doctor while she is in with a trauma to ask how long until my stable patient is discharged! I don't know why I could not communicate this information to the patient's mother, but somewhere along the line we were not connecting. After the girl told me that she was in extreme pain, I got the doctor to write an order for IV pain meds. When I tried to flush the IV, the line was blown. I informed the girl that I would have to start a new IV or give the medicine as a shot, and she suddenly no longer had pain! She didn't have pain for at least two hours, until the doctor started talking about discharging her. While fetching yet another blanket for my patient, I noticed that another patient was being brought back to my other room, so I glanced at her chart. It said, "laceration to foot." The girl was wheeled into the room and she smiled and waved at me as she passed by. I relaxed a little bit, thinking that this would be an easy case. I went in the room and started my assessment of her. She had a make-shift bandage over her foot, so I put my gloves on and lifted it off. I could not believe what I saw- her foot was cut so badly that you could see the tendon to her toe. While I was examining her foot, her parents lifted the sheet up to block her view. I quickly understood why. These were some smart parents. I asked the girl to rate her pain for me. She said it was a two out of five. Had she had the chance to see how badly she was hurt, I'm sure it would have been a seven out of five! I just couldn't get over how different my two patients were- the one with nothing wrong with her was screaming "NURSE!!" every time I walked by the room, and even screamed at the top of her lungs when I took her temperature across her forehead. The patient with a cut down to the tendon was polite and never even complained. When going from the heavenly patient to the, uh, opposite of heavenly patient, I wanted to tell her how bad the girl next door was making her look. But I like where I work, and I don't want to lose my job yet, so I served her with a smile my entire shift. I was shocked and hurt when they stiffed me on the tip though..... Maybe that third cup of coffee was too cold?

Hi, I'll be your nurse today

Fri, 06 Oct 2006 04:03:32 GMT

At my sister's graduation ceremony, one of the speakers repeatedly instructed the graduates to "savor the first time you introduce yourself to your patient as a real nurse." I remembered this as I was walking into my patient's room my first day back in the ER after officially becoming an RN. I entered the room, proud, with my head held high. "Hi, I'm Katie, and I'll..." My proud moment was ruined by, "He threw up again and I think he might have had diarrhea." NOW I feel like a real nurse! This patient was an adorable boy who was having some gastrointestinal issues. The doctor ordered a stool sample, so the boy and his dad went to collect one in a toilet hat. When I walked into the room a few minutes later, the smell hit me instantly. I can just dump the whole container into a big biohazard bag and ship it to the lab, right? Wrong. I had to get this tiny specimen cup and pour the diarrhea into it. I put on my gloves, opened the container over the trash and attempted to aim everything into the little cup. I managed to hold back the gagging for about two seconds, but then the reality of the situation hit me hard. I turned my head away from my work and looked back at the boy, his parents, and his two uncles as they all stared at me from across the room. The looks on their faces verified that what I was doing was, indeed, disgusting, and that maybe throwing up would not be so out of line. That's when those wonderful gagging sound-effects started. Please don't throw up in front of your patient, I kept telling myself. After a few interesting noises that I've only heard from my cat when she has a hairball, I had the majority of the specimen in the ridiculously small cup.
Lesson of the day: The RN behind your name does not make smells any easier to tolerate.

The NCLEX

Mon, 02 Oct 2006 18:35:43 GMT

I slept until 11:00 today. I know for my younger brothers this is considered "waking up early" but when you are used to getting up at 5:20 every morning, sleeping past 9 is really exciting (and a little guilt-producing). But you know what? I'm allowed to sleep in this late because I have nothing to study for!!! It is the weirdest feeling to sit here and not have anything hanging over my head. I absolutely love it!
The last week has been very intense. Going into the NCLEX without the two weeks of solid cramming I was planning on was intimidating. I got lost on the way to Fort Worth for my exam, but I left two hours early and still made it there with plenty of time. Once there, I felt like a criminal. I had my profile picture taken and I was repeatedly fingerprinted. While I understand that these things are necessary, they do not help with test-taking anxiety! I'm sure some of you already know this, but how well you are doing on the NCLEX determines how many questions you get. There is a complicated formula that explains all of this, but I'll give you a basic explanation. You can get anywhere from 75-265 questions on the exam. If you are acing the exam or failing miserably, the computer will shut the exam off at 75 questions because you have already proven your competence or lack thereof. If at 75 questions the computer hasn't determined where you stand, it keeps asking questions until it can decide whether you have passed or failed. (If you want to read about this, click here). While taking the exam, I quickly realized that I did not know anything. There were only two questions that allowed me to think, "I know this!" All of the others were guesses (although many were narrowed down to two options). Around question 40, I determined that I had failed the test. I kept on going, trying my best to focus on the questions and to stop thinking about how I was going to break the news to everyone that I had failed. When I got to question 74, I started shaking. I hit "next" and it brought up question 75. Now I was really shaking. I could barely concentrate on the question - all I wanted to do was hit "next" and have the test shut off. I've heard that the screen just goes black when the test is done, so I was praying for a black screen. Suddenly, my vision started going fuzzy black around the edges. This is not what I had in mind when I was praying to see black!! Maybe I shouldn't have taken all those meds before coming to the testing center!! Thankfully, I didn't faint, but when I hit "next", I didn't see a black screen. Nothing happened. The background was blue and a little box came up that said, "Loading next item." NOOO!!!! It's bringing me to the next portion of the test. I had not proven myself and I was close to failing, I just knew it. But then a survey popped up on the screen. I was done. For about two seconds I was relieved and I allowed myself to start breathing again. But then it hit me. I only knew two answers! It shut off at 75 questions because I FAILED MISERABLY!!! I began debating whether or not I should tell people I had the full 265 questions so that when I tell them that I failed, it would at least look like I gave it a good fight. I answered the stupid survey questions (which is an evil thing to make someone do after they have failed an exam), stood up on my wobbly legs, and left. The next two days of my life were miserable. I have been told by several people that the TX Board of Nursing updates their website every Wednesday night, so if I passed the boards on Tuesday, my license number should appear on the website by late Wednesday night. I obsessively searched for my name every fifteen minutes on Wednesday. I did not get much sleep- I’d wake up and run out to the computer, only to see “no results” when I would enter my name. When my name was still not up by Thursday morning, I knew for sure that I had failed. I went to work heartbroken, hoping that no one would ask me about the exam. Unfortunately, that did not happen. Everyone wanted to know how many questions I was given. I decided to tell the truth and just resign when I got the official results back. I went to one of my internship classes and checked my cell phone around 8am, and I had a message from my dad. “Congratulations, on passing!” was the first and only thing I heard before I almost dropped the phone. I ran to a computer lab and looked at the website- there was a license number next to my name. I actually passed. After all I have been through, I was finally done. I suddenly had confidence, which I have been lacking for way too long. Now all I have to do is learn some clinical skills, and I’ll truly feel like a Registered Nurse! But don’t worry, I have a great teacher and I know I’ll be there in no time.