Thursday, September 27, 2007

On skin windows and flying patients...

Last night was a gorgeous, huge, glowing full moon yet all I can think to write about are pressure ulcer dressings and modes of moving fatty boombalatty patients who would otherwise kill your back. I'll never be a poet at this rate, topics like that just don't translate very eloquently.

Last night I lifted my 110 kilogram patient with just one finger! No, I'm not freakishly strong or even gifted with special powers, although it's understandable if those are the first conclusions you reach. It turns out the PUH MICU has installed these overhead lifts in each patient room, so if you put the special sling under your patient, you simply attach the straps of the sling to the arms of the lift, use the handy-dandy push button controls, and lifto-shifto, you can boost that patient up in bed! In mere seconds! Your old-beyond-its-years nursing back thanks you profusely, as do your colleagues who are too busy to put on gloves and risk their own backs just to help you get your patient straightened up in bed. The sling thingy even tilts a little sideways so you can put some pillows underneath and turn your patient with ease. You know, to prevent nasty pressure ulcers...which brings me to my next point...

Maybe this is already a universally known technique, (and by universal, I mean widely known to the huge population of people who are RNs and deal with skin care issues...perhaps not yet material for Good Morning America, but of growing importance to a wee minority...) but a colleague at PUH has introduced me to duoderm windows! It's a stroke of genius, an inspiration of brilliance. know when you have those nasty tunneled oozing pressure ulcers, and of course by their very nature they are in the most inconveniently dirty places, such as the on the very underside of your patient, a mere centimeter (sometimes not even!) south of the a*us? So of course keeping a dressing over such an ulcer, nonetheless keeping it clean and dry, becomes a seemingly insurmountable problem. Then if you do manage to put a dressing over it, each time you have to change it, you are just bothering and irritating the already-sensitive skin by peeling stickies off it? Well...get ready for brill-ee-unt colleague crafts a window out of duoderm, places it over the offending sore, then packs it, and covers it with gauze and finally a piece of tegaderm which adheres to the duoderm, but not the patient's skin! SO, the duoderm stays in place and each time the site is soiled you do not need to rip off a piece of duoderm, plus you can change the tegaderm as much as you might need to without hurting the adjacent tissue!

Oh my goodness. I think this has turned into one of those, "You know you spend too much time in hospitals when these things get you you excited..." posts. So sorry. Soon I will be in Europe and perhaps I will be excited by things like world-class art, ancient monuments, and legendary pain au chocolat. I certainly hope so. I just have to survive 168 more hours of work before I leave....I know, I know, could I have thought of a more depressing way to say, "I leave for Paris in less than three weeks!"??

Picture of MAXI SKY 600
*This is an example of the patient sling I am in love with.
*Disclaimer: The people in this photo are not me and my patient, nor do they even remotely resemble me or my patients. For example, notice the cheery smiles on their faces and the sunlight streaming in through the window...and that's just to start with...

Tuesday, September 25, 2007

Just checking in...

In case anyone is wondering, I'm still here, and I'm still alive. Somehow. Even though throughout the month of September I've only got seven whole days off. In response to Clean Dry and Intact's comment, I'm not sure I have very good advice on how to survive five shifts in a row...when I had the time, I tried to clean my whole house, do every piece of laundry, and run every little errand that I had, so there'd be nothing to worry about or stress over during my long stretch at work. But now, since I've only got little onesie or twosie days off, I just try to rest and sleep as much as possible on my days off. Then I try to schedule to get just one little thing done before I go to work each night...even if it's as little as taking out the garbage. In the meantime, I'm considering the pros and cons of hiring an errand boy. Can I get an au pair even if I don't have kids?

NurseSF asked why I use acronyms for the hospitals I work at, and whether it's better to do that or to be honest about where you work, etc. I'm not really sure what's best, but for myself, I'm just paranoid about HIPAA. I always change any details about my patients that I write about in order to protect their identity, even their genders or ages. I guess I'm just worried that if someone recognized me or the hospital I write about, they might think I'm revealing private patient information. I don't really mind if people I work with read this, but I just wouldn't want it to get back to the managers or anything. I suppose there's a slim chance of that, but just to be safe...

So underneath my bitter, tired, overworked facade, I'm truly super-duper excited about my upcoming trip to Paris. I'm just a little too worn out from working to open my guide books and focus on the teeny French words on the pages at the moment. Thank goodness I have three weeks left till I leave. Wait, only three weeks?! Damn.

Monday, September 10, 2007

On second thought...

There are some things which can be defended with the age-old excuse: "It seemed like a good idea at the time." But even I have to admit that there are some things to which I have to say, "No, it never seemed like a good idea. But maybe later, down the road, I'll look back and say, 'it was sort of a good idea,' " Case in point, somehow scheduling myself to work 12 out of 14 consecutive night shifts. Yes, 12-hour night shifts. Yes, I realize that's 144 hours, or a couple of 72-hour work weeks. But I'm hoping that as I'm sitting at a sidewalk cafe in Paris, ordering another bottle of wine, or browsing the little boutiques in Le Marais district and contemplating an adorable pair of red shoes, I tell myself, "Self, I'm really glad you worked some extra hours because it's making my adventure in Paris so much more better," except with better grammar of course. And in French.

I'm working at both hospitals now, PUH, and per diem on my old unit... the hospital that is like an old boyfriend to me. You know, comfy, I have good memories from our time together, I miss it there, and time and other hospitals only serve to help me forget the reasons why I left in the first place. But anyway. I'm sort of hoping that by splitting up my shifts, some at each hospital, it won't make a 5-night stretch feel like five nights. Heh. Stop snickering at my faulty logic. Paris! Red Shoes!

Oh! And now for some nursing content....things that are also NOT a good a idea: (Ahem..residents, listen up...) No matter how "unresponsive" you think your intubated patient is, always always always always ALWAYS write PRN sedation orders for him. Always. Because when said patient is an angry sweaty confused 400-pound man, and he suddenly wakes up with a tube in every orifice, and you're a little too slow returning his nurses's pages, there really isn't too much said nurse could have done prevent him from contorting his massive body in such a way to pull the ET from his throat. Wrist restraints be damned. Additional things that suck about this little vignette: Patient was already requiring 100% ventilator support, meaning that when he removed the ET tube from his throat, I had to call a code to get lots of people in that room STAT to re-intubate him. And sedate him. And also, you know how night shift nurses kind of work like a big team, and really step in to back each other up? Yeah, not so much. Apparently this is not universally true. The two other travellers on the unit really stepped up, one of them watching my patient for a couple of brief intervals to let me take brief breaks off the unit, and also helping me change a foley and insert an NG then lavage until clear. The other helped me turn and clean the verylargesweatypatient then even offered to take my other patient from me once she realized how swamped I was with verylargesweatypatient. To be fair, later in the shift the charge nurse stepped up and helped me set up my arterial line and drew labs for me when the three sets I had drawn hemolyzed.

Another little piece of advice to residents: When the patient's hematocrit drops from 48 to 32, please notify the nurse and ask her to re-draw the blood sample before you order a GI consult, and order four units of blood on the patient. Which I would have done, had I noticed the lab value before the residents did. But I didn't, because I was too busy titrating drips, inserting a foley and an NG, and various other little tasky things.

Anyway. I'm done ranting now. Back to work tonight, at the Old Boyfriend Unit (OBU). Kind of looking forward to it. But in the meantime, there are guidebooks to tab.

Tuesday, September 04, 2007

I am highly trained professional

And occasionally I get poop in my hair at work. And no, it's not my own poop. Although, as the astute Jodi pointed out, "I think this is one of those cases where even if it was your own poop, it wouldn't be any less gross." I love that Jodi thinks like me, by acknowledging that indeed there are situations where the fact that the poop is your own versus someone else's DOES make it less gross. Yes indeed, I am a well-educated and highly trained professional. I spent lots of money and went to years of schooling in order to be paid to where your poop, on my head. How did the poop get on my head? Seriously, do you really want to know? Are you thinking to yourself, "Wow, that sounds gross. I'd better take steps to avoid that happening to me." Yeah, I doubt it. You're thinking, I will never complain about the papercut I got at work again. And to nurses out there...I bet you really don't want to know how it happened either, because I know you're all chuckling to yourself but thinking, "At least it wasn't me....this time." And FYI...try not to fling sheets off the bed, no matter how carefully you think you checked it.

So...contrary to the above anecdote, I really am liking my job at PUH. I'm back on night shift now, and so far everyone is pretty cool to work with and I think I'm getting into the swing of things fairly quickly. For some reason, I've been feeling braver as a nurse lately. Like last week I did three peripheral blood draws. No big deal, right? Right, except that's more than I've done in three years as an oncology nurse ("What? You mean some people don't automatically have central lines placed upon hospital admission?! That's crazy talk.") My usual response to an order requiring a peripheral stick is to call the phlebotomist, or look at the patient's arms myself, and failing to see a huge neon sign with an arrow saying, "Right here! Even a blind monkey couldn't miss it!" I sweetly ask another nurse to help me. No, I'm not proud. I was a blood draw weenie. Finally I sort of realized that I couldn't avoid peripheral sticks for the rest of my nursing career, and maybe it would be fun to have one more skill. Next up: IVs. Uff.

And also...after I just revealed my generally pathetic lack of skills as a bedside ICU nurse, I've decided to take the CCRN. I know, blood draws AND certification?! Crazy talk. Oh well. No one doesn't want an extra dollar an hour, right? Plus, dorky old me, thinks maybe it will be fun to study and learn more or refresh myself on general critical care knowledge. There's something strangely enlightening about studying something that you're already doing...that super-wattage lightbulb that goes on..."So THAT'S why my patient's heart rhythm kept going into Tourssade's...."

And also...even MORE exciting that CCRN, and blood draws, and poop in the hair....(I know, settle down, already!) I'm planning a huge vacation, the biggest trip of my little 31 years. I'm going to Paris and New York City in October! Okay, maybe my trip to Saudi Arabia was bigger, but I hardly planned a bit of it. It was more like, "The private royal plane is leaving around 8am. Your driver will pick you up at 7:30. Maybe you should pack or ask a maid to pack for you." So yeah, turns out this time around I have to fly coach and arrange my own travel and even pack myself. Hah. Anyway, I've got my plane tickets, and even places to stay, but I'm totally overwhelmed and freaking out by the amount of planning I need to do. I've got mountains of guide books, but I haven't even started tabbing them yet! Uff. But it's a good kind of exciting freak-out. Enough to make me forget about buying a house or studying for the CCRN to even studying my Arabic or French. Fortunately my closest friends have left the country for a few weeks, leaving me lots of extra time for planning and hermiting with my computer.