A busy night at work

So last night did not begin auspiciously. I began my shift with two patients asking for pain meds while a third was just being admitted from the PACU with some huge bloody dressings and two JP drains. The day nurse was nice enough to get the new admission settled while I was madly drawing up percoset and dilauted. My one guy had a chest tube following a partial lung resection, and they had just dc'd his epidural that afternoon, so he was really hurting, and my lady was recovering from sickle cell crisis. My fourth patient is a regular on our floor, an older lady with afib and rotating infections (including, of course, MRSA isolation) and issues with a big dose of dementia who enjoys putting on her "coat" (a gown) and walking off the floor. The day nurse told me she was more oriented than usual, but that she had stepped on her foley tube and her urine had since turned to a nice shade of cranberry.

OK, I can do this, right? My charge nurse was extra awesome and helped set up my continuous pulse ox while I was dealing with my poor lady whose heart rate had been in the 130s since early afternoon. She had been given a few meds, but nothing had really worked, and, well, I don't know what people were thinking, but it was making me very uncomfortable. So after the hydralazine, po metoprolol and then an IV push of another 5mg of metoprolol, I called the cover docs and said, listen, can we do something here? They said give her another 5mg. I did, and though it was difficult to get a very accurate assessment of her (at one point when I was asking her if her chest hurt she said simply "I'm just going to agree with anything you say") she finally started breathing 40/min and was clutching her chest. Out came the EKG, and a third dose of IV metoprolol. Still her rate was in the 130s/Afib, so we started her on a Cardizem drip, and FINALLY she calmed down into a more comfortable 80s-90s range.

Just as she is getting settled, my chest tube dude calls me. I've been giving him rotating doses of oxycodone (q4) and dilauted (q3) and oxycontin (q12), but suddenly his heart rate is in the 150s. I guess it was a lesson the health care gods wanted me to learn tonight. So on came another round of 3 IV pushes of metoprolol and an EKG, portable chest xray, and lots of meds including ativan, ambien and more dilauted to calm him down. (I thought giving him ambien at 3:30 in the morning was kind of mean, but he was anxious and sweaty and he did finally fall asleep after that, even though his heart didn't slow at all.) Just as I was leaving he went off to get a CT scan to eval for a pulmonary embolism.

Things were crazy, but all my night shift peeps totally stepped up to help me out, drawing labs and giving pain meds and just helping out wherever they could. My charting probably left a bit to be desired, but everything got done and at least all my meds and vital signs were well documented. It made me very aware of how glad I am where I am, where there is a real sense of a team and I wasn't just left to flounder, or given reluctant help or an attitude. I'm definitely baking for next week, because they totally rock and deserve to be fat and happy.

I'm at that stage with nursing where for the most part I am holding my own, but still I learn something every single shift. I really feel like I learned practically nothing in school, not because the schooling was bad, but because when I was busy learning how to do an assessment I wasn't really able to absorb many of the practical details of what I was really assessing. Now that I'm comfortable in the setting, all the details are finally making sense. Or to put it another way, all the stuff I memorized without necessarily understanding is now starting to make practical sense. I'm absolutely tired of often feeling just a little bit lost at work. But with every new experience I get that much more, well, experienced. And I am sure glad that it just keeps getting better and better.