Sheesh. I don’t ever remember being as tired as I’ve been this week. I worked 3 days last week, had a day and a half off, then went back to work 3 days. And I guess it almost killed me. I’ve really done little other than sleep since I got off work from Tuesday shift…which is Wednesday morning. (7p to 7a shift). Last night I finally got 8 hours of sleep in a row, so I woke up feeling like a million bucks. But I still laid down at 1 and slept for 3 hours. Helluva nap. Yaaay, Saturday!
ANYHOO.
Here’s some of the cool stuff I’ve seen recently:
Saved a guy’s life! Non-responsive, took his blood glucose. So low, the machine told me to get lab back up. In the toilet, in other words. Enter my friend D50. D50, a highly concentrated sugar called Dextrose, comes in a syringe. A very big piston syringe. Probably 8 inches long, and as big around as a 50 cent piece, I guess. My hospital’s protocol is to use half as a life saving measure. I did 4 syringes! That’s EIGHT administrations, of this thick, lifesaving, sugar in a tube. Kinda the consistency of honey. I was in constant contact with our Hospitalist. First we started the guy on a D5W drip which is a dextrose (sugar) concentration of 5%. To no avail. His body just laughed at that bag of fluids. Then we increased the concentration. I hung a bag of D10…which no nurse on the floor had really ever even seen before. Just like you think, it is 10% dextrose. Comes in a much smaller bag. Yeeeaaah…NOTHING. The only thing that worked was the amps of D50. I did this routine every hour (thank God it was at night and I had my other patients all put to bed and no one needed me). Sugar would test at 40 or below, I administered D50, either a half or whole syringe, I would check his sugar and in the space of 1 hour, we’d finally climb to 100 (normal) and quickly it would fall again. Did I mention he was drinking juice boxes like crazy when he was awake? Throughout the night, he drank 15 juice boxes and two “real” sodas.
I asked the doc on like my 3rd or 4th call and after I had established a little credibility with him, “So what is going on with this guy, doc? Does he have a tumor sucking up all of his glucose?” (because that could be a real possibility.) But, I’m not an oncology nurse. I’m a cardiac nurse.
The guy was in for acute exacerbation of Heart Failure. Turns out, Dr. S told me after googling it (he told me that – cool guy), that heart failure and hypoglycemia sometimes happen together. Wild.
I texted my boss after I gave report that AM. I told her that the guy WOULD crash, it was a just a matter of time. Just a matter of someone not being able to monitor him that closely on Day shift. He was transferred to ICU, finally.
Jack, my patient, told me “I’ve never been that close to death before. Thank you for staying with me.” I’ll never forget you, Mr. Jack.
Then there’s Ms. Juanita. When your mom, who has never had any mental issues in the 40 years of your life, starts seeing things, falling down, and rambling unintelligibly, you should bring her to the ER. And once ER gets her all settled, you should admit her to the Telemetry floor where we can watch her heart beat with pretty cool moniotrs. Because once she gets all nice and tucked into bed, her heart will reach 180 beats per minute and she will be THISCLOSETOHAVINGAHEARTATTACK, and will be even stark-er, raving-er MAD. Like, crazy. The new little nurse who admitted her had her on a Cardizem drip. Cardizem, or amiodarone if you like, is a calcium channel blocking drug. If we’re giving it as a drip, and especially turned up as high as we had it, it is because we’ve also got the defibrillator pads stuck to her chest, because we’re waiting on her heart to up-and-quit. Because her heart will have to wear out, acting like that. Now imagine. That is scary to a non-psychotic patient. Add a little, ahem, a LOT of psychosis to the mix, and see what fun you have.
Sodium levels in the blood stream REALLY REALLY affect you. Sodium shouldn’t be lower than 135. (can’t be higher than 145) Narrow window. Hers was a very scary 117. It would seem easy to fix. Just give her salt, right? Well, it doesn’t exactly work that way. We’re also messing with her ICP or intercranial pressure. Right, the pressure in her head. And therefore, you have to fix this kind of stuff very slowly. So she found herself on a fluid restricted diet, and normal saline IV fluids that have potassium added, too. Because that was screwed up, too.
By the last couple of hours of my 2nd night, (her 3rd night in) she was remarkably more “with it.” Her IV site in the crook of her left arm (ER personnel! Quit putting IVs there! I love you, but day-um) was looking very angry, and I was doubting if it was even working properly. So I yanked it and started an IV in her other forearm. She had no issues with any of that. She teased me, when I was unwrapping her AM meds, that I had just better put her pills in her mouth for her, lest these pills go the way of the one last night. (She had dropped a pill in the bed last night, and we looked EVERYWHERE for the damn thing. Couldn’t find it, so I just replaced it.) And now she had a glimmer of a twinkle in her eye, and was teasing me about the lost pill! How awesome! And she finally was realizing her limitations. Great sign. My 3rd night, another nurse mistakenly walked into Ms. Juanita’s room, introducing herself as the night nurse. Ms. Juanita was VERY disappointed, and asked where I was. Because I told her I’d be back and would try very hard to have her as my patient again. And night 3, she remembered me, the conversation, and even my name! Turns out, the other nurse had just walked into the wrong room, lol. But how awesome, Ms. Juanita remembered ALL of that. She was really getting better. The last I saw her sodium level, it had come up to 130. It was evidenced by her being much more alert and oriented. And her heart had simmered down to where she was able to take oral Cardizem, instead of by IV drip to control her heart arrhythmias.
Ya know, I’m only 5 months in. And it is very easy for me to already feel like I really don’t do much but give pills every night. To feel like my nursing is just task-oriented. To wonder if I really help anyone at all.
I kept one alive and I truly helped another get better. Happy.
No big New Year’s Eve par-tay for me this year. I work New Years Day night and this year, I think I’ll just have a low-key dinner with Goatee Man and call it a night. Happy 2012, ya'll.
