Sometimes I learn about my career, i.e. to be a better nurse; sometimes it is about being a better friend, i.e.  listening without my ego being in the way.  But what I see as the hardest lesson, at least as far as I am concerned, is to just be and to let the world revolve without my input.  It really isn’t all about me, in reality it is nothing about me.

By the time I arrived at work the patient had undergone a battery of tests to get to the cause for his ALOC. His brain CT scan was negative, blood assays showed he was in metabolic acidosis along with a blood glucose of 417 mg/dL. I noticed he only had one IV line started which was hooked up to the body warmer (warm saline is sent through the IV); I already had orders for an insulin drip, calcium carbonate drip, and more fluids. 2 more large bore IV lines were started and the balance act started. It is important to not only lower the blood glucose (insulin drip) but also to continually monitor since he could drop his glucose too fast, I also had to keep an eye on his potassium levels which tend to alter with diabetic ketoacidosis, the labs had also indicated his calcium levels were low hence the calcium carbonate. The subsequent lab assays showed his potassium was dangerously low at 2.6 mEq, so I started a 10mEq potassium chloride rider as well (actually the first of 4 riders). At this point I had to continually monitor his blood glucose to make sure it didn’t drop too fast and titrate the insulin appropriately, keep track of his cardiac rhythm since potassium and calcium can cause aberrancies, continue to monitor his core temperature since it was important to bring him to a normal range but not above, keep track of his urine output, maintain close supervision of vital signs to guard against hypervolemia, and since the patient was on bilateral wrist restraints also follow safe restraint use protocol.

I took care of him for about 2 hours prior to transferring him to another hospital since our ICU did not have any beds available. By the time he left his blood sugar was 261 mg/dL his potassium was 2.6, his core temperature was up to 96.1 and he was alert if not completely oriented.

Of course we treat them all the same and just wonder why would parents wake up their children at 0300 to have their colds checked and cured; somehow a belief has been perpetuated out there that if you just come to the ER we can make magic happens and cure the common cold in an hour.  The children are cranky, the parents are sleep deprived and wondering why they have to wait while we bring a patient back who is clutching her chest ahead of them.  I realize that the majority of people do not get the concept of triage but, really wouldn’t you think that if you go to the ER in the middle of the night, you may just have to wait.  And besides it is not McDonalds after all.

Yeah people never cease to amaze me.  We had a patient a couple of months ago who found out that if you come to the ER by ambulance you are brought directly into a room (of course it didn’t dawn on him that ambulances are not cabs).  Well, we were extremely busy and his complaint was a sore big toe due to an ingrown toenail.  Well, we advised him that it would be a while and that as soon as was possible we would get him into an exam room.  As he sat there it occurred to him that if he called an ambulance he could be taken back immediately.  He had the audacity to call 911 from our waiting room, he was picked up by an ambulance crew (they are required by law) outside the ER; and then brought around to the ambulance entrance.  Once we got past the sheer disbelief the ER physician went in to talk to the patient and to assess him.  Well, he was taken back out to the waiting room since this was obviously not a life threatening emergency.  Eventually the patient was seen and his ingrown toenail treated; he was flabbergasted when he learned that the city would charge him a fee for improper use of emergency response services (calling 911 and getting an ambulance), and that he would also have to pay for the ambulance fee since his insurance company also agreed with us in seeing that this was a true idiotic move.

Just how much is too much I wonder…

www.kiva.org is such an organization. Take a peek and see what you think. I don’t believe in trying to make someone else’s mind up for them. I think the decision has to be made privately. Check it out.

Hello?  Just wanted to introduce myself..

Tags: sealion, ocean, cute animal pictures

Tags: flock, browser, web

Of course as with any other profession or group of people, there are those nurses who have been in the field a long time and who for whatever reason, have lost the little bit of compassion or patience that brought them into the field to begin with. Maybe it has to do with more patients, decreasing staff, less pay, longer hours, and at times patients and doctors who are not only rude but downright mean to nurses. A professional nurse will try to compensate in some way with the outright anger of some and the sheer frustration with others by trying to find some sort of peace at home or just a good punching bag; however, we are human too and although we may try to be angelic and forever kind and understanding even if others are rude and obnoxious, you must admit cleaning up just one more barfing, cussing, bleeding, and sexually explicit patient just gets old and well.. it can drive you insane after a while.