Ambulatory Surgery Department. I've been working here for the past 2 months now, ever since we moved back to Maryland. It's my old stomping grounds, having worked at this hospital, in this unit for 4 years as a nursing assistant while in college for my bachelors and nursing degrees. I spend my days either getting patients ready for surgery or getting them ready to go home if they are being discharged on the same day as their surgery (outpatient). Which portion I works depends on what 8 hour shift I'm assigned, and that all depends on what shift needs to be covered since I'm woking PRN or "as needed". I've been lucky in that my manager is giving me full-time hours. Just no benefits, which I don't need anyways as I'm covered through my husband's job.
It's a LOT of paperwork, but thank god the majority of it is computer charting! Definitely don't miss paper charting or having to translate and enter in the doctor's orders. The only drawback of this job so far are the 8 hours, 5 days/week shifts and the 0545 start time if I am assigned to pre-op patients that day(s). It's sucks having to wake up at 0400, but it's getting easier. Just need a cup of coffee and I'm good. Usually if I'm on the pre-op side of the unit for the day, I get an assignment that ranges from 6-8 patients, with usually two that we have to get ready for a 0730 case. Cases ranges from orthopedics, vascular, GYN, ENT, URO, pain management, angio, and endoscopy. We get a lot of GYN cases, and through the years I've realized that fibroids is something every women should look out for as they age, endometriosis sucks, and there are a lot of women walking around this country without their uterus. My responsibilities included getting the patient undressed to their birthday suit and into a hospital gown, making sure all the necessary labs are available or drawn, that there is a recent history & physical, that the consent is signed/witnessed,that the patient has been NPO, obtain a baseline set of vital signs and a brief admission assessment. Slap on an IV and some LR fluids and call it a day. Nothing left to do, but wait for the surgeon, anesthesiologist, and the OR nurse. Easy peasy. Well, unless your patient doesn't speak English (blue phone), or they take a million gazillion meds that you have to go over when they took last, or the patient is late and the surgeon wants to go now now now, or they have no veins. Another thing a love about this job is all the practice I get starting IVs. I'm actually not too bad *knock on wood*
Post-op for patients going home the same day is a different animal. There is usually a nurse that comes in at 8, 9, 10, 11, and sometimes 1pm. Today I was the 1000-1830 nurse. Patient assignment is pretty much on a first come first serve bases. We try to rotate who takes the next patient and keep the ratio to 3:1 max. Today I probably discharged about 8 patients and admitted 2 to the floors. Depending on whether the patient came directly from the OR or after a stent in the recovery room, we recover them from between 30 mins to 2+ hours. We make sure they're not so sedated and more on the alert and oriented side before giving them some "apple juice, cranberry juice, ginger ale, water, tea, or coffee" and "Graham or saltine crackers". Luxury, huh? Other responsibilities include, making sure they don't get nauseated, treating any nausea, they their oxygen saturations is within normal limits, that their pain in tolerable, and that all GYN and URO cases can pee. Oh, and that any patients having a colonoscopy can pass gas, or the words of one of my patients "you mean you want me to fart?", or else no crackers for you! Lol. In the end, if they meet all the criteria then we go over discharge instructions and prescriptions from the surgeon, take out their IV , and give them a free ride in a wheelchair to the car :)
It's a pretty sweet job. I'm really enjoying myself and learning a lot! It's definitely easier than being on the floors, but the craziness and ridiculous amounts of surgical cases we have on a daily bases makes up for it. Today was 61 surgical cases, tomorrow will be 63+! It's a big and busy hospital, but it's totally for me. I'll be in ASD for another month and then my next adventure a full-time nurse in the PACU will begin :)
Monday, July 25, 2011
Friday, May 6, 2011
Changes
Unfortunately I have been neglecting this blog too long. Once I started working the night shift at the hospital it was difficult to find time in between work and life to blog. If I wasn't working then I was eating, sleeping, spending time with my husband, or tending to the doggies :)
Well, as a update, I ended up working on the nigh shift for about 4 months. It was great! I learned a lot and had so many experiences I wish I was able to share. They definitely made me a better nurse and I was lucky to work with an awesome group of nurses.
As of now I am in between jobs. My husband ending up getting a full-time job in northern Virginia, near the MD/VA border. As a result, we had to move to Maryland... much to my happiness :) I will be starting my new job as nurse in the hospital I used to work in as a nursing assistant. I'll start off in the Ambulatory Surgery Department (my old department) and eventually will transfer over to the PACU (recovery room) as my permanent position.
Even though I had so many great stories and experiences working as a Telemetry nurse, I'm sure my new job will be just as exciting and educational. One things for sure... I'm not going to miss having 5-6 patients per shift :P LOL.
Well, as a update, I ended up working on the nigh shift for about 4 months. It was great! I learned a lot and had so many experiences I wish I was able to share. They definitely made me a better nurse and I was lucky to work with an awesome group of nurses.
As of now I am in between jobs. My husband ending up getting a full-time job in northern Virginia, near the MD/VA border. As a result, we had to move to Maryland... much to my happiness :) I will be starting my new job as nurse in the hospital I used to work in as a nursing assistant. I'll start off in the Ambulatory Surgery Department (my old department) and eventually will transfer over to the PACU (recovery room) as my permanent position.
Even though I had so many great stories and experiences working as a Telemetry nurse, I'm sure my new job will be just as exciting and educational. One things for sure... I'm not going to miss having 5-6 patients per shift :P LOL.
Thursday, November 11, 2010
L'eau du Mucomyst
Having worked in a hospital environment for so long, I've become accustomed to many of the odors and scents that might offend people not used to them. I rarely become nauseated or sick from the many "wonderful" smells that diffuse throughout the hospital.
I've only every also vomited from a smell in the hospital...
1) During nursing school, I was following an ICU nurse for the day who had patient with vaginal cancer and all sorts of GYN problems. Apparently she was having drainage from her hoo-ha which was nasty and foul of smell. When we turned the patient to change out the pad from underneath her (she was unconscious and on a ventilator), I almost passed out from the smell. I've since blocked it from my memory. Luckily, I don't come across patients with this condition in my department.
2) Mucomyst. How I hate the word. If you've ever given this medication that you know what I'm talking about. It's a liquid that patients drink, usually before a procedure that requires a dye to be injected into their bloodstream. The mucomyst helps to protect one's kidneys, especially if their kidneys aren't functioning properly. Well, the medication smells like rotten eggs!!! Profusely and strongly!!! I feel so bad for people who have to drink it. Even though it's usually mixed with some flavored drink (apple juice, gingerale, etc) there's just not masking the smell of drinking down rotten eggs. I honestly don't think I'd ever be able to get it down. So yesterday, I was extracting the liquid from the vial it comes in with a needle and syringe and I accidentally (because what crazy would PURPOSEFULLY want to get this on them) spilled some of the stuff on my hands. It took a lot of washing and sprays of deodorizer to finally get the scent off me. Even then, I still smelt it lingering occasionally. Gross. I seriously almost puked in the med room sink! Then today, as fate would have it, my patient needed a final dose before her procedure. As I was taking the vial out from our Pyxis, it fell out of my hand and shattered on the floor. It was like someone had dropped a giant stink bomb in the med room!!!!!! The worst!!!! Luckily, our unit housekeeper could smell the stink all the way down the hall and came to clean the smell up.
*sigh* I'm sure I'll never live this down! I just don't understand WHY anyone would ever create a medication that smelled sooooo horrible and expect people to drink it! If I never have to give another dose of Mucomyst, it'll be too soon :P
I've only every also vomited from a smell in the hospital...
1) During nursing school, I was following an ICU nurse for the day who had patient with vaginal cancer and all sorts of GYN problems. Apparently she was having drainage from her hoo-ha which was nasty and foul of smell. When we turned the patient to change out the pad from underneath her (she was unconscious and on a ventilator), I almost passed out from the smell. I've since blocked it from my memory. Luckily, I don't come across patients with this condition in my department.
2) Mucomyst. How I hate the word. If you've ever given this medication that you know what I'm talking about. It's a liquid that patients drink, usually before a procedure that requires a dye to be injected into their bloodstream. The mucomyst helps to protect one's kidneys, especially if their kidneys aren't functioning properly. Well, the medication smells like rotten eggs!!! Profusely and strongly!!! I feel so bad for people who have to drink it. Even though it's usually mixed with some flavored drink (apple juice, gingerale, etc) there's just not masking the smell of drinking down rotten eggs. I honestly don't think I'd ever be able to get it down. So yesterday, I was extracting the liquid from the vial it comes in with a needle and syringe and I accidentally (because what crazy would PURPOSEFULLY want to get this on them) spilled some of the stuff on my hands. It took a lot of washing and sprays of deodorizer to finally get the scent off me. Even then, I still smelt it lingering occasionally. Gross. I seriously almost puked in the med room sink! Then today, as fate would have it, my patient needed a final dose before her procedure. As I was taking the vial out from our Pyxis, it fell out of my hand and shattered on the floor. It was like someone had dropped a giant stink bomb in the med room!!!!!! The worst!!!! Luckily, our unit housekeeper could smell the stink all the way down the hall and came to clean the smell up.
*sigh* I'm sure I'll never live this down! I just don't understand WHY anyone would ever create a medication that smelled sooooo horrible and expect people to drink it! If I never have to give another dose of Mucomyst, it'll be too soon :P
Quote of the Day: "Does it go in the mouth or penis?"
My patient today had to have an EGD (esophagogastroduodenoscopy); and yes, I spelled that by memory after having to spell it a million times working as a nursing assistant in a surgical department.
As the story goes, before the doctor could explain how the procedure works, the father of my patient asks "Does it go in the mouth or the penis?". My preceptor and I almost died laughing inside, but tried to keep a professional appearance. The doctor replied by telling both the patient and his father, "Oh no. If they go near your penis then let me know. I'll punch them for ya"... he was a male doctor, so I'm sure he could empathized with the thought of his manhood being threatened.
If you've ever had an EGD or work in the medical field then you'll know that is a procedure where the surgeon places a tube aka a "scope" down your MOUTH to see into your esophagus/throat(esophago), stomach (gastro), and junction of the stomach and small intestines (duodeno). It by no means goes anywhere near your penis!!! That would be a ureteroscopy or if the doctor needed to take a look into a patient's bladder and ureters. My patient's penis, bladder, and ureters were completely fine!
Well, it's just one of those events that makes nurses and doctors smile, giggle inside, and laugh out loud when discuss amongst each other :) Totally made my day!
As the story goes, before the doctor could explain how the procedure works, the father of my patient asks "Does it go in the mouth or the penis?". My preceptor and I almost died laughing inside, but tried to keep a professional appearance. The doctor replied by telling both the patient and his father, "Oh no. If they go near your penis then let me know. I'll punch them for ya"... he was a male doctor, so I'm sure he could empathized with the thought of his manhood being threatened.
If you've ever had an EGD or work in the medical field then you'll know that is a procedure where the surgeon places a tube aka a "scope" down your MOUTH to see into your esophagus/throat(esophago), stomach (gastro), and junction of the stomach and small intestines (duodeno). It by no means goes anywhere near your penis!!! That would be a ureteroscopy or if the doctor needed to take a look into a patient's bladder and ureters. My patient's penis, bladder, and ureters were completely fine!
Well, it's just one of those events that makes nurses and doctors smile, giggle inside, and laugh out loud when discuss amongst each other :) Totally made my day!
Thursday, October 14, 2010
Nursing Pains
I woke up two days ago with some pain in my right shoulder. I can't pin-point whether it's muscular or a pinched nerve. I'm leaning towards muscular because it hurts with range of motion movement. The worst pain is when I'm reaching across my chest and lifting my arm up and trying to touch my back. It was a pain (literally) to take off my scrub top today after work.
Growing up with a family of nurses, I've heard numerous body pain stories. From back pain to shoulder pain to feet pain.... you name it, a nurse somewhere hurts there! LOL. I don't know if the sore shoulder is because I slept on it wrong or pulled it during work, but it hurts. I'm only 25 and don't want to disable myself so early in life. My mom's warnings of "You only hurt your back once" and stress of proper body mechanics keeps coming to mind.
I know I've probably taken my body and youth for granted in the past, but this new pain has made the lightbulb go off. Bodily injuries can go hand in hand with nursing if you don't take care of yourself. We turn obese, immobile patients in bed. We wheel 300+lbs people in wheelchairs. We push beds that weigh twice our size. We run, jump, bend, and do cartwheels down the hall! HAHAHA. Okay, scratch the cartwheels, but many nurses have battle wounds and scars from years of physical labor. I really need to start taking better care of myself and watching out for my body... or else I might find myself in the wheelchair rather than the one pushing it :P
Growing up with a family of nurses, I've heard numerous body pain stories. From back pain to shoulder pain to feet pain.... you name it, a nurse somewhere hurts there! LOL. I don't know if the sore shoulder is because I slept on it wrong or pulled it during work, but it hurts. I'm only 25 and don't want to disable myself so early in life. My mom's warnings of "You only hurt your back once" and stress of proper body mechanics keeps coming to mind.
I know I've probably taken my body and youth for granted in the past, but this new pain has made the lightbulb go off. Bodily injuries can go hand in hand with nursing if you don't take care of yourself. We turn obese, immobile patients in bed. We wheel 300+lbs people in wheelchairs. We push beds that weigh twice our size. We run, jump, bend, and do cartwheels down the hall! HAHAHA. Okay, scratch the cartwheels, but many nurses have battle wounds and scars from years of physical labor. I really need to start taking better care of myself and watching out for my body... or else I might find myself in the wheelchair rather than the one pushing it :P
Tuesday, October 12, 2010
IV Push Can Be Scary!
Okay, so most aren't too bad to give and you literally just push the medication into the heplock access; like a Heparin IV boluses. A lot of medications given IV push, however, require the nurse to be aware of how many mg/min you administer. Example, 2mg of Diluadid (a pain killer) needs to be diluted with at least 5ml of normal saline and then pushed into to the IV over 2-3 minutes, PLUS you need to follow each IV push with an equal amount of a normal saline flush at the same rate.
How fast you push the medication can have ill effects on the patient. I remember from nursing school my instructor making a big deal about how if you give Lasix IV push too fast, you could cause your patient to go DEAF! That always stuck with me. I have yet to push Lasix, but I did have to push IV Dilantin last week.
Funny thing about Dilantin... it's suppose to help in preventing seizures, but if you push it too fast YOU COULD CAUSE YOUR PATIENT TO HAVE A SEIZURE!!! As noted from my preceptor, the previous day she gave the patient Dilantin push at a rate of 50mg/min. She got this rate from one of the drug handbooks on the unit. But our pyxis machine (holds and dispenses medications) warned to administer at a rate of 25mg/min. When I asked my preceptor, which rate I should use she said, "Let me put it this way, after I gave the patient Dilantin yesterday, she had a mild seizure". WTF?!?! Well, that made up my mind. Even though it was going to take me 8 mins to administer 4mls of this med PLUS another 8 mins to flush with normal saline, I didn't want to risk my patient having another seizure! It seemed like the longest 16 minutes ever!! Thankfully the patient was not alert or oriented (her brain had been fried after being in a diabetic coma for 2 days), and THANKFULLY she did not have a seizure!! Let me tell you though, every time she twitched her legs I prayed "please don't seize! please don't seize!"
Well, that was one of the more interesting (to say the least) medication administration experiences I have had. I'm sure there will be plenty more to come! Just wait for the day when I have to push Adenosine... that should be quite the story, as it would be for anyone :P
How fast you push the medication can have ill effects on the patient. I remember from nursing school my instructor making a big deal about how if you give Lasix IV push too fast, you could cause your patient to go DEAF! That always stuck with me. I have yet to push Lasix, but I did have to push IV Dilantin last week.
Funny thing about Dilantin... it's suppose to help in preventing seizures, but if you push it too fast YOU COULD CAUSE YOUR PATIENT TO HAVE A SEIZURE!!! As noted from my preceptor, the previous day she gave the patient Dilantin push at a rate of 50mg/min. She got this rate from one of the drug handbooks on the unit. But our pyxis machine (holds and dispenses medications) warned to administer at a rate of 25mg/min. When I asked my preceptor, which rate I should use she said, "Let me put it this way, after I gave the patient Dilantin yesterday, she had a mild seizure". WTF?!?! Well, that made up my mind. Even though it was going to take me 8 mins to administer 4mls of this med PLUS another 8 mins to flush with normal saline, I didn't want to risk my patient having another seizure! It seemed like the longest 16 minutes ever!! Thankfully the patient was not alert or oriented (her brain had been fried after being in a diabetic coma for 2 days), and THANKFULLY she did not have a seizure!! Let me tell you though, every time she twitched her legs I prayed "please don't seize! please don't seize!"
Well, that was one of the more interesting (to say the least) medication administration experiences I have had. I'm sure there will be plenty more to come! Just wait for the day when I have to push Adenosine... that should be quite the story, as it would be for anyone :P
Saturday, October 9, 2010
Keep Holding On
Wow, I can't believe I'll be going into my 4th week (a month!) as a nurse. I don't think it has fully hit me that I'm a NURSE! I think it might be because I'm still orienting and feel as if there is sooo much still to learn.
I love my job and while nursing is hard and not for everyone, I think it's one of the most rewarding jobs out there. As a nurse you are constantly learning, evolving, and growing. Not only do you learn new things everyday, but get to meet new people too.
This past week I had a patient who really stands out in my memory. She was a lady who had suffered from a diabetic coma for two days before anyone knew and found her. It's amazing that she was even alive. In layman's terms, she's a diabetic and her blood sugar reached dangerously high levels that she passed out due to dehydration; too much glucose surrounds the cells and the concentration gradient causes water to be pulled out of the cells in an attempt to balance things. This extra water is excreted by the kidney out of the body as urine. In this dehydrated state, cells such as brain cells cannot function and eventually lose the ability to function.
The result: my patient is not alert or oriented. While she opens and closes her eyes when she's not sleeping, she is in a constant far off gaze. She doesn't follow you with her eyes as some stroke or brain trauma patients do. She doesn't respond to painful stimulus. She doesn't talk or move voluntarily. She has trach in her throat because she cannot consciously get rid of the sputum/spit that builds in her throat. Likewise, she cannot chew or swallow so she has to receive nutrients and medications through a PEG tube (a tube that goes into her stomach). What a life. And will she ever get better? I believe that miracles do happen, but logic and statistics argue differently.
But she IS still alive. Parts of her brain still function to keep her breathing and her heart beating. She is still a person; a human being. And as a human being deserves to be treated with dignity and respect. Even though her random movements and jerking of her arms and legs, her opening of her eyes and yawning give her family hope, it's sad to think that that's all it could be. Just hope.
As a nurse, you are trained to think critically and logically. We work in a field driven by medicine and science. Yet, we also deal with issues of culture, emotions, and spirituality. We deal with life. And even though my education tells me that this woman will always remain in this flaccid state of limbo... those rare moments when she smiles at me also give me hope :)
I love my job and while nursing is hard and not for everyone, I think it's one of the most rewarding jobs out there. As a nurse you are constantly learning, evolving, and growing. Not only do you learn new things everyday, but get to meet new people too.
This past week I had a patient who really stands out in my memory. She was a lady who had suffered from a diabetic coma for two days before anyone knew and found her. It's amazing that she was even alive. In layman's terms, she's a diabetic and her blood sugar reached dangerously high levels that she passed out due to dehydration; too much glucose surrounds the cells and the concentration gradient causes water to be pulled out of the cells in an attempt to balance things. This extra water is excreted by the kidney out of the body as urine. In this dehydrated state, cells such as brain cells cannot function and eventually lose the ability to function.
The result: my patient is not alert or oriented. While she opens and closes her eyes when she's not sleeping, she is in a constant far off gaze. She doesn't follow you with her eyes as some stroke or brain trauma patients do. She doesn't respond to painful stimulus. She doesn't talk or move voluntarily. She has trach in her throat because she cannot consciously get rid of the sputum/spit that builds in her throat. Likewise, she cannot chew or swallow so she has to receive nutrients and medications through a PEG tube (a tube that goes into her stomach). What a life. And will she ever get better? I believe that miracles do happen, but logic and statistics argue differently.
But she IS still alive. Parts of her brain still function to keep her breathing and her heart beating. She is still a person; a human being. And as a human being deserves to be treated with dignity and respect. Even though her random movements and jerking of her arms and legs, her opening of her eyes and yawning give her family hope, it's sad to think that that's all it could be. Just hope.
As a nurse, you are trained to think critically and logically. We work in a field driven by medicine and science. Yet, we also deal with issues of culture, emotions, and spirituality. We deal with life. And even though my education tells me that this woman will always remain in this flaccid state of limbo... those rare moments when she smiles at me also give me hope :)
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