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

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!

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

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

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 :)

Hi, I'm a new nurse... will you be my pin-cushion?

Today I got to practice one of the most essential skills you will learn as a nurse = starting an intravenous (IV) line. I've seen what seems like millions started at my previous job as tech on an Ambulatory Surgery unit. It was the nurses' job to insert an IV catheter into a patient's vein prior to their surgery. This IV access is then attached to tubing connecting the patient to an IV bag filled with saline solution and electrolytes. This allows patients to stay hydrated and gave nurses access to administer medications without re-sticking a patient.

While the task may look easy enough... just find a vein and let'em have it... its not. Some veins roll; some are not long enough to accommodate the length of the catheter; some are really, really, really, REALLY tiny; and some are just dried up and busted. Ideally, you want to use a vertical, straight vein that runs parallel to the arm. No horizontal or squiggly lines for this nurse :P

So I got to shadow a nurse at my hospital's peri-op area (where patients get ready for surgery). I first watched her start 2 IVs and then it was my turn from then on. I actually got in on my FIRST try!!! Yay!! I swear, only nurses get excited when they see the flashback of blood in the catheter hub... kinda like getting excited over urine flow when inserting a foley catheter :P Anyways, I think my initial success was beginner's luck as my next try was not as successful. The vein kept rolling. After my second attempt, I gave the task over to the nurse. The next patient I saw didn't want a new, inexperienced nurse doing her IV. She said that she was a "hard stick" and I respected her decision. I know she didn't want to be mean and in all honesty, no one wants to be a pin-cushion. I always stick to the assertion that patients know their own bodies the best, but they also have to trust their nurses and doctors. In this case, I knew that I was inexperienced and was more likely to have missed. My third attempt was also unsuccessful. I thought I had a nice, juicy vein, but I think it was too short or I hit a valve (aka brickwall). Either way, I accidentally busted the vein :/

Well, I ended my time on a good note. My last attempt was a success. Quick and easy :) So I'm 2 for 2 right now. Not too bad for a newbie according to my educator! I know that as I start working on my actual unit I'll have TONS of opportunities to start IVs, whether it's for new patients being admitted onto to the unit or crazies pulling their IVs out. Luckily, as the saying goes... practice makes perfect!

Orientation...

... should I say re-orientation. This started off my orientation to a new hospital and a new job as a registered nurse. After graduating from nursing school, I have to honest and admit that I procrastinated a bit. I waited almost 2 months before taking the NCLEX (nursing licensure examination or the nursing boards). Luckily, I passed! Thank god too because I never want to relive that nightmare. Everyone always says that it's the hardest test you will ever take as a nurse; it is! Everyone always says that they walked out thinking that they failed; you do! And everyone is ridiculously thrilled when they learn that they passed; you are! Obtaining my license in the mail was one of most happiest and proudest moments of my life.

I consider myself among the luck/blessed new grads that found obtaining a job easier rather than harder. I was able to score 3 interviews at 2 different hospitals. I got accepted to work as a telemetry nurse in a small, local hospital. In layman's terms, I work on unit and with patients who have heart complications (post-heart attacks, chest pain, congestive heart failure, etc) and are hooked up to heart monitors while they are being hospitalized. Oh, and I'll be working the night shift = 7pm-7am :)

So this week was my orientation week. I spent three days in a hotel conference room with other new hires from 3 different hospitals under one health system. We learned about the health systems mission, policies & procedures, views towards health case, as well as received information on medical benefits, retirement plans, etc. It was fun meeting new people, but the material and powerpoints were extremely boring. Plus the hotel was freezing. I just kept reminding myself that I was getting paid to be there and at least we got a free lunch.

Today was my first day orienting to the hospital on-site. I also FINALLY felt like a really nurse! A newly graduate nurse, but all nurses had they feeling at some point in the beginning of their career. Even though the majority of the day was spent going over more policies and procedure, I was excited and anxious for the first time since getting hired. It hit me that 1) I'm going to be responsible for 4-6 human lives during my shift, 2) I could easily kill a person as I could save them, and 3) I'm alone in a new hospital. Well, not completely alone. I made a friend with another nurse who I will be working with. I can only hope/pray that 1) I don't kill anyone and 2) I learn to love this new job/life as much as I loved the former hospital I worked in.

Well, I guess only time will tell. Tomorrow is my second day orienting to the hospital. More computer education, a medication administration test, and orientation to my actual unit :) I can only hope that my new co-workers like me *fingers crossed*