Funny Thought for the Day

So, to check orientation of all of our patients when doing our assessments, we have to ask each patient three main questions: Their name, where they are, and what time/date it is. Well, with my younger middle aged patient with something simple like Cellulitis or an earache, I usually skip over this and assume, from my normal conversational interactions with that patient, that they know who they are, where they are and what day it is. Just a hunch.


So it then becomes a matter of where do you draw the line? Is there an AGE where I should assess or not assess for orientation? Is there a diagnosis?

I really think it just depends, its different for every patient. Granted, the older the patient, the more likely I am to check for orientation right off the bat. Some people fool you pretty easily, they are having a full fledged normal conversation with you and you think they are oriented, until you ask them what month it is and they say its February when really its August. And its 1982.

So the other night, I got a new patient under my care. She was elderly, but with her husband. She seemed to be pretty with it but on the verge pretty forgetful. So I decided to definitely check for assessment. This is how it went down:


Me: "This is going to sound pretty silly, but I have to ask, Can you tell me your name?"

Patient: " Mrs. IKnow MyName"

Me: "Okay good, Can you tell me what day it is?"

Patient: "It was just Thursday, but now its Friday."

Me: Okay good. Can you tell me where you are?


Patient:   "Yes."


Me:  ...........


Patients Husband:  "Dearest, I think she wants you to tell her where you are."

Patient: Oh! I thought you just wanted to know if I knew where I was. I know where I am.

Me:    ...........


Patient: ....... I'm in ThisLovely Hospital........ *looks around at everyone*, Right?




*sigh*


~ WNB

Sheer Brilliance

So I have this 86 year old patient. When I first got her a couple days ago, I thought she was a little..."slow", because she never talked, didn't listen to us, did whatever she wanted to do, was confused, and kind of had a constant "dazed and confused" look to her. But after spending a couple of nights with her, I realize she's actually remarkably sharp.


We put her as a fall risk because my hospital flips out if anyone falls and we do everything we can to prevent falls. So basically even if you're 20 and in for the night, we'll find a way to peg you as a "fall risk". But regardless- This little lady was the epitome of what a fall risk should be. Confused, elderly, likes to pull her IVs out, unsteady on her feet, gets up on her own without calling, etc. Complete, high fall risk. So our hospital standard protocol is to put these little alarms on these patients that ring pretty loudly if it releases from the patient (i.e. the patient got up from the bed). The alarm is done by a string (old school) and is connected from patient to bed.

The alarm definitely worked for a couple days. It went off so many times that I was beginning to hear that tune in my sleep off-shift. But she was so active that there were times when we found her flying free around the room without the alarm having gone off because it wasn't put on. So even though we could see she was definitely getting her strength back and she was walking OK around the room by herself, we still wanted her to be a high risk because well......see above. We like everyone on fall precautions.



Well, last night I had to hand it to her. When I first got on shift, (literally- first five minutes), she was found sitting naked on the side of her bed, pulled IV out, took her heart monitor off. And she's smiling. Cool.

We asked her if she had to go to the bathroom. She shook her head no, said she just went. Also, cool. So we got her alllll situated back in bed, tucked in, comfortable and Definitely put that bed alarm back on. Securely. For sure.

Despite  the fact that she was forgetful and I was pretty much talking to Dori, I felt like it was worth trying. I sat down with her and slowly explained to her the importance of calling for help before she goes to the bathroom and we will come help her get up, etc. We shook on it and made a deal.


Well, go flippin figure, next time I come to check in on her, where do I find her?

In the bathroom. 

Why didn't the *trusty* bed alarm go off?

Because she unvelcroed it from the bed, and was holding the entire thing in her hand, so that the alarm wouldn't go off. Sitting on the toilet.


As mad as I was that she figured all of that out, I had to hand it to her. Never in all my six years of being in the healthcare field have I *ever* seen someone dismantle a bed alarm, nonetheless a confused elderly 86 year old. I have seen many many people take the clip off of themselves and keep the bed alarm at the bed so it wouldn't go off,which is smart, yes, but easy to figure out. But to take the whole thing off the bed is really thinking outside of the box.  I was truly impressed. I didn't even know she knew where the bed alarm even came from. But I still tried to act semi-responsible and mad. Kind of like a parent that is shocked his kid did something totally kick-ass awesome even though its totally not a good idea.


Thats all today. That was definitely the highlight of the night. In case you're curious, she actually behaved after that incident and actually sang multiple songs for us from her bed, all night. Not sure if she sleeps, ever. At all.





With love,

~WNB


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Interesting Request

So today I had this male elderly patient.

For some reason, he was perfectly content with finding it necessary to scream for no apparent reason...all the time.

However, simple, short & sweet conversation was, to some extent, still possible.

So today I'm taking vitals on everyone on my floor. I had a full house on my side, so I was pretty busy. He was my last room to stop in, but when I drove my little cart by, he was....you guessed it--screaming. So yay me- decided I might as well go in then and do his vitals and then hopefully tuck him in and he can sleep.

Well, I talk to him, announce I will be doing his vitals and accucheck, and he responds with telling me he peed. All over the bed.

Fantastic! Awesome. Truly, truly great. So I go ahead and get everything I need to get him back to a dry state. Well, since I was alone, and he wasn't too interested in helping me, It was up to me to roll him on his side by myself. However, with every little ounce that I moved him, regardless of if it was to roll over or to simply pick his hand up, he screamed. I had the door closed for his privacy but I was beginning to wonder if people outside would falsely wonder if I was abusing him since he was screaming so much! But, I figured- the actual abuse would be if I let him sit in his pee, right? So I kept changing him, despite the hollering. And the hollering truly didn't make any sense. I would ask him what was wrong and he would just look at me.

So eventually I finished. Barely. I did his vitals. Accucheck. Tucked him in his newly dry sheets. I said goodnight. I turned to leave the room, and I hear....

"Wait!"
Me: "...Yes?"
"I should scream louder."




yes. Yes, that is a fantastic idea. Because I'm pretty sure the next wing over can't yet hear you but if you keep screaming, maybe, just maybe- they might be able to.


And the best part is I have other patients. I am in one of the other rooms at another point, and she tells me, "Oh-I like this hospital a lot, I mean- You guys are great. But there is this poor old man screaming across the hall and that is just not right. I mean I'm sure you go and help him but why are other people just letting him scream? Shouldn't people be helping him? Does he need help? Are you guys just letting him suffer? That is just not right."

I just sort of stared at her and politely explained that yes, we are in fact taking very good care of him but actually, in fact, he really just fancies screaming if we go so as far to prick his finger for an accucheck reading.



*sigh*.



Its the nursing life.

~WNB

LOL.
Taken from This Funny Place.

The Hall of Beer

Ahh, where have I left off!? I have not been able to find ANY wifi lately, so I am typing my blogs as I go so they are fresh in my mind, and then copying them into blogger whenever I can reach wifi, hopefully soon! Therefore, you may find a lot of blogs up all at once. Oh well.

Anyway, I think I left off finishing our night in Heidelberg? Yes. Next day, we were on the road again to Munich, Germany! I was pretty excited because I had heard a lot of good things about Germany, especially the baroqueness of Munich and how beautiful it was…. As a photographer, many of my friends told me I would love it there. And I did, it was nice, for pictures. We ended up getting there way later than expected because of an unfortunate traffic jam, so we missed an opportunity for another bike tour through Munich. So we were at least able to enjoy about an hour of daylight in Munich, walking around the streets.

Some street shots:

We all turned the corner and were sort of just like....woah.

I tried really hard to capture this girl posing all tres chic on her bike, but this was the best I could do...

Special moment! On the subway ride into Munich from our hotel, I got separated from my group of friends. So I sat alone and then random local germans started sitting around me, which I didn’t mind of course—I just stuck to myself and didn’t say a thing. Which was funny, because my friends were all speaking English to each other (obviously) and I wasn’t speaking to them, or listening, so no one could really tell I was an American. So then this old lady enters the subway, and is having a hard time walking. I didn’t notice this until someone next to me gave up their seat so she could sit down, which was so nice. But then for the next 25 minutes I could feel the lady staring at me, intermittently. But it wasn’t an intense stare, it was more of a curiosity stare. I think she was trying to figure out where I was from. After the end of the subway ride, and after I got up, I realized she was still having trouble standing up from her chair. Now this reaction is only natural, as I work with the elderly all the time at work, so I leaned in to help her stand and helped her walk safely to exit the train, and then said goodnight and she smiled. She didn’t need me anymore and so I caught up with my friends. Then I turned behind to look if she was OK, and she came up to me, and spoke a long phrase in german. Due to the fact that I only know how to say “Hello, thank you, excuse me, sorry, etc.”, I obviously didn’t get any of that. So I had to make a really sad face and shrug and say, “English” and pointed to myself. She was sad too, and smiled and walked away to exit the station.  Turns out, two of my friends speak some German for their Opera training, and they told me that she said, “Thank you, Love.”  So sweet!!!! Ahh! Special moment indeed!

A small group of friends and I were then starving. I started to notice that the people of Munich were a lot more “Sketchy” than any other city we had visited prior, even more so than New York City. As dark approached, men outnumbered women on the street, and then men were teenagers to about age 35-40, and all really not trustworthy-looking. Everyone looked at us as if they were waiting for their moment to launch—Looking at the “American” tourist women. So I wasn’t really a huge fan. Being so, I decided it was definitely best if I stuck with my friends that night, regardless of what we would be doing. We decided to grab dinner in one of Germany’s (and certainly Munich’s) most famous “Biergarten", where its just this gigantic hall of wooden tables, and you just sit down and they bring beer to you as if it were the bread before a meal, and then you order food. In case you are having trouble visualizing this, picture walking into Gaston’s bar from Beauty and the Beast, where its loud and rowdy and all the men are clanging their beer glasses together for a toast, and singing, lots of singing. Another friend of mine described it further as the opening scene to Lord of the Rings, but I cannot verify this as I don’t really follow it. So, it was definitely a fun atmostphere. The menu was completely in German and no one in the whole place spoke English, so it was pretty much up to us to just try and pronounce what we wanted over the rowdy hall. It was interesting. We all got served a huge liter of beer. Lets review the fact that being that I don’t drink often, I especially don’t drink beer. I’ve had It once or twice and wanted to spit it out, its just undesirable to me. I’ve heard it gets better after a few, but I had my doubts. However, I ordered a little bit more “girly” version of beer and it was called, “RaBn” pronounced “Rassen”, and it was a mix of beer and lemonade. Suprisingly enough I was able to finish the entire liter by myself, even it took me as long to finish that as it took my friends to finish three. But regardless, I was still pretty surprised I finished. When I looked at it when it came, I certainly didn’t think I would be making a dent. I didn’t even want beer but you are sort of shunned for not getting beer in a beer hall! But it was funny because even after a liter, nothing changed. I expected to fall over when I stood but nothing was any different.

This was after I had 1/4 of it to drink! This is a lot bigger than it looks.

The Ceiling...so cool....

Everyone else then decided to hit a few more bars for the night but I honestly can’t keep up with all the drinking so I decided to split off with a separate group (another couple) and we went off for some German ice cream, and went to this music festival that was actually city wide! It is a festival that goes every Saturday night, and lasts a month long. Every month they change what they celebrate. This Saturday it was the “Night of the Music”. Five tours went separately in different ends of the city and made up to 20-30 stops at local cafes/clubs where different types of bands were playing. Our first area was in a small corner underground of Munich and it was swing dancing! All of the sudden we left the streets of Munich and found ourselves transported in time. It was just like out of a movie, old fashioned swing singer, old and young couples swing dancing with perfection….it was surreal. We then went to a collection of other cafes and heard some lovely different types of music and really got to see the atmostphere of Munich.

Swing dancin' :-)

And then we totally navigated the subway system by ourselves on our way home! This is an accomplishment for me. And its funny because when on that subway, this older gentleman comes up to us, and is like, “You’re American? I’m from Manhattan.” And we were like, “Yes!” And it was funny because I told him Manhattan subways were so much harder, and he said that actually Munich as harder. So, not sure on the level of hardness of public transportation in Munich.

Tomorrow we travel to Innsbruck, Austria (In the swiss alps!) on our way to VENICE, Italy!!! So excited!

~A Writer in a Nurse’s Body

PS- my spellcheck here is only in Switzerland mode so these are not spellchecked. Sorry for my grammar loving friends!!! :(

An Elder Funny

Things have changed a lot at my job over the last five years. The patients have changed, technology has changed, medical practice has changed, paint on the wall has changed, our carpeting has changed, family member types have changed, languages we speak have changed....among many more. And it's our job to just sort of roll with the flow.

Well there is one change I have noticed- increasingly present over the last year- that tickles my funny bone.

The geriatric population that I take care of now is now just as attached to their cell phones as the younger generations. Not only am I seeing 80% of my 80+aged patients with cell phones on their table, (or in their bed), but they charge them too. Now at bedtime, after the dentures come out, the cell phone gets plugged in, too.

Yesterday I had spent a little while with a patient and was just about to leave the room when she said, "wait!" I turned around, "yes?"

"can you bring me my cell phone from my bedside table?"

Not only that, but these aren't just cell phones. They are iPhones. And blackberries. Droids. And other really nice phones. They are attached.

In today's day and age, I'm not sure why I have noticed this change. Is it that when cell phones became popular, the 80 year olds now were then 70s and wanted a phone?

My guess is that its the cell-phone addicted children of these elders that are responsible for the change. I think the elders could get by without ever having had a cell phone. It's the children, the middle aged children that are so dependent on their cell phones that it makes them feel insecure and crazy that they can't just call their parents, wherever they may be. So they buy mom and dad a cell phone and teach them how to use it, and then they become dependent on them too.

I just laugh at the thought of what the generation of today, ages 15-40, what technology we will be bringing with us to the hospital. I've already seen laptops, a couple iPods...what else is next? Interesting funny. :-)

~WNB