So I had this very elderly lady last night. She was having some difficulty urinating, but yet wasn't showing much on the bladder scanner and didn't give out much when we straight cath'd her (put in a very temporary catheter just to extract urine). She then felt it necessary to also remember she hasn't had a bowel movement in a week. Problem solved. Sometimes if you're anatomy is slightly strange and you're constipated and you're laying in bed a lot, your bowels can sort of impinge on your bladder, to make it easy. So new goal was to get her to poop. I knew I wasn't going to accomplish much medication wise with a closed pharmacy at 400 AM and an attending doctor that most definitely wouldn't want to be woken up at 400 AM with a request for a laxative.
So I decided to go with the good ol' fashioned.......prune juice! YAY!
I've heard the old age tale that it works best when you heat it up first. But It was 4 am and my brain wasn't working at full capacity, and when I was staring at the microwave and staring at my choice of cups, my brain couldn't remember which ones were OK to put in the microwave so I just decided to give it to her cold and call it a day.
So down goes the prune juice.
About an hour later, she presses the call bell. This is our conversation:
Patient: "That prune juice you gave me...."
Me: ".....Yeah?"
Patient: " It was cold."
Me: "Oh. Yeah. I'm sorry." *makes weird face*
Patient: "My husband heats it up at home and always gives it to me that way."
Me: "Oh...well next time we can heat it up for you."
Patient: "Actually, I've always hated it warmed but never had the heart to tell him because he was sweet enough to make it."
Me: "Oh.......so you liked the cold prune juice?"
Patient: "Yeah."
Me: "Okay........"
*Awkward moment*
Me: "Um, is that all you had to tell me?"
Patient: Yep.
As I was charting a little bit later into day shift outside her room, I overheard her telling the day nurse how glorious the prune juice was and I had to work really hard at stifling my laughter in the hallway. Thank you to the confusing microwave! o_O Win!
~ Another special nursing moment from WNB
.
10 + Years in Nursing In Medical Surgical, Women's Health, Telemetry and Informatics.
Monday, August 6, 2012
Saturday, August 4, 2012
Just Answer the Question
These can be the most aggravating types of assessments:
Me: "have you ever had an ulcer before?"
Patient: "well my grandmother did, on my maternal side. She died from that ulcer, then my uncles step-son lives near her in Alaska and had to take care of her cat because it had no where else to go and then that cat turned out to have diabetes and my brother had to give it insulin- you know what insulin is, right?- and then the cat ate this flower once so then my uncle couldn't buy flowers anymore."
"okay. But have you ever had an ulcer?"
Patient: "oh uh, no. My stomach is great. My friends aunt had stomach cancer though."
-_____-
Very nice people indeed, but when I have 110 questions to ask when admitting someone and they answer every question with a story that always circles back to a friend/aunt/uncle or CAT, you kind of just want to stick yourself with 100 units of insulin and call it a day.
Am I already jaded??!
:/
WNB
.
Me: "have you ever had an ulcer before?"
Patient: "well my grandmother did, on my maternal side. She died from that ulcer, then my uncles step-son lives near her in Alaska and had to take care of her cat because it had no where else to go and then that cat turned out to have diabetes and my brother had to give it insulin- you know what insulin is, right?- and then the cat ate this flower once so then my uncle couldn't buy flowers anymore."
"okay. But have you ever had an ulcer?"
Patient: "oh uh, no. My stomach is great. My friends aunt had stomach cancer though."
-_____-
Very nice people indeed, but when I have 110 questions to ask when admitting someone and they answer every question with a story that always circles back to a friend/aunt/uncle or CAT, you kind of just want to stick yourself with 100 units of insulin and call it a day.
Am I already jaded??!
:/
WNB
.
Friday, August 3, 2012
A Satan kind of Business
Yesterday I went to a hospital-sponsored "Birthday" breakfast, where employees get to sit at a breakfast table with the hospital CEO/CFO and some other important big-wigs. I have been employed at this hospital for what will be 6 years this August, and this is the first birthday that I've actually went.
We just hired a new CEO, and there have been mixed feelings about him. Normal, I suppose,when a new big wig comes to play, as this instantly makes people fear they will lose their job. A CEO has to really work in order to gain the trust from its employees.
So I wasn't sure what to expect from this "birthday breakfast" with the CEO....how many people would go? Would it be 1:1 time with the CEO? What would we talk about? Cupcakes? Breakfast? The weather? Monkeys? History? Rules? Africa? Eggs? Pancakes? Opinions?
We started off the breakfast with one of those "icebreakers" where we all had to share our name, how long we've been employed, what we do.....squishsquash like that.
Then we got into the real mishmosh, the nittygritty of things we've been wanting to hear about. When are we getting our raises back? Whats going to happen to the hospital? Are we going to remodel? Are our jobs secure? Everyone sits tensely in their seats, politely yet rebellious as a lion inside, ready to pounce, yet trying to behave. People get very tense when it comes to money and their jobs.
Lately our hospital census has been in the toilet, meaning we have not very many patients. This raises a lot of concern, being that without enough patients , we won't have enough money to sustain the business or pay our employees. So everyone has been nervous, so of course this issue was brought up with the CEO. His response is what really got me thinking.
He jokingly said, "I guess we gave out too many flu shots this year." People laughed quietly.
But what he said.....it's absolutely true, and yet it isn't true. True, we did give out a lot and they were effective. But we didn't give out "too many". We prevented a lot of people from getting sick this year, and it may have impacted our census, maybe it didn't.
But it got me thinking....running a hospital is like running a Satan business. We thrive, we depend on people getting sick or injured. When less people get sick or injured, our business suffers. We market our business just like any other type of business out there- We billboard and advertise on TV to get people to think of and choose us when they are sick or injured and need to choose an ER.
I guess the point I'm trying to make here is that, an ideal world would be if a hospital could support itself and its employees without depending on others suffering. It can't happen, I suppose, considering money doesn't just magically appear and fund organizations.
In my schooling, we learned about the growing concept that hospital patients were changing. In this present day and in the coming future, a typical hospital patient is a lot sicker than in the past. More and more illnesses and conditions are treated in the outpatient, long term care, clinic or home care setting. This is great for public health care but it could be why we are seeing a lower census as of late. Some of these sicker, long term hospital required care patients don't have insurance or insurance that is going to pay. Also, these patients aren't turning over the beds and are taking up space, draining the staff, etc. So its like the hospital administrations depend on the misfortune of the community to sustain itself, but we need you to get better quickly, so you can be a patient of ours, pay us and then leave so we can give your bed to the next paying patient. Like I said, its a Satan Kind of Business....
It's similar to the concept of warfare health care. Back in the days of surviving WWI and WWII, we learned and advanced so much in health care because of all the emergent practice we had on suffering soldiers. Suddenly we had patients that were going to die anyway if we didn't try something, so it gave surgeons and doctors of the age to experiment and practice....and sometimes save lives resultingly, sometimes not. But it taught and revolutionized health care. It's the concept of trial and error. It's yet another example of how health care thrives off the mass suffering off its population.
Yet this concept turns on itself. The more people that suffer and come in to the hospital, the more money the hospital makes. For non-profit organizations, such as mine- this allows us to then put the money back into the hospital, better machines, more nurses, better doctors, new units, more services, which all lead to safer, and better patient outcomes and satisfaction, which then leads to word of mouth in the community to others, which therefore leads to more money back into the hospital from others that are suffering. It's a cycle. A Satan cycle. A necessary cycle in the health care industry. A sad cycle.
I've had this post, this thought, stemming in my head for a long time, since June. I even had half of it written out but decided to halt the writing on it because I felt it was getting too political. I really know nothing about politics or finances. Nothing. I know that. All I know is nursing, nothing administration. All I know is what nurses see and how nurses are affected. So what prompted me to finally go through with this post? My unit, the smallest unit in the hospital, recently shut down last Friday along with the second smallest unit. At first we all thought it would just be the weekend. Tomorrow we will hit one week. All of us are on our toes. This is where a low hospital census hits home. My entire staff team is now orphaned, being sent out around the whole hospital, floated. It's miserable. We all want to be back on the unit we were hired too, the unit we have raised and grown to love throughout the past year.
The only, and I mean only, good thing about this sad misfortune, is that I am at least gaining experience on other units in my hospital. But I miss the familiarity.
Thats all for now folks,
~WNB.
.
We just hired a new CEO, and there have been mixed feelings about him. Normal, I suppose,when a new big wig comes to play, as this instantly makes people fear they will lose their job. A CEO has to really work in order to gain the trust from its employees.
So I wasn't sure what to expect from this "birthday breakfast" with the CEO....how many people would go? Would it be 1:1 time with the CEO? What would we talk about? Cupcakes? Breakfast? The weather? Monkeys? History? Rules? Africa? Eggs? Pancakes? Opinions?
We started off the breakfast with one of those "icebreakers" where we all had to share our name, how long we've been employed, what we do.....squishsquash like that.
Then we got into the real mishmosh, the nittygritty of things we've been wanting to hear about. When are we getting our raises back? Whats going to happen to the hospital? Are we going to remodel? Are our jobs secure? Everyone sits tensely in their seats, politely yet rebellious as a lion inside, ready to pounce, yet trying to behave. People get very tense when it comes to money and their jobs.
Lately our hospital census has been in the toilet, meaning we have not very many patients. This raises a lot of concern, being that without enough patients , we won't have enough money to sustain the business or pay our employees. So everyone has been nervous, so of course this issue was brought up with the CEO. His response is what really got me thinking.
He jokingly said, "I guess we gave out too many flu shots this year." People laughed quietly.
But what he said.....it's absolutely true, and yet it isn't true. True, we did give out a lot and they were effective. But we didn't give out "too many". We prevented a lot of people from getting sick this year, and it may have impacted our census, maybe it didn't.
But it got me thinking....running a hospital is like running a Satan business. We thrive, we depend on people getting sick or injured. When less people get sick or injured, our business suffers. We market our business just like any other type of business out there- We billboard and advertise on TV to get people to think of and choose us when they are sick or injured and need to choose an ER.
I guess the point I'm trying to make here is that, an ideal world would be if a hospital could support itself and its employees without depending on others suffering. It can't happen, I suppose, considering money doesn't just magically appear and fund organizations.
In my schooling, we learned about the growing concept that hospital patients were changing. In this present day and in the coming future, a typical hospital patient is a lot sicker than in the past. More and more illnesses and conditions are treated in the outpatient, long term care, clinic or home care setting. This is great for public health care but it could be why we are seeing a lower census as of late. Some of these sicker, long term hospital required care patients don't have insurance or insurance that is going to pay. Also, these patients aren't turning over the beds and are taking up space, draining the staff, etc. So its like the hospital administrations depend on the misfortune of the community to sustain itself, but we need you to get better quickly, so you can be a patient of ours, pay us and then leave so we can give your bed to the next paying patient. Like I said, its a Satan Kind of Business....
It's similar to the concept of warfare health care. Back in the days of surviving WWI and WWII, we learned and advanced so much in health care because of all the emergent practice we had on suffering soldiers. Suddenly we had patients that were going to die anyway if we didn't try something, so it gave surgeons and doctors of the age to experiment and practice....and sometimes save lives resultingly, sometimes not. But it taught and revolutionized health care. It's the concept of trial and error. It's yet another example of how health care thrives off the mass suffering off its population.
Yet this concept turns on itself. The more people that suffer and come in to the hospital, the more money the hospital makes. For non-profit organizations, such as mine- this allows us to then put the money back into the hospital, better machines, more nurses, better doctors, new units, more services, which all lead to safer, and better patient outcomes and satisfaction, which then leads to word of mouth in the community to others, which therefore leads to more money back into the hospital from others that are suffering. It's a cycle. A Satan cycle. A necessary cycle in the health care industry. A sad cycle.
I've had this post, this thought, stemming in my head for a long time, since June. I even had half of it written out but decided to halt the writing on it because I felt it was getting too political. I really know nothing about politics or finances. Nothing. I know that. All I know is nursing, nothing administration. All I know is what nurses see and how nurses are affected. So what prompted me to finally go through with this post? My unit, the smallest unit in the hospital, recently shut down last Friday along with the second smallest unit. At first we all thought it would just be the weekend. Tomorrow we will hit one week. All of us are on our toes. This is where a low hospital census hits home. My entire staff team is now orphaned, being sent out around the whole hospital, floated. It's miserable. We all want to be back on the unit we were hired too, the unit we have raised and grown to love throughout the past year.
The only, and I mean only, good thing about this sad misfortune, is that I am at least gaining experience on other units in my hospital. But I miss the familiarity.
Thats all for now folks,
~WNB.
.
Sunday, July 22, 2012
Another WIN for Therapeutic Modalities
Hello everyone! Sorry I haven't posted in approximately ten years. I have either been out of town, nothing to say/write, or just trying to find seconds to spare just to breathe. But there's no excuse! So look for a lot of upcoming posts. Many weeks of no posts= a lot of pent up thoughts waiting to escape into blog posts! Yay!
So this post stemmed from last night at work. Here's the situation:
My patient had a total abdominal hysterectomy approximately 2 days before she was under my care. Under report I learned that she had not had a bowel movement since surgery (but this is common with recent abdominal surgery), and that she has having a lot of bloating and pent up gas cramps/pain. When I first saw her, she was having some intense nausea. However she had just received a one time dose of morphine, which can very often cause some intense nausea, especially depending on how its given. She also received a PO (by mouth) dose of percocet (she was in a lot of pain). Percocet can also cause nausea. So I decided to give it a little while and told her I would come back.
Well, not ten minutes later is she throwing up, but not much. I still attributed it to the recent doses of narcotics and helped her clean up and decided just to keep an eye on it. However about thirty minutes later she was in intense nausea again, so much so that she couldn't stand up, and was vomiting. My mind started reeling....is there an obstruction? As with any abdominal tampering, its possible to get an unfortunate bowel obstruction. If severe enough, this would then cause anything that's in your intestines above the blockage to come out upwards because it has no where else to go. Keep in mind that she was promoted to a regular diet, just as of the previous day.
So keeping in mind the very real possibility that we were facing an obstruction and may be putting in an NG tube (this would drain out the contents from your intestines above the obstruction), I didn't want to scare her so I didn't even mention it yet. She was already having enough anxiety from her pain and nausea.
Then a thought occurred to me....I always try and put myself in patients shoes. I have had my own very extensive share of gastrointestinal problems and have a lot of experience with different therapeutic techniques, both with western and alternative therapy.
So despite the fact that I've been blessed enough to have never had abdominal surgery, I have had my fair share of "gas issues", especially thanks to my ever so lovely lactose intolerance. So I thought, what do I do for gas cramps/pain?
I went in the room and asked if anyone had taught her the "Left side trick". She looked at me strange because I pretty much made up that phrase on my own, but what else do you really call it in a quick bundle? She obviously said no and I then proceeded to have her lay on her left side and massage her entire abdominal wall in a clockwise motion, slowly and rather firmly (but not enough that it hurts). This follows the natural pathway of your intestines and helps guide the gas out the exit door, so to speak. If you're super lucky, it may even promote the probability of having a bowel movement, in addition to the gas passage increasing the then probability of a bowel movement.
So I had her concentrate on this technique, as I so often do when I'm in gas pain. I also encouraged her to take some deep breaths, and to remain on left side, while also in the fetal position. I find that in the fetal position, the pressure of your knees against your abdomen also helps guide things out the exit door, and....well, it "opens up" the exit door completely, making it that much easier to pass gas.
Now for the epic result?? I checked back in about thirty minutes after that education time, and I honestly didn't have much faith in my alternative non-medication therapies. I came in offering a powerful anti-emetic that she was now eligible to receive, but turns out? She was feeling much better already. Her nausea had receded slightly and the gas cramps were improving. Win!
Even more win, when I went to go to check on her in the middle of the night, I heard some unexpected news that she actually passed gas! Woot! She even managed to pass a very tiny (but one all the same!) bowel movement. Woo hoo! A + for non-medication therapies, for the win!
I couldn't believe it worked. I mean, I thought everyone knew that trick. I thought it was an old age wive's tale, or whatever they call it. I learned the trick in a mother-baby class in college, when we were taught how to alleviate gas in babies. I assumed it would work for adults, and its always worked for me and now for my patients too! :)
So, thanks for reading through a rather gaseous post.....it can be helpful if you also suffer at times! Who the heck doesn't??! Admit it. You probably just farted. Yeah, I just said fart.
Anyway, like I said, I'll try to post more upcoming! Stay tuned....
With Love, WNB
.
So this post stemmed from last night at work. Here's the situation:
My patient had a total abdominal hysterectomy approximately 2 days before she was under my care. Under report I learned that she had not had a bowel movement since surgery (but this is common with recent abdominal surgery), and that she has having a lot of bloating and pent up gas cramps/pain. When I first saw her, she was having some intense nausea. However she had just received a one time dose of morphine, which can very often cause some intense nausea, especially depending on how its given. She also received a PO (by mouth) dose of percocet (she was in a lot of pain). Percocet can also cause nausea. So I decided to give it a little while and told her I would come back.
Well, not ten minutes later is she throwing up, but not much. I still attributed it to the recent doses of narcotics and helped her clean up and decided just to keep an eye on it. However about thirty minutes later she was in intense nausea again, so much so that she couldn't stand up, and was vomiting. My mind started reeling....is there an obstruction? As with any abdominal tampering, its possible to get an unfortunate bowel obstruction. If severe enough, this would then cause anything that's in your intestines above the blockage to come out upwards because it has no where else to go. Keep in mind that she was promoted to a regular diet, just as of the previous day.
So keeping in mind the very real possibility that we were facing an obstruction and may be putting in an NG tube (this would drain out the contents from your intestines above the obstruction), I didn't want to scare her so I didn't even mention it yet. She was already having enough anxiety from her pain and nausea.
Then a thought occurred to me....I always try and put myself in patients shoes. I have had my own very extensive share of gastrointestinal problems and have a lot of experience with different therapeutic techniques, both with western and alternative therapy.
So despite the fact that I've been blessed enough to have never had abdominal surgery, I have had my fair share of "gas issues", especially thanks to my ever so lovely lactose intolerance. So I thought, what do I do for gas cramps/pain?
I went in the room and asked if anyone had taught her the "Left side trick". She looked at me strange because I pretty much made up that phrase on my own, but what else do you really call it in a quick bundle? She obviously said no and I then proceeded to have her lay on her left side and massage her entire abdominal wall in a clockwise motion, slowly and rather firmly (but not enough that it hurts). This follows the natural pathway of your intestines and helps guide the gas out the exit door, so to speak. If you're super lucky, it may even promote the probability of having a bowel movement, in addition to the gas passage increasing the then probability of a bowel movement.
So I had her concentrate on this technique, as I so often do when I'm in gas pain. I also encouraged her to take some deep breaths, and to remain on left side, while also in the fetal position. I find that in the fetal position, the pressure of your knees against your abdomen also helps guide things out the exit door, and....well, it "opens up" the exit door completely, making it that much easier to pass gas.
Now for the epic result?? I checked back in about thirty minutes after that education time, and I honestly didn't have much faith in my alternative non-medication therapies. I came in offering a powerful anti-emetic that she was now eligible to receive, but turns out? She was feeling much better already. Her nausea had receded slightly and the gas cramps were improving. Win!
Even more win, when I went to go to check on her in the middle of the night, I heard some unexpected news that she actually passed gas! Woot! She even managed to pass a very tiny (but one all the same!) bowel movement. Woo hoo! A + for non-medication therapies, for the win!
I couldn't believe it worked. I mean, I thought everyone knew that trick. I thought it was an old age wive's tale, or whatever they call it. I learned the trick in a mother-baby class in college, when we were taught how to alleviate gas in babies. I assumed it would work for adults, and its always worked for me and now for my patients too! :)
So, thanks for reading through a rather gaseous post.....it can be helpful if you also suffer at times! Who the heck doesn't??! Admit it. You probably just farted. Yeah, I just said fart.
Anyway, like I said, I'll try to post more upcoming! Stay tuned....
With Love, WNB
.
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