Friday, November 18, 2011

Every spoon has "poo" in the middle

As sometimes happens in nursing, I had an inordinately poo-filled night. And I wasn't the only one. It seemed like all the patients on the unit planned ahead and saved up their best contributions for last night.

If I wasn't cleaning poo, or testing poo, or documenting poo, or helping move a patient so they could be cleaned of poo, I was listening to the other nurses talk about their tips and tricks for dealing with poo.

At one point, while I was scooping a sample of poo into a specimen container with a plastic spoon, my imagination went a little overboard. And my brain said, "I'm never eating chocolate ice cream again."

Well, screw you, brain! You're not the boss of me, and I won't take that kind of mandate from a two pound lump of self-justifying grey matter. I'm having a chocolate fudge brownie sundae for breakfast, and there's nothing you can do about it.

Tuesday, November 1, 2011

Critical hit

I have my permanent placement! I am now a staff nurse in the critical care stepdown unit. I've had a few shifts there already, and so far, it's a blast.

On this unit I have only two or three patients at a time, instead of the six on the pulmonary floor, but I'm still exactly as busy. It's just a different kind of busy. The patients are more acutely ill here, so they need closer monitoring, and their care usually has more complex technical requirements.

For instance. One of my patients today had an arterial line hooked up to a transducer for constant monitoring of her blood pressure. She needed that because she had been admitted for hypertensive crisis-- a blood pressure of 230/118 (which can be described as scary high). We were giving her a constant infusion of nitroglycerin to lower that pressure, but dropping it too quickly could interrupt blood flow to the brain, which would be a bad thing. So every N minutes I had to check the trend line of her BP measurements, and titrate the infusion rate slightly up or down to keep her pressure in the target range ordered by her physician. Similarly I had to titrate another drip based on heart rate to keep her cardiac output up, and a third based on blood coagulation tests to prevent stroke. That's not to mention diuretics to remove excess fluid, an hourly tally of urine output, electrolyte runs to counter a side effect of the diuretic, and the obligatory O2 cannula and monitoring of her oxygen saturation. Et so forth and cetera.

And my patient in the next room had his own set of completely different issues.

Overall it was a very busy day, but I think it's a kind of busy that suits me well. I'm picking up the technical skills really quickly. Once I figure out exactly how the policies and schedules differ, and modify the timing habits I developed on med/surg, I think I'll have a really good handle on the job.

Oh, and about that skills assessment I had to do a little while back? The one all new grads are expected to fail? I aced that sucker. Go me.