Morning Sniffles » rants

Gone to soon

morning sniffles — Tue, 20 Jul 2010 16:54:22 +0000

It was around 3:00 in the morning when Mrs. S’s condition has deteriorated.
We have just finished tranfusing another set of 6 units of platelet concentrate. She reported that she is having difficulty breathing and the pulmonary fellow on duty ordered for an IV push of Furosemide, a diuretic that was supposed to ease her pulmonary congestion.
She did not recover, the fellow ordered for an NIV or the Non-invasive ventilation but as the respiratory therapist was starting to set it up, it did not work immediately. While the RT was trying to jump start the machine, the fellow prompted us to prepare for an intubation. I wheeled in the crash cart in the patient’s room. Everything happened so fast. She crashed and so we called code blue.
Resuscitative measures brought her back and as we prepared for her to be brought down to the medical ICU, she crashed again. At that time, relatives have told the code team to stop. They want a DNR.
We let her go. I shook my head in disbelief.
She has just been diagnosed to have Idiopathic pulmonary fibrosis

Being hit the hard way

morning sniffles — Sun, 11 Jul 2010 07:56:39 +0000

I feel so sad to learn through a Twit from a friend that one of her fellow bikers was hit by an unruly car driver. The woman who hit the victim told the police that she actually saw the biker wave his hand to signal that he is going to take the shoulder lane but she did not mind to slow down. The biker was not seriously injured but suffered some bruises. Good thing that he is a member of the roadside assistance club that helped me pull through this serious accident.

The sports allowance

morning sniffles — Sun, 11 Jul 2010 07:50:47 +0000

I was excited to report for work after hearing that we will be given with the sports allowance. Seeing that no one is in the ATM booth, I immediately tried checking my balance only to find out that I only have P300 in it. When I reached the ward, I learned that only regular employees were given with such an allowance. So I came to thinking where did that P300 come from? I did not avail of any : rv loans. Maybe it was a mistake.

Sleepless

morning sniffles — Fri, 09 Jul 2010 06:34:53 +0000

I stayed in the dorm right after my blood extraction so I could get catch a nap before going to work for my night shift.
I was able to fall asleep easily but a few minutes after, I was awakened by a very loud noise. I got up and went out of the room to see what it was. I was so dismayed to see that the engineering people are trying to place some stainless steel drum in the comfort room.

Will you pull the plug?

morning sniffles — Tue, 25 May 2010 12:39:41 +0000

Mrs. M is an 86 year-old retired public school teacher who admitted due to sepsis secondary to coronary artery disease, type 2 Diabetes Mellitus, Chronic Kindey Disease (CKD)
She has necrotic non healing wounds on bilateral legs down to heels of her feet. She also has grade 2 bedsores at the sacral area that are about 8 cm in diameter.
She was on dopamine, dobutamine and furosemide drips when she was transferred to our ward from the suite room.
When her blood pressure has stabilized, the dopamine and dobutamine drips were taken out accordingly. And when the edema has subsided, furosemide drip was shifted to oral. She was then ordered to get out of bed and sit on bedside chair which she did but during her activity, she bled to much forcing her to stay in bed.
Within the week, her appetite has decreased resulting in decreased oral food intake. Nasogastric insertion was made to give way to osterized feeding to meet her daily caloric requirements.
Her oxygen saturation through arterial blood gas has deteriorated requiring her to be hooked to mechanical ventilator. Her increased mucus sections required frequent suctioning but being traumatic as it is, it was hard to introduce the oral airway as she bites it.
The family requested for DNR, no intubation, no suctioning, no chest compression no IV insertion attempts and what not. A couple of days passed and she was weaned off the ventilator. She was on oxygen per nasal cannula. Her vitals were stable but despite oral diuretics, she continuously retains water advancing to anasarca and deterioration in her level of consciousness was noticeable. Despite that, the family has decided to take her home with NGT and oxygen support on. It was not clear to me if she has brought home against medical advice but one thing is for sure, they will just wait for her to flatline at home which is equivalent to pulling a plug of a patient who is on life support machine.
I understand that they would not want to add more pain to patient by declining all invasive measures that could save or prolong her life, but still, is it right to just let her suffer until her last breath?

Obsessed about loosing her

morning sniffles — Fri, 19 Mar 2010 16:19:11 +0000

On my way home, I had this thinking about loosing our patient who has been confined for more than two years. She has been in and out of the intensive care unit since then. She has just turned 95 on March 10th.
This morning I woke so early and punched in at 6:10 am. I came in early to get the bedside-to-bedside endorsement done before the grand endorsement. While on my way, the caregiver of our resident patient texted me to bring her some cheese, to which I replied that there was none left. It was 5:30 am.
As I reached the ward, I was informed that the said patient was hooked to mechanical ventilator late last night de to difficulty breathing and for some reason it suddenly stopped working so the charge nurse was doing the ambubagging. I hurriedly entered her room and she’s becoming cyanotic (bluish discoloration) showing signs of respiratory distress. The pulse oximeter does not register pulse rate nor oxygen level in her body. No blood pressure can be acquired even on palpatory way. I and the bedside nurse tried but to no avail.
The charge nurse asked me to page the cardio and pulmonary fellows. The bedside nurse did it. But as we waited for the fellows to arrive, her condition got worse, the charge nurse asked me to call the code. I dialled 7 and in a heartbeat the PA summoned the code blue team to our ward. I wheeled in the crash cart into the room. The team was there in less than a minute.
They hooked her to cardiac monitor and four doctors tried to start peripheral line. One has started cardiac compression and was shouting to push to epinephrines. It started at 6:31 am and ended at 6:37 am. After the fourth epi has been pushed, she showed sign of revival.
We felt relief. She’s prepped to be wheeled in to the medical ICU again.
out of silence, the tension was pulsating. We love our abolita (as I fondly call her).
At past 2:00 pm I texted the caregiver asking for the patient’s condition and they said that she is stable. A few minutes after that, the PA summoned code blue team to medical ICU. We became worried. I called the medical ICU and as if a large rock was removed from my chest, it was not our beloved patient.
I learned from the medical ICU nd the caregiver that she will be wheeled in to her favorite room in our ward once she has tolerated the weaning process from the mechanical ventilator.

Freak out week

morning sniffles — Fri, 19 Mar 2010 02:25:11 +0000

I was approached by my headnurse and she told me the gretest shocker of my nursing career… being a member of the education committee, I am tasked to host the upcoming symposia, Oh crap!
I tried to appeal saying that I am just a menber of the committee and the horror err honor should be with the group head. There I fell flat on my face because the head of the group is my headnurse and there’s no bargaining. I just told her to prepare a crash cart nearby in case my chest exploded due to palpitations.
The most cruel part of it is that it’s gonna happen on my birthday! It’s my off and it’s gonna be an unpaid task.

An act of perversion?

morning sniffles — Mon, 08 Mar 2010 04:38:19 +0000

I was furious yesterday. For one, I ended up having 7 patients and another, a male pervert patient patted me on my butt twice. They said he was a doctor but he does not look like one. He is extremely obese confined in bed requiring total care in terms of oral and body hygiene. They said he’s been coming in and out of the hospital for quite a while already. Instead of me having pity on his condition, I tended to hate him. I left the charged nurse for his diaper change and I called upon his bedside nurse to assist him. Maybe that moron has overdosed some testosterone cream making him act that way. It was not the first time that he did that to a nurse. As a precaution, he is being assigned to male nurses.

Turning the other cheek

morning sniffles — Mon, 15 Feb 2010 03:46:24 +0000

It was a busy night for me, as usual, but I was able handle the shift smoothly until the incoming staff nurse begun intoxicating me with her demands to endorse my other patient to her. This is what she normally does, makes sure that the endorsement gets done early so she could start or end her shift ahead of the others. It was okay if I was not busy but the thing is, I was attending to two patients when she started asking about the patient that I was supposed to dowload to her. It was really irritating. There was also this other orientee who waits for me to get done so she could endorse all her two patients to me. She was quiet though because we had an agreement that she we let me know if she’s already ready for the endorsement.
So when I was done attending to my patients, I sat down and asked who between them will I attend to, then she snapped at me. Begun with her lithany of me being arrogant. All the three nurses there were shocked. And as the orientee and I started with our endorsement, I tried to assure the orientee that everything will be okay and we giggled. This made the mad nurse furious as she thought we were laughing at her.
I have heard that she had issues with other staff nurses because of her attitude.
I still kept my silence. I wanted to snap back but then again, a mature person would not do that. Instead, I turned the other cheek. She will get transferred to another ward anyway. I cried though in the morning when I got the thing off my chest with my batchmate during our post duty breakfast.
I was thinking if I will let it slide or bring it up to our headnurse.

Not my trip

morning sniffles — Mon, 25 Jan 2010 09:23:15 +0000

I was able to punch out at past 10:00 this morning from my 7pm to 7am shift. I was able to finish my focus charts early but I was caught up between the chaos of cleaning chest incision wounds and giving medication to a disoriented patient. I thought I could make it through my shift early. It just as frustrating as my first month of being an orientee. I was home at 12nn and slept immediately but I woke up at 3:00am soaked in sweat. The power supply server in our air tripped and it needed an rv repair It was restored just now and I am trying to get my doze mode back on.