Tuesday, April 6, 2010

countdown to ICU continues

My last few weeks on the only floor I've ever known as a nurse have not gone well. I have had one big confrontation with a busy-body co-worker, and 90% of the rest of the nurses pretend I don't exist.

For example, Saturday I took a post-op day 1 esophagectomy patient, whose attending happens to be my very favorite. I started at 3 with a dismal report- very low urine output, even after 1000ccs of bolus and maintenance fluid at 125 cc/hr. BPs super low, pain super high but couldn't do much because of the low BPs. Patient couldn't get out of bed as she was suppose to, and lungs sounds were crappy. I took the patient hoping it would be a challenge that might help prepare me a little for the ICU.

I was managing alright, even got the BPs to stabilize and the PCA and epidural back on, getting her pain down from 10/10 to 6/10. The family liked me and felt confident in me enough to go home for the night. I spent almost every second of my shift at her bedside, only dashing in and out of my two other (stable) patients' rooms, or delegating their meds to the two other nurses who were actually offering me help.

At about 8pm, respiratory showed up to do a breathing treatment. I'd been playing around with the pulse ox for about 45 minutes, warming up her hands, trying her ears, toes, etc. Respiratory tried to help me, and finally got an ok reading, 92% on 3L nasal cannula. BUT- in the process she went from A&O x3 to A&O x1. I was like, oh shit... what is happening??? Urine output for four hours was 25ccs. Resident on call wanted to bolus her AGAIN. I regret not saying NO way. I regret not turning all of her damn fluids off right then.

Suddenly, her sats started dropping. I stat paged respiratory. I told my charge and assistant charge nurse that I would need help with a driveline and meds because I could see this was not going to be good, and I got a great rolling of eyes from them and nothing but reluctance, so I just left. I was stat paging phlebotomy now for labs, and they weren't showing up. Respiratory and pain service were my only help at this point, and they started drawing ABGs and said they'd fill my other tubes for labs.

Now you have to realize, I've never drawn labs in my LIFE! I again went to the charge nurse, asked her for help, she refused, and I said "should I call RRT? (rapid response team" (Resident on call STILL wasn't there, patient now on a rebreather with 100% O2). She says "Call RRT just for labs?" as if it were the stupidest question ever. I went back to respiratory, the supervisor was now there, and said "should I call RRT?" I'd paged the resident on call about a hundred times by now, respiratory said to call RRT, so I paged him one more time and said "If you can't make it now, I'll get RRT".

Guess what? He shows up one hour and 45 minutes after the crisis began, and said "Bed 14, nurse Michelle, call report." I went to the charge nurse and said "She's going to the unit". Her snotty response? "What? I can't even understand you." The other nurses around were listening now. I said, very slowly: My. Patient. Is. Going. To. The. Unit. Did you get that? Because our charge and ass charge didn't step foot in that room the entire time, and I never felt so on my own before.

Grrrr. Now my patient is on a vent with major hypervolemia. Her daughter saw me and hugged me and told me thank you, thank you but I felt like a fraud because I wish I had turned off the fluids. I left the unit with tears in my eyes.

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