Day 2 off Orientation

Disclaimer: These blogs highlight my own opinions, and do not represent the opinions of my employer. Thank you!

Okay so today felt like the nurse shift saw my first day and they said I’m so sorry and so they gave me easier patients LOL. It was really an informative and insightful day because the patients were nice/cooperative, and they were, in all honesty, easy which was which was comforting to see. I was like okay these are not too bad. I initially thought that I was gonna get the restraints patient and I was freaked out, so it was blessing to see that I got the nice neighbor instead. And the team didn’t let me suffer, which I’m very grateful for. Anyway, I was pretty much able to handle what was thrown at me. I had some questions here and there, but it was good.

Also, one thing that I would like to commemorate myself for is that I was involved in the plan of care. I spent a little bit more time looking at notes and seeing what people wanted, and it made a huge difference. I got to say, “okay this is what the cardio wanted to do, okay this is what they wanted to do.” I looked at the HPI, I looked at the lab results such as the exams and diagnostics, and bro Nursing Central is my Bible now. It is probably the best purchase I’ve ever made in my life. Yes, it’s $178, but it was the best $178 I’ve ever spent. I was able to kind of really get in tune with the medications, and really understand why we were giving certain medications. So yeah, honestly, I think I really killed it today it’s good.

My first patient came in for chest pain and shortness of breath. He was on all these meds like Lasix cause of acute CHF, and he had all these meds, like Lasix, Entresto, and valsartan, and he never used it. Homeboy just like messing around, but he ended up coming into the ED for shortness of breath, and his heart was worse with a BMP of like 2,000, troponin was like 7,000, (I was like oh my goodness this boy really messed himself up you know). His Ejection fraction was 20-30. I was like I’ve never seen it that low before. Dilated cardiomyopathy, pulmonary congestion… a classic CHF patient. He would be a model nursing example lol. Anyway, the patient was also a meth user as well, so he was very antsy and anxious. He had hyperkalemia and they were ruling out PE. They were pretty much sure that it was the reason. PE increases the carbon dioxide in the blood stream making the body more acidic. The cells release their potassium to help neutralize the acid part causing hyperkalemia. So, I let cardiology know, and we did hyperkalemia protocols which was very interesting to do for the first time I’ve never done it before. So, I was like oh okay this is what you do. We gave the dextrose 50% 25 mg/50 ml, and we gave him regular insulin 10 units. And I had to do like blood sugar checks q30 minutes. Honestly, really effective cause the hyperkalemia managed to resolve. You know but it was also interesting to see his patho because I got to see sinus tach on the EKG turn into the upside down p-wave, I got to see the ST depression, you know indicating something’s wrong, and then I also got to see what the what the EKG does when the hyperkalemia is at that level which was that the EKG was turning into SVT. I saw that the T-wave and the P-wave were moving closer together. I was like wow this is so interesting, and so that was like an emergency procedure. I like dropped everything and made it priority. It happened during med pass too, so I was like swamped, but I think I still killed the game which is something that I’m proud of in all honesty. Anyways yes, they were more towards a pulmonary embolism, so I gave him a Heparin drip. I forgot to verify the heparin drip before I left, but that’s ok they’ll do it with night shift. It’s ok, it’s not the end of the world. Anyway, the patient also had complaints of chest pain that was sharp and starting out with a one, then it went to five, and then he said it was aching in an eight. So, I was like, oh my gosh, but I gave the Norco. You can tell that it was a respiratory issue because he had the pain on inspiration, so like it happened when he was breathing. So it wasn’t a heart related issue.

My next patient was there for altered mental status and she had a transient ischemic attack. Honestly, with her main situation, everything was resolved. She was cleared to go, but she had anxiety as a past medical history. She was so anxious when it was time to go, from what we figured out. I guess when the ambulance people came over, she would have a blood pressure of 170. So as a result, the ambulance couldn’t transport her. The NP played Scooby-Doo over there, and instead of giving Clonidine or Hydralazine to lower the blood pressure, to which she would tank like immediately, she ended up saying that Ativan would work better. She was a lot calmer bro. Not gonna like, the poor lady was knocked out cause the Ativan, and dead weight, but the blood pressure stabilized at SBP 140, which was lower than the ambulances required SBP of 160. I also found it very interesting that you had to dilute the Ativan before administration, and that you could fit a blunt tip syringe through an NS flush.

Next patient’s story is wild. So, the patient came in for the worst headache of his life for three days. They saw hemorrhaging from an aneurysm. To which they did a clip ligation via open brain surgery. Patient didn’t have any residual loss, muscular wise or neuro, but he had a flat affect and generalized weakness. So, once he was stable, he went to the Acute Rehab Unit for generalized weakness. There he ended up coding. Code blue, V-fib on the rhythm, and they defibrillated him twice, gave him two rounds of epinephrine, and then did CPR. They achieved the return of systemic circulation and then sent him to the brought him upstairs afterwards. His blood pressure is on the softer side (Lower BP), and he had residual Chest Pain from the CPR. I felt so bad because they probably broke some ribs to get the heart pumping. Anyway, the patient was nice. He was out of the bed with PT and OT one person assist with the front wheel Walker, and it was cool because I got to see the aspiration of pseudo-meningocele fluid which is something I’ve never seen before I was like oh wow so cool. Yeah, that’s it.

I have another patient whose biggest complaint was chest pain. He initially had an escape junctional rhythm of 30 which is extremely low honestly. So, they ended up giving him a permanent pacemaker, DDD paced which stimulates the Atrial and the Ventricle to beat, he was stable enough for a discharge. I learned that they give him the pacemaker card via mail, so I was like okay cool here’s the information if anyone needs it. Bring it to your follow-up physician, so that they know. So, he was cool. Keflex is a prophylactic antibiotic from the surgery. Thank you Nursing Central for teaching me that.

Yeah, that was that was pretty much all my patients. Like I said, I did an absolute wonderful job because I did more digging into the patients, and I looked more into the patient's care, (why are we getting this, what are we doing with this, what’s happening with that) and so it was like it’s a huge difference: compared to how the first day was. Yeah, I was up on my feet, but like I still killed the game you know what I mean? And I ended up making a difference in the patient’s life, then got that little rush I was looking for. I was like okay; this is me in the ED right now. Boom for med passes to do, and got to do blood sugar checks, and care briefing. I said boom and then I delegated!!! I said “please Lead nurse, when you’re able to, help me with this sugar check for me” yeah boom. I did a wonderful job, no complaints, I understood why everybody was getting something, I understood like what was happening with the patient… yeah dude, I see myself becoming a great nurse. It’s happening, and I just got to keep going with it you know what I mean? Anyways I’m home now so I got to go okay bye-bye