My Mom Is Having a Stroke!!!!

Many times in nursing, there are times when a nurse may feel like panicking.  Although, it is never a good thing…and in fact a nurse should never panic or at least let the patient know they are panicking, there are definitely times when a nurse may feel like panicking. 

One night, I was taken by surprise when the daughter of one elderly patient, who was ready to be discharged home later that day, came running to the nurses’ station shouting that her mom was having a stroke.  I rushed into the room, not exactly certain what to expect.

There my patient sat, in her chair, her mouth very twisted, drooling.  She was having terrible difficulties with speech, but seemed mentally clear and was able to follow all instructions.  Her hand grips were equal and strong, she denied having a headache, she denied any numbness or weakness anywhere and was able to take steps normally with no vision changes.  I asked her to smile to check on the symmetry of her mouth, but she struggled to do this and was unable to despite repeated attempts.  I didn’t think she was having a stroke, but clearly something WAS horribly wrong.  The symptoms seemed to come on suddenly, out of the blue, and there was no progression.  Her vitals were fine.

Resisting the urge to call for help at this point as I WAS the help, and before sending out the alarm, I decided to calmly ask a few more questions.  The answer that sent a bell off in my head was that the symptoms exactly coincided with the insertion of her dentures.  I asked her to take them out.

When she popped the top denture out we all broke out laughing.  She had put her dentures in upside down!  The twisting of her mouth, the inability to speak or smile, and the drooling was due to the fight she was having to keep the dentures from falling out!

Boy, would I have been embarrassed to have sent up flares and had a doctor come in only to discover the same thing.

This is one of those patient stories you remember forever!  Moral?  Always take the time to evaluate a situation before panicking!

Conflict in Nursing

Nursing school teaches us a lot of different things…important things.  In fact there is so much stuff being taught, the only thing we know for sure is that we are all sleep deprived, paranoid idiots.  I say this because of course sleeping is one of the last things nursing students do.  And the paranoia comes into play because we are convinced that the nursing faculty is out to get us and sabotage our careers in whatever fashion they can think of next.  We are idiots because we know absolutely nothing and the professors will go out of their way to remind us of this at any given moment.  ;)
Not to drag out all the horrible moments of nursing school for those reading, but my point is that there is a lot of learning happening in nursing school.  However, although our heads are being filled with a million different diagnoses and of course all the: anatomy/physiology, pathophysiology, pharmacology, treatments, lab, test results and intervention that go along with all these, one thing that seems to be forgotten is how cruel the world of nursing actually is. 
It is a proven fact that nursing is one of the cruelest societies out there in the employment world.  The gossiping and backbiting that occurs among nurses is phenomenal.  It is in fact staggering when a new graduate enters that world and has to learn the hard way that nursing is like this. 
With these behaviors occurring in the workplace, it is not unheard of to find conflicts among co-workers, nurses and patients/families, nurses and doctors.  In fact, I don’ think there is a day that goes by where there is no conflict between someone. 
A certain nursing tech on my unit  was having trouble adjusting to the way of life on the unit.  This tech was an international citizen who had a doctorate in nursing in her home country, but was not allowed to practice as a nurse in the United States until she passed her boards.  She was a little bitter that she could only work as a tech.  Because of this, she was very hard to get along with.  She would consistently question anything that a nurse would ask her to do, she would refuse to take a patient assignment for many reasons some being: she didn’t like the nurse who was assigned, she didn’t think it was fair that she got a new patient, or she just didn’t want a new patient.  She also thought it was beneath her to answer call bells (this was definitely annoying because it meant that the call bell would keep going off and the sound is enough to drive you bat crazy). She was rough with patients, and when it came time to clean them up or turn them, it was necessary to remind her to be careful and gentle all the time. 
She would constantly back talk and yet it was others who were always getting in trouble with the manager because she would go and complain or “tattle” if someone wasn’t up to HER par.  In short, it was becoming impossible to work with her at all, because instead of arguing with her for 20 minutes, everyone just began to not let her or ask for her help, which threw everyone off schedule.
Needless to say, the stress and tension level on the floor was incredible.  Finally, someone decided to take a stand and make this craziness stop.  It did stop and the extra stress was removed from the work place, which made it much easier for everyone to do their jobs.  There was a sense of relief and peace among everyone working together.
Conflict may exist in the nursing workplace…but that does not mean that it needs to be accepted or allowed.  Conflict will only affect the job and safety of everyone. 

Nursing Sucks (At Times)

I hate to say this statement…but in all actuality…some days it sucks to be a nurse. I know this sounds bad and many of the new nurses or new graduates who read this are not really going to understand how I can say this statement so casually…but honestly…some days it just sucks.
But let me explain a little… It is very common for nurses to have bad nights. In fact you usually end up having more “bad” nights then good nights. However, every now and then you get those nights where you just want to stop and stomp your foot or even better go into the supply room and crawl into a corner and cry your eyes out. I had one of those nights just recently.
Event #1- The night was going relatively fine until the code alarm went off. Thankfully it wasn’t on my wing but of course my co-worker and I both went running to see if they needed help. When we arrived, we made a quick decision that she would stay and help and I would go cover our patients. I just want to throw in here, that I had everything under control and in fact it was one of the rare moments where everyone was sleeping, in spite of the loud alarm blaring over the intercom. When she returned, she informed me that the patient was not stable and probably was not going to make it but she was going to be transferred to the ICU.
 Event #2- About an hour later, my co-worker was informed she was getting a new admit. As she was getting report she began to question whether the patient should be admitted to an acute care floor. But of course, he was anyway. My co-worker found out this patient, had been admitted for respiratory failure and had just been extubated less than 24 hours before being transferred to our floor. He arrived and seemed to be doing perfectly fine. He was ambulating to the bathroom and participating in his care, and answering questions. My co-worker left the room to let him rest. About an hour after this, one of our techs entered into the room to take his vitals. He was not in the room for more than 10 seconds when he came running out telling the other nurse to go check on the patient. My co-worker and I went to check on the patient. We found him having trouble to breathe and upon listening to the lungs, discovered he had almost no air movement. I quickly went to call the doctors and rapid response. Long story short…this patient also coded and was moved to the ICU, with the family deciding to remove preventative care and instead focusing on palliative care. This of course, gave us a clue that this patient probably would not have a very good outcome either.
 Event #3- Admist the normal business of the rest of the night, once again the code blue alarm went off…again not on our unit. Once again we went running, to yet a different unit to find another patient coding. I once again went to cover the rest of our patients. Thankfully this patient, was able to be revived and was fine but also moved to the ICU for further monitoring.
Event #4- At this point, I wasn’t exactly sure how much more I could take of this night and it was only 0300. I went into give some medications to one of my patients who had been on our unit for many months. As I entered the room I noticed that the pulse ox was doing funny things. It was saying that his heart rate was going from 129 to 49 and then back up to 130s. Then his heart rate suddenly plummeted to 29 and at this point his oxygen saturation went from 100% to 49%. Once again rapid was paged to the floor and once again the code cart (our fourth one that night) had to be cracked in order to save the patient. The patient was transferred to the progressive care floor.
 Event #5- As we were finishing up our night, another nurse came up to inform us that the patient from the third code had actually died even though he was probably the most stable one after the codes. It was this news that managed to be the last straw. With this news, my co-worker and I just looked at each other and walked out the door with slumped shoulders.
My word of advice for you newbie nurses...Remember...There are always going to be rough days...days where nothing seems to go according to plan...days where no matter how hard you try you just can't seem to save your patients...days where you can literally feel death hanging in the air...and days where you just know there is nothing you can do to change it or to help...days that will make you wonder what the point is or if there is even a point... But thankfully there is also ALWAYS good days...days where you can make a difference...days where you can save a life...days where you can be one person that can help...and days that make it all worth and days that make you understand that no matter how many nights suck...there is always a point...and that is doing what you can to bring about the most good for the most amount of people

Yes!!!...Insulin Scares Me

Before I get too far into this post…let me just say right now… “Yes, insulin scares me!” Okay now for a little background information to that statement.
After getting report, my co-nurse and I were looking over orders and preparing to assess our patients. A general practice of most nurses is to do a quick prioritization to decide who to access first. My co-worker was caring for a patient who had been in the hospital for a while. She is a low maintenance patient, one who is usually prioritized as the last patient to be seen. However for some reason my co-worker decided to go see her first (nurses’ instincts and gut reactions are a real thing). As she walked into the room, I heard her hollering at me to call the dr, Rapid Response and the Nurse Expert. I wasn’t really sure what was going on so it was a little difficult to talk to these three groups of people but the task was accomplished.
I rushed into the patient’s room to help. As I entered I noticed the patient sitting in bed, looking as if she was having a stroke. There was a blank look on her face and she was not responding to any of us. I quickly grabbed the glucometer and supplies to check her glucose level. However at that moment, the phone rang. I tossed the supplies at the nursing tech and told her to check the sugar.
After talking to the doctor, I ran back into the room. The general ruling of the room seemed to be a stroke. I asked what the glucose result was…in the hustle and bustle of the situation, the glucose had not been checked. I quickly poked the patient’s finger and got the glucose result…it was 21!!! “Um…guys I don’t think it’s a stroke” is what I told the others in the room.
From there, the care of the patient went according to protocol and within minutes she was responsive and talking to the nurse. It turns out that previous nurse had mistakenly given the patient 10 units of Novolog around 1730 when her glucose was only 77.
So yes, insulin scares me. It is a medication that can quickly lower glucose levels and if that level gets too low it can lead to seizure, coma, and death. It was a scary situation but one that was handled well and thankfully no permanent damage was done to the patient.