Hello there! I’m still here. You probably thought you got rid of me…
I’m still here, like that annoying fly that buzzes around your ceiling light, or that spider that vanishes magically once you blink.
Believe it or not, I have a point to this post.
I have exciting news! I’ll keep it short.
Come April 1, I will be going back to school to become a certified wound, ostomy, and continence nurse. Like my family has said, I will be certified-ly continent. (They’re real funny…)
I will be living in Cleveland, Ohio from April until the end of May learning about wounds and ostomies. I can see your face now, does it look like this?
I thought so.
I don’t know what got me interested in wounds or osotomies, but I am and you should be thankful because someone has to do it! If you get a boo-boo, I’ll be sure to put a pretty band-aid on it. If you get the flesh eating bacteria, I will run far away with a big “SEE YA”.
Just Kidding! I’ll take care of you. I got yo’ back, dawg, ya digg? Need a wound healed, hit me up.
Oh man, I’m glad I didn’t get a degree in blog writing because I would’ve been fired a looooong time ago. Fortunately for me, nursing doesn’t require blogging….only selling a small part of your soul. (kidding..)
A few days ago marked my 1 year anniversary of working as a nurse. Yay! What a long, yet seemingly short year. I’ve definitely learned a lot, such as:
-No matter what you do, some patients will never be happy.
-No matter what you do, most doctors will be angry.
-No matter what you do, you will always be called to come in on your day off.
Since I don’t really have much to say that hasn’t been said on my facebook status, I decided to compile a list of frequently asked questions with the answers that I wish I could say but do not for fear of being slapped in the face with a lawsuit.
Q1. Can I have something to help me sleep tonight?
A1. Why, yes. I’ll just go to our stock room of sleeping aids. What do you feel like tonight? Ambien, zzzquil? How about a swift kick to the head to knock you out while I go chart? Yeah, I like the third option too.
Q2. What time will the doctor be here tomorrow?
A2. Well, let me just go get his schedule book and take a look. Oh, there you are..penciled right between “I don’t” and “freaking know”. They will either be here before the sun rises or after the sun sets. They are, in fact, vampires.
Q3. Do you think I could stay just one more night?
A3. Sure, why not? Would you like a chocolate or a mint on your pillow tonight?
Q4. I know the doctor said I can’t eat or drink anything before surgery but I’m starving! Can I please have a quick snack?
A4. Oh yeah sure, I’ll just go ahead and pack up your things and get your room ready in the ICU for after surgery.
Q5. Would you please go get a diet pepsi for my sister’s-husband’s-friend’s-cousin’s-ex wife?
A5. Anything else, master?
Q6. How do you change the channel?
A6. By simply pressing the button that says channel up, you moron.
Q7. Do you ever get a break?
A7. I would if you would leave me alone for 5 minutes.
Q8. Will I get to go home tonight?
A8. If it were up to me, you would’ve been gone days ago.
Q9. How long will my surgery last?
A9. Between 1 minute and 24 hours. Depending on how well you behave.
Q10. Are you even old enough to be a nurse?
A10. No, I was just picked up off the street, showered, given a pair of scrubs and here I am giving you a dose of morphine…at least I think it’s morphine. Hmm…oh well.
Q11. Can I get benadryl, ativan, morphine, and dilaudid together?
A11. Do you want to die?!
Q12. What in the world do you guys do on those computers all the time?
A12. Shh, I need to concentrate. I’m about to win a million dollars with this poker hand!
Q13. I called 2 minutes ago, where were you? I need my pillow fluffed.
A13. I’m sorry, I was tending to a patient who had an actual problem.
Q14. Can I get a room with a better view?
A14. Sure, may I suggest the Holiday Inn?
Q15. Will my insurance pay for this?
A15. I don’t know, will it? I’m a nurse, not your insurance agent.
Hear-ye, Hear-ye! Ignore the fact that I’ve failed at updating this blog for months on end and focus on what I’m about to tell you - This is the most important week of your life. Seriously though, no other week will matter as much as the one I’m about to bring to your attention.
HAPPY NURSES WEEK! (May 6-12)
That’s right, bow down to us for we are your Queens/Kings of health care.
In honor of this wonderful week I now decree that:
1. Will not complain
2. Will not be crazy
3. Will be independent or “selfers”
4. Will be cured of all illness on May 6 therefore forcing the hospitals to shut down for the week.
1. Will lose the ‘tude
2. Will bring us all flowers and chocolates
3. Will give ALL enemas
4. Will clean up all bodily fluids from patients
5. Will say: “You are right, we should do it that way, nurse” or “You’re a freaking genius, nurse!”
All nurse employers
1. Will give all nurses a raise and free tickets to Disney World
2. Will wash every nurses car
3. Will provide a great banquet with the finest foods, for free….on a cruise boat.
So, for a week everyone who reads this is mandated to make me (and all nurses) feel like we’re God’s gift to mankind.
Money and gifts gladly accepted; Including printing out this picture, coloring it and mailing it to me:
Let’s begin the celebration with some funny, possibly inappropriate pictures!
Hence why leg bag foley catheters should be “in-style”
Sad, but oh-so-true
Except for a week, it’s the doctors’ job. ;)
If you find a nurse cute, send this to her/him. Good luck!
Or you could try this line on that cute nurse ;)
It’s funny because it’s true
For all you nursing students out there!
In all seriousness, thank a nurse sometime this week and maybe you’ll get a high five.
That is all, ANNOUNCEMENT OVER! :)
I’m biased, obviously, but I’ve come to the conclusion that those who run the hospital really have no idea what they’re doing. I fully believe that floor nurses (floor, as in those nurses who actually work with patients) would do a far better job at hospital management since we’re actually on the battlefield versus sitting on our bums in a fancy chair (that probably costs more than our paychecks combined).
Okay, before you report me to my superiors remember three (3) important things. 1) this is my blog, I can say what I want. 2) I’m severely sarcastic so what I say about 99% of the time should not be taken seriously. 3) this blog is mostly made to be humorous.
Just in case you still don’t understand my sarcasm, then I will say (to cover my behind) that I do not actually think floor nurses could run a hospital. I do realize that it’s a business and we are not business majors. HOWEVER, I do think every hospital should have a set of rules made up by floor nurses. If these rules are not followed then they will be punished with 10,000 IV needle sticks (mwahahahaha).
Introducing: Rachel’s Rules That Every Hospital Should Abide By Every Day, Forever
1. Doctors will be installed with a GPS tracking system so we can track them down and drag them to the patient they so freely told yesterday that “yes, I’ll be in bright and early tomorrow” and it is now 5 o’clock in the evening. After they are dragged in, they will be forced to sit in the corner for being tardy.
2. All doctors will be required, with no complaining, to take care of the bedridden patient that they ordered to have GoLytely (laxative) when we all know that it will not, in-fact, go-“lytely” all night. Same goes for enemas.
3. Those doctors who refuse to give Ativan or Haldol to a confused and combative patient will have to sit with that patient until they “calm down naturally” or “fall asleep”. Good luck.
4. All required meetings will be ran by floor nurses. It’ll take, at most, 10 minutes since we’re already used to multi-tasking, doing things quickly, and getting to the point.
5. Anyone who yells at or belittles a floor nurse for doing his/her job will be stuck with an 18 gauge needle until they apologize and then be required to wear a “kick me” sign for the rest of the day.
6. When a superior has a “bright idea” to add to the never ending to-do list a floor nurse has, that superior will be summoned for 10 years worth of jury duty. No questions, no complaining, no excuses.
7. Doctors and superiors will be required to work the floor at least one day every month while the floor nurses write ridiculous orders and give useless things for them to do.
8. All floor nurses will get the same raises, if not more, as the top dogs of the hospital receive. After all, we’re the ones keeping your clientele alive.
9. Every floor nurse will be given a Segway equipped with a computer in order to provide faster service, of course. *wink*
10. Hot tubs and masseuses will be provided, free of charge, before and/or after every shift.
When something bad happens and you sit there and dissect the situation after the fact, you begin noticing things. These things all lead up to an event. If only something could have intercepted these tiny hints then maybe it could have been prevented.
The work day was all kinds of messed up. I started it off floating to the cardiac unit. Mind you, this was the first time I’ve floated as a nurse. Although I loved learning about the heart during school, I wasn’t so keen on taking care of people with acute heart diseases. Looking back, I would have much rather stayed on that floor for the second half of my shift than float back down. The cardiac unit nurses promised that they’d only give me medical patients (no cardiac patients with extreme problems) so I had one patient with pneumonia, one with suspected cellulitis, and I’m not sure what the last one had.
If you can count, you’d noticed that I had only three patients. THREE! I was in heaven. On my floor I’m used to having up to eight patients to myself. That’s how nice the nurses were, they gave me a light load. I was really only there to take some patients off their hands so they could catch up.
At six o’clock I floated back down to what I thought was going to be an easy four hours. As a nurse, you soon learn to never assume things.
Long story short the patient had been vomiting for about two days. Usually a nasogastric tube is placed to prevent the person from aspirating on vomit (sucking fluid into their lungs). This time, no NG tube was given [hint #1]
The patient’s lungs sounded horrible. Gurgles were heard without having to use a stethoscope. His oxygen saturation would go no higher than 88% on 3-4 liters oxygen [hint #2]
The patient would do odd things. He’d strip off all his clothes and get restless, but yet a little later he’d be completely normal. He was intermittently confused which often happens with you don’t have enough oxygen in your blood. [hint #3]
Earlier the doctors had found that he had a huge hiatal hernia (stomach slips up through the diaphragm into the upper chest cavity) but nothing had been scheduled to fix it yet. [hint #4]
I fully believe that when humans miss these vital hints, God steps in and helps.
There were a few tests done but for some reason the VQ scan (rules out pulmonary embolisms) was missed. So I packed him up on and sent him on his way. He had refused x-rays prior, but I was hoping he’d comply with this last test.
Here’s where God came into play.
The patient refused the VQ scan and was sent back up to us [God send #1]. The tech working with me was getting him placed back into bed when he began acting and looking very odd. She called in my orientation preceptor to check him out [God send #2]. By the time I got into the room, the patient was back in bed and slowly turning from pink to blue. His eyes were rolling back and vomit just rolled out of his mouth, much like a water boiling over a heated pot. Brown, coffee-ground vomit.
The seconds ticked by like hours. He instantly turned ashen blue and we lost him.
The code was called, the crash cart was brought to the room but CPR was useless. His lungs were filled with fluid and he had a heart beat, so blowing air into his mouth would just shoot vomit back at you. All we could do was wait until the code team came to his rescue.
They suctioned out his lungs, bagged him (give air, like CPR but not mouth-to-mouth) and he was transferred to ICU. And that’s the last I saw him.
There’s guilt that a nurse carries after coding a patient. Is the family mad? Do they think we did this to their loved one? Could we have done something more?
Eventually you begin to realize that it was going to happen no matter what. I see now that God had been looking out for us all. There was a reason that he had missed that VQ scan, refused it later, and coded while we were in the room trying to get him back to bed. What would’ve happened if he coded while we were busy with another patient? Who knows when we would’ve checked back in on him. He very well could have died while we thought he was okay.
All I can do is learn from the situation and thank God that He gave the patient a chance to live instead of left to die alone, with no family, suffocating on his own vomit.
Happy New Year!
Okay, enough with the celebration.
If I were to quit nursing, no one would need to worry because I have found a new career - naming nail polish colors. It wouldn’t be plain, boring names like tickle-me-pink or sky blue. Nope, it’d be colors pertaining to nursing situations. You’d be surprised at how many colors nurses see everyday.
I know, I’m absolutely brilliant. I should be given millions for my fabulous ideas. I agree with you, so pay up.
The idea came to me after I had painted my nails blue before work one day (I hardly ever paint my nails so you know I was bored). My co-workers poked fun about me being cyanotic since my nail beds were blue and BAM there goes my mind.
(Side note: Cyanotic is the blue-ish color one’s lips and nail beds often become when one isn’t breathing)
Here’s what I’ve come up with so far.
(Second side note: if this idea has already gone into play by another genius, just play along with me and let me believe that I came up with it)
Since you waited patiently, here’s what I’ve come up with so far:
Drink-this-barium glow in the dark
You’re speechless and I’m amazing.
(hahaha just laugh along with me)
You’ve been on my mind lately but I haven’t really found anything worth talking to you about. To be honest, this is quite the one-sided conversation and I’m more of a listener. If only you’d talk back. Have a conversation. Maybe I’d feel more inclined to write more often. I blame you.
Work is the same. I clock in, save the world, clock out. It’s hard work but without me then everyone would be in deep despair. On a daily basis I’m told that I’m a hero. No one would be here without me. Shoot, if I keep talking like this people would mistake me for a doctor. ;)
I’ve figured that eventually I’d like to become a certified wound nurse or certified in chemo administration. I haven’t looked too far into it, but the thoughts are there so eventually I’ll probably act on it.
Although I definitely don’t miss studying. I do miss one thing college offered that work doesn’t - breaks. Millikin seemed to be quite generous when handing out breaks. We’d get a week off for Thanksgiving, and about 5 weeks off for winter break, as well as the usual week off for spring break..I was spoiled. Now all I get is a day or two off here and there. Throughout school I’d have those wonderful breaks to look forward to - “Only a week before spring break, I can do this” blah blah blah. Now all I say is “I have tomorrow off..but then I work again” Boo real world! However, money is good.
Not much has changed. Everyday I’m becoming more confident in the things I do. I’ve become great at inserting catheters and so-so at starting IVs. My co-workers keep telling me that I’ll get better and to just keep trying. So that’s what I plan on doing.
Stop breaking your hips!
If it’s raining, don’t run. Embrace the rain, stand in it. Look at it as a free shower.
If you live alone, stop that! Get a roommate for goodness sake or one of those buttons you wear around your neck. They really should make those more fashionable though.
If you’re accident prone, walk carefully and slowly or add a lot of padding to everything in your house. Make your floor a giant pillow.
If you hate milk, so do I…so we’re screwed there.
If there’s snow or ice on the ground, barricade yourself inside and don’t step a foot outside. Or learn how to ice skate. My boyfriend will teach you. (I’m allowed to volunteer him for anything, it’s part of the unspoken contract between girlfriends and boyfriends)
If you have rugs on your floors, burn them all. No need for rugs, they’re so last season.
If you have pets, you better train them to catch you when they trip you.
If you drive, don’t get in a wreck (it really is as simple as that).
If you shuffle your feet, pick them up! Not only is it bad for your shoes, it’s highly annoying to everyone else around you.
If you wear shoes with laces, don’t anymore. Buy velcro shoes and bring them back into style.
Basically avoid any situation that puts your hips at risk.
Dear future and present patients,
I can not read your mind. Tell me what you want, don’t expect me to just know. I know, nurses are basically the most brilliant and talented people, and we can do a lot of amazing things but mind reading is not one of them. You have to ask me for pain medication. I can not just automatically give it to you. Your family can’t ask for you. YOU have to give me the sign. My favorite thing that I see once in awhile is a note placed on the chart that says “Wake patient up for pain medication”
Communicate with your family. The last thing I have time for is to answer ten phone calls from various family members asking what’s going on, how you’re doing, what happened. One time it came to a point where I wanted to record myself saying “He’s fine, no he didn’t have a stroke, the doctor will see him tomorrow” and play it when a family member called. Seriously, communicate with each other.
Continue to communicate with your family on what you want done if you aren’t able to make the decision. I had one family that spared no expense and the patient ended up dying from the multiple procedures they wanted done. Sometimes you have to know when to quit. Decide for yourself what quality of life you want. Do you want to be hooked up to machines or would you rather be let go? Once you make that, put it in writing and give it to your family.
Stand up for yourself. If a doctor wants to do something you don’t want to, tell him/her. You always have the right to refuse. I stand up against them for you, but it makes a bigger, more serious impact on them if you do it.
If you haven’t pooped in a few days - don’t freak! All it seems you patients care about is when you had your last bowel movement. Take into consideration that you are out of your usual habit. You aren’t eating the same kind of food, you aren’t eating as much, you aren’t moving as much, and you’re probably taking pain pills. Narcotics slow down everything, especially the poop maker. I can always give you an enema, but we both know no one wants that. So calm down, you’ll poop again.
Your favorite nurse
I want a vacation. Disregard the fact that I’ve only been working for 4 months, it’s the Christmas season. I deserve one.
Much love, Rachel BSN, RN
If you were a patient in the hospital, would you rather have a young-looking nurse or an old-looking nurse? First thought; nothing more or nothing less.
Most people assume that if you’re young that means that you’re fresh out of school, don’t have the experience, and therefore will kill them (accidently, of course).
While being an older looking nurse means that you have more experience under your belt, you’ve been practicing for centuries, you definitely know what you’re doing therefore you KNOW how to kill patients (just kidding!).
I’ve come into work a few times, gotten report then entered the patient’s room to introduce myself/do my assessment. Usually I get a warm welcome, get asked a few questions, and I’m on my way. More recently, however, I’ve found very degrading facial expressions staring back at me. Kind of like this:
But not really, that’s a little over-the-top..but you know, the eyes that say “are YOU even old enough to be out of kindergarten, let alone be MY nurse?”
Granted, this doesn’t happen everyday, but there have been a few that have discredited me just by how young I look. Which leads to my question, how would you react if I, or someone my age, came into your room and said “Hi, I’m so-and-so and I’ll be your nurse for the evening”? Would you answer with a “no way, leave and come back when you’ve aged 50 years”?
When I received those crazy stares, I was definitely discouraged and started second guessing myself. Sometimes I don’t think patients realize how much impact they have on their nurse. I do believe my skin will thicken the longer I’m a nurse, but as a new infant nurse my skin is quite thin.
So, to all my future patients: I may not have all the answers to your (sometimes ridiculous) questions, but I do have the ability to realize when I need to ask a more senior nurse. I will never do anything that I don’t know how to do without consulting with a co-worker first. However, please know that I did graduate from a 4 year nursing program with honors, I do have some sort of knowledge about my job. I am still learning, so bear with me. I am doing my very best, I promise. I’m not as dumb as my young age portrays.
Patients are rude.
"Yes, Rachel, we know..your skin is thin and patients hurt your feelings. Suck it up."
No, no, no. That’s not what I mean. Patients are rude because they don’t tell me what’s going on inside their body or what’s going to happen next.
I had a patient that was in such agonizing pain that I was drugging her up with just about everything I was allowed to give. All was fine, until about 8-9o’clock came around. I was giving her night time meds. I pushed some Toradol (pushed means give it through her IV line) then by the time I finished giving her the rest of her medicine she wanted a dose of morphine. So, I went and got some and pushed half of the dose.
Why did I only push half of the dose? Because this lady was snowed.
Snowed [snoh ed] adj - gone, out of this world, high on narcotics, blah blah blah.
She had been snowed since she got to the floor. She was easily aroused and oriented, just slept a lot. She had enough awareness to know when she was in pain and still had the ability to ask for medicine. As a nurse we have to take pain for whatever the patient says it is. If they ask for some, we give it (depending on some things like respirations, etc.)
About a half hour after I pushed the Toradol and morphine my tech (CNA) came to me and said that the patient was short of breath and her blood pressure was low.
WHAT?! Oh God, Oh God, I’m killing my patient. I only gave half a dose! BAAAAAAHHH!
I go into the room, place her on some oxygen and call the doctor. Surprisingly the doctor ended up calming me down saying that he thinks it’s the patient’s anxiety. He ordered some tests and sent me on my way.
After I had put on the oxygen the patient calmed down and was basically fine. Phew, crisis averted.
Now, my point:
The patient should have told me “Hey, I’m going to ask for this pain medication but after you give it I’m going to flip and not breathe which will in turn cause you to go into crisis mode and get some adrenalin pumping. Sound like fun? Okay, 1..2..3!”
Oh man, how perfect nursing would be if patients would actually do that. I could mentally prepare myself, give the doctors a heads up and my life would be at peace.
So yes, patients are rude. They keep these secrets just for the pure evil pleasure of watching their nurse freak out. People these days…
I should have sent one of the Sisters into the patient’s room after that fiasco.
I bet you thought I’d given up on this thing… WELL, you’re wrong. (Kind of). It’s not that I have given up, I just haven’t had the inspiration to write about anything.
I’ve had a lot go on at work, but then again I haven’t but since this blog is about nursing, I will talk about experiences I’ve had at work. WARNING: this may quickly become boring.
I’m off orientation. I’ve been off for 2-3 weeks now. I have officially been “thrown to the wolves” as my co-workers call it. Speaking of co-workers, I absolutely love mine. Throughout school we were told that some nurses will eat their young, but that is definitely not the case with me. A couple factors could play into that -
1. I am just so absolutely adorable, they just couldn’t help but take me under their wing and nurture me with nursing wisdom.
2. I previously worked on that floor as a CNA (patient care tech as we call it) so the nurses already knew me, we already established a professional relationship and got to skip that awkward step when I came back as a nurse.
3. They are older, much more experienced nurses, so they have that motherly nature.
4. They are just amazing nurses who have a lot of compassion for the underdog (me).
So, working with these lovely ladies (no male nurses on my floor so far) has been a joy. Most of them will drop what they’re doing to help me out. A lot of them would protect me, in a sense, from the harshness of nursing. The transition from studying to working has been bumpy, yet still comfortable. Cue words of intense wisdom from me:
Future graduate nurses - find a hospital with good co-workers. Without such a good set of co-workers I’m sure my first experiences as a new nurse would be tragic, horrifying and I’d probably be in the insane asylum talking to myself instead of to you. Trust me, nursing is stressful, terrifying, and can downright suck. But if you have amazing co-workers to help soften that harsh reality, your stress level will decrease dramatically.
(Cont’d) Do some very deep soul searching before you begin your new job. Realize that you know nothing (except how to keep someone from dying). Nursing wisdom comes straight from experience. I’ve made a fool out of myself plenty of times. I’ve used the “I’m new, I’m learning, I’m sorry” statement on a daily basis. I also use the “I don’t know but I’ll go ask” with about every patient I’ve had. I told one of my co-workers that I say “I don’t know” a lot to my patients and she said that she still says that sometimes (she’s been a nurse for years). My point, if you come onto the floor realizing that you need to learn and not as a snobby-know-it-all new grad then your co-workers will be more apt to help save you from deep suffering.
Everyday I walk onto the floor, I never know what lies ahead. I’ve had crazy days where I’m running around like the energizer bunny, and good days where I have plenty of time to do all my charting, pass all my medications, and talk to my patients. Nursing is never a constant and that’s something I have to get used to. I’m not always welcoming change with warm, open arms so it’s hard to not be too stressed out. However, I’ve found that if I’m thrown into situations and take it with stride then I don’t have time to be stressed out. I take one step at a time and get everything done that I can in my shift. In reality, if I leave that floor at the end of my shift and my patient is still breathing - I have accomplished enough.
I’m slowly gaining confidence when calling a physician. If it’s an easy fix I just call him/her, tell them what’s going on and what I’d like for them to order. Most of the time he/she says that’s okay and to write the order. The call lasts less than a minute, I write the order, and I go on my merry little way. Sometimes I have to call the physician to discuss the patient and we kind of brainstorm on what to do next. That call can be fun and a good learning experience if the physician is nice. It’s not so enjoyable if the physician is mean. To help me cope with the mean ones, I just tell myself that they probably have no idea what nurse they’re talking to (although I tell them my name) so they don’t have a face to place on the person at the end of the line. They also have tons of patients at different hospitals so they probably get millions of calls while they’re at home trying to relax. I’d probably be annoyed as well. However, it’s conflicting because they shouldn’t be a physician if they don’t want to be called all the time. Most of the time I just shake it off. I did my job, I did what I was supposed to do and they might as well be mad at me instead of the patient.
The fun part of my job is having time to talk and listen to my patients. It’s always amazing how willing most patients are to talk to someone. It’s insanely boring laying in a hospital bed. I don’t know from experience, but I can certainly imagine. About 95% of the patients don’t bring computers, iPads, iPods, books, magazines, puzzles, or anything exciting to do. Most of them lay in the bed and watch TV…and we all know how there’s nothing good on TV anymore. Some patients just lay there and don’t want the TV on so they’re alone with their thoughts. I’d drive myself insane. So it’s understandable why patients jump on opportunity to talk…about anything. I’ve gotten all kinds of life advice from patients. I’ve heard all about their kids, grandchildren, and great grandchildren. I’ve been told that I should be beaming with pride about being a nurse. I’ve gotten tons of thank-yous and smiles. I definitely enjoy my job and the patients. Now, if only we could get rid of the charting part of nursing ;)
I was told throughout school that we’re only learning about 10% of what we need to know as a nurse and the other 90% comes from experience. It was shocking during school, but it’s definitely proven to be true now that I’m actually a nurse. When I began a little over a month ago, I realized that I knew absolutely nothing other than how to not kill a patient. I’ve learned a lot so far and still have so much more to learn. My preceptor/co-worker once told me that it’ll take 6 months to begin feeling comfortable and 2 years to actually feel as though you know enough to be a good nurse (basically know enough to not have to ask questions numerous times). 2 years seems like forever, that means that I have 2 years worth of learning to still do. Yikes! I hope I can survive that journey *crosses fingers*. So you’ll have to stay tuned to see if I don’t explode. :)
For all those future new nurses - be a sponge and be patient. The latter is what I need to work on. I just want to fast forward to the 2 year mark and instantly know what I’m doing, but I know I have to take this journey in order to become that wise nurse. I still have a lot of learning to do and a lot of questions to ask. Just pray that it’s smooth sailing, for the most part.
It’s always been a joke in the nursing world on how physicians tend to write worse than kindergartners. I’m sure you’ve noticed as well by attempting to read your primary physician’s signature. You have it easy, we get sent hand written orders like we’re stuck in the 1800’s. Dear physicians of the world - there is a wonderful invention that came out..ohhhh a few years ago, it’s called a computer. Say it with me com-pu-ter. You can easily type out what you want on a fancy keyboard and it’ll appear on the screen in front of you like pure magic! No more hand cramps or forgetting to dot your i’s and cross your t’s! It’s not hard, I’m sure your children/grandchildren/dog could teach you.
Take a look at this order sheet below. Sometimes you have to squint your eyes, turn the paper upside down, hold it out rreeaallllyy far from or super close to your face. Whatever it takes to decipher this encrypted message. Try reading it and coming up with what it says. Now, mind you, if you aren’t familiar with medical terms then most of it won’t make any sense but I’ll provide the answers below (at least I’ll try).
I’ve numbered the lines via Microsoft Paint to make it easier to follow when I decode it.
Top - Post-op orders
1. Admit to RR then to 2nd floor (Admit to recovery room then to 2nd floor)
2. VS (vital signs) per RR (recovery room) then qshift (q=every in medical slang, so it says - vital signs per recovery room then every shift)
3. Activity ad lib (ad lib = patient can do whatever whenever he feels like it)
4. Diet reg. (regular)
5. IV D5 1/2 NS with 10mEq KCl at 125 ml/hr (medical jargon again, it’s IV fluids with 5% dextrose and 0.45% sodium chloride, or normal saline, with 10 milliequivlants [measurement] of potassium chloride to run at a rate of 125 milliliters per hour)
6. Ancef 5 gm IV q8h x 24h (in this order the 5 is a division sign and the hour is a degree sign. Read as - Ancef [antibiotic] 5 grams through IV every 8 hours for 24 hours)
7. Dilaudid PCA as per protocol (Dilaudid is a pain med, PCA = patient controlled analgesic. Dilaudid is hooked up to this pump so the patient can deliver pain medicine whenever. There’s a protocol on the dosage.)
8. I’m not sure why I numbered this line because it’s crossed off. It’s something about Vicodin though.
9. MOM 30 mL PO q6h PRN (Milk of Magnesium [laxative] 30 milliliters by mouth [PO] every 6 hours as needed [PRN])
10. Maalox 30 mL PO q6h PRN (Read as - Maalox 30 milliliters by mouth every 6 hours as needed)
11. Colace 100 mg PO q12h PRN (Read as - Colace 100 milligrams by mouth every 12 hours as needed)
12. Dulcolax suppos. PRN (Read as - dulcolax suppository [entered via rectum] as needed)
13. Fleets enema PRN (as needed)
14. Zofran 4 mg IV q6h PRN (Zofran is an anti-nausea medicine give 4 milligrams via IV every 6 hours as needed)
15. NV checks R upper ext qshift (Neurvascular checks right upper extremity every shift)
16. Sling/Swath R upper ext (right upper extremity)
17. Cough/Deep breathe q1h while awake (Famous for after surgery, patients need to clear their lungs of the gunk that’s been sitting there throughout surgery. It states - cough and deep breathe every 1 hours while awake)
18. Inc. Spirometry q1h while awake (Incentive spirometry, plastic doohickey they give that patients use to breathe deeply. States - Incentive spirometry every 1 hours while awake)
19. St Cath in 6h if unable to void (Straight Catheter is something a nurse will do if a patient is having trouble voiding, it’s a quick way to empty the bladder. Void means to pee. Read as - straight cath in 6 hours if unable to void)
20. Hgb, Hct in AM (Hemoglobin and hematocrit in AM - blood tests to check how you’re doing after surgery basically)
21. PT/OT - active ROM R elbow, wrist, digits R hand (Physical therapy/occupational therapy - active range of motion right elbow, wrist, digits right hand)
22. Same as above, apparently I wasn’t paying attention to what lines I was numbering.
23. Apply S…. Cream/ABD R axilla qd (I can’t even make out that S word but I know what cream they’re talking about, it protects the skin from becoming irritated in areas of high friction - like the armpit [axilla]. Read as - Apply blahblahblah cream to right axilla every day)
24. Again, same as 23…my bad.
TA-DA! Now that you’re a pro at this you can march right up to the front desk and ask to see your own chart and read the orders yourself!
Have a wonderful day :)