Adult Temper Tantrum

My last day of my externship was a very interesting one. When the 42 year old in chronic afib who refuses to take his Coumadin because it is "rat poison" (no shit Sherlock) is the least interesting of your patients, then it has been an interesting day.

One patient we had was a woman in her early 50's who was released one morning and came back later the next day for the same kind of pain she had been told was not a heart attack and that Ibuprofen would relieve. So naturally, the MD told her that she would be weaned off of morphine and that she would not get any Phenergan at all, but if she actually threw up she would get Zofran. Soccer Nurse and I stood outside her door and heard the MD explain all of this to her, then the MD came out and discussed everything with us, especially her drug seeking behavior and not to call him for any additional morphine because she wasn't going to get it from him. We smiled and said it wasn't a problem.

The next four hours were filled her calling for "something for her stomach." Naturally, she didn't get anything because she didn't throw up. So lunch time rolls around and we get another call from her. We walk in and on the floor there are peas and potatoes scattered all over.

Soccer Nurse asked what she needed and she said my favorite quote of the summer," I throwed up." Soccer Nurse walked gingerly through the minefield of peas and potatoes and asked where she threw up. She pointed at the floor and said as if we were dumbasses, "I throwed up there on the floor."

It was obvious that this woman took her spoon and threw food from her lunch tray onto the floor. Soccer Nurse pointed out that there was no way that could have been in her stomach because it was intact and no stomach fluids were seen. I think he threw in a comment about doubting she swallowed her food whole without chewing, but I may be making that part up.

I loved working with Soccer Nurse for so many reasons and his lecture to her about her behavior was priceless. He made it clear that what she did wasn't acceptable, nor was he fooled by her claims, so no, she wasn't getting any Zofran. He also pointed out she created a safety hazard with the food on the floor and now he had to call someone to clean it up. He was calm, professional and stern. It was FABULOUS! I on the other hand stood there with my eyes wide open trying not to say, "WTF do you think you are doing? If you are going to drug seek, don't do it for Zofran."

It was my first and not last Adult Temper Tantrum.

FOS

FOS = Full of Shit

It's a real life nursing diagnosis. You get this label if you come into the hospital complaining of chest pain, but really you are just constipated.

I was surprised this summer that we averaged at least one FOS per week.

So what happens to you if you are an FOS patient. The following are included in your stay:
Chest X-ray
Cardiac Monitoring
Nuclear Stress Test
Cardiac Enzymes
Colace

Now please choose at least two from the following menu:
Cardiac Echo
Abdominal Echo
Abdominal CT - getting to drink that yummy Crystal Light flavored contrast
Abdominal X-Ray
Additional Blood Work

Depending on the results will get you any one or more of the following:

Mild
Glycerin Suppository

Moderate
Fleets Enema

Industrial Strength
SMOG Enema
Manual disimpaction by a really pissed off nurse*

Luckily no one required the Industrial Strength this summer.

*Why a pissed off nurse? Because no one I met this summer would have been happy to stick their finger up someone "who could have avoided this by eating fiber" rectum.

Dirty Old Man

This summer Soccer Nurse (my preceptor) and I had a client that was a self described "dirty old man." I didn't give to much credence to his claims, because to me he really wasn't that outrageous. He did give me one of my favorite quotes of the summer. He felt that his manhood was a bit lacking, so he told me "One inch shorter and I'd be a lesbian."

Crackhead Calendar

Dear Crackhead,

If you smoke crack, it will constrict your blood vessels, which may induce chest pain. If we ask you, "When was the last time you smoked crack?" don't answer "a while." "A while" to most people may mean something like 3-4 months ago, not 30 minutes.

Thank you

CathyXIs, Student Nurse

The Summer is Over

I haven't been that motivated to write lately. Call it enjoying the summer, being too tired, not giving a shit, what have you.

It is probably better that I've let my summer stories simmer a while. I can write them with a little perspective and hopefully humor.

I finished my PNA program a couple of days ago. I had an AWESOME experience. I give full credit to my preceptor, Soccer Nurse (he coaches his son's soccer team). Not only is he a great time manager, nurse and human being... he also homebrews.

Finally in the Groove

It has taken several weeks for me to finally feel like I have a clue about what I am doing on the floor.

My preceptor is awesome. He is funny, organized, laid back and doesn't sit around complaining all the time about how awful the hospital/floor/money/job is.

Nothing terribly exciting has happened so far and based on what I have seen, I don't anticipate anything really dramatic. It is a good slice of what floor nursing is like.

Since I am on a cardiac floor, the RN's do their own vital signs, especially manual BP's. I will walk out of this experience a Vital Sign Diva. I've done a lot more teaching than I thought I would get to do. It is amazing how much repetition is needed for some people.

There are other people from my school on different floors doing externships. Based on what their stories are, I am extremely fortunate to have my floor and preceptor. I am learning a lot and not just a gopher.

Matters of the Heart

I got a call yesterday offering me a summer PNA (Professional Nursing Assistant) externship in cardiology. This means I will be spending my summer on the telemetry floor being a nursing assistant, but also being mentored by one specific nurse on that floor. I will work their hours and be their NA.

Cardiac medicine was my first choice because I am interested in it post graduation and figured this was a great way to find out if I really wanted to do it. Plus, it is one of the major reasons why I got into nursing in the first place. When my dad had his aortic valve replacement/CABG (coronary artery bypass graft) a few years back he spend some time in the CCU of his hospital. He had an AWESOME nurse named Pauline who took care of him for the two days he was in there. I looked at what she did and how she did it and thought, "Self, you could totally do this." Plus, I loved how she took care of my dad and took care of me by telling me what I could do for him and explained everything that was hooked to him. I thought she was a goddess when Dad was ready to be extubated and it was taking respiratory forever to come and do it. She shooed Mom and I out of the room and did it. Now I know that it was within her scope of practice, but to me it meant a lot for Dad not to have to be intubated for another 1/2 hour while we waited for RT.

I can't wait. Now where did I put my NA study manual??? I'm scheduled to take the test the day after my school final - great timing. But at least I will get a week off before starting the program.