Tuesday, November 23, 2010

A Calling or Just a Job?

Have you ever had a really crappy shift where you couldn't find a vein if it slapped you in the face, the patients just get sicker, the pyxis had none of the meds you needed, the lab took hours and hours for stat orders, the docs were grouchy, etc. Yeah. I had one of those a few days ago. Days like this make me question if I am just too lousy a nurse to be in this profession even though I usually love it so much.

With apologies to my atheist friends, I truly believe God/Higher Power/Universe always knows how to make up for this garbage kind of day. The next shift I had some of the sweetest patients. The docs were not troublemakers. The lab was super quick with results. And the pyxis was well stocked with all the necessities. I actually felt semi competent. I had a patient's mother thank me for being a blessing to their family. Wow :)
One thing that really struck me was when a patient's daughter, a hospice nurse, told me she was thankful that her mother had gotten a nurse for whom nursing was a "calling" not just a job.

I really appreciated that comment, but it made me wonder. What is the difference between a calling and just a job? I have wanted to be a nurse since I was a child, but know many nurses who went to nursing school to please parents, to retrain after their factory job went away, or to have a way out of a bad marriage. They are excellent nurses. I certainly enjoy getting a paycheck. I don't think I would want to be a nurse for free. I do get a deep personal satisfaction when I can make a difference in someone's life or even just provide some comfort when it is needed.  What is nursing to you, a calling or just a job?

Monday, November 22, 2010

Pulseless Electrical Activity

Courtesy of Wikipedia -Pulseless Electrical Activity or PEA (also known by the older term Electromechanical Dissociation or Non-Perfusing Rhythm) refers to any heart rhythm observed on the electrocardiogram that should be producing a pulse, but is not. The most common cause is hypovolemia.
The approach in treatment of PEA is to treat the underlying cause. These possible causes are remembered as the 6 Hs and the 6 Ts.
A patient in their 50’s had been in our ER all day with abdominal pain. The person was finally rushed to surgery after 5 liters of IV fluids, and a levophed drip could not get their blood pressure out of the toilet.
A large length of gangrenous, dead bowel was discovered during the lengthy surgery. It was removed and a colostomy was made. The patient came to Recovery with much better blood pressure.
Although the patient was on a ventilator, we noticed they were starting to look a little blue.   They had a normal looking rhythm on the monitor. However the pulse weakened and then stopped. PEA. Call a code. Start compressions.
It turned out the patient was extremely acidotic*** and ended up getting 4 amps of bicarb in addition to the 2 during surgery that they had gotten. A pulse returned. Not out of the woods for sure, but able to go to ICU at least. I checked when I came in the next evening. The patient was still alive.

Friday, November 19, 2010

A Pain in the Butt

"As soon as I leave here I'm going to St. XYZ's ER. If they tell me something different, I'm gonna sue. I'm on Medicaid so I can go to every ER in this city if I want to".

-My ER patient, who was told that his hemorrhoid did not require immediate surgery, but was instead advised to try a 2 week regimen of topical ointment and sitz baths before a follow up appointment with the general surgeon.

Friday, November 5, 2010

When You Gotta Go...

Ten hours into her shift, Nurse Nancy finally has a few seconds to run to the bathroom...