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  • Vegas times

    I rarely get to go out this stint in Las Vegas since we are raising our young niece and nephew now. Only played poker three times since we started back to work in August.

    This is is still a heck of a place, and healthcare is in huge need of reform. Thatís how it is everywhere though...

    We have a patient who is 25. He is autistic, and they have classified him as a suicide risk BC he jumped off his second floor balcony. He is severely delayed and can speak, but he is like a three year old child. He broke his right lower leg, and he had to have a big surgery that left him with an external fixator. This means he has a metal device on the outside of his leg with screws down through his skin into his bone to stabilize the fractures so they can heal. Bearing weight or putting any weight through this leg is a huge contraindication while that device is in place.

    Behaviorally, this young man has shown no signs of behavioral problems or suicidal ideations. However, one night, he became agitated. Yelling, pushing, hitting, and KICKING with this injured leg. Security was called, everybody runs in the room, and of course that makes the situation worse. Looking over his medications, itís now 10pm, and he hasnít had any pain medications since 6 that morning! Typically, the patient asks for pain medication, and we give it to them. However, in mentally disabled patients or those who donít normally communicate, you use alternative pain scales or better yet your common sense. Obviously, the kid needs pain medicine BC he has metal rods and huge metal device sticking out of his leg. Anyway, imho, his pain has made him agitated, he canít properly communicate, and now there are four security guards holding him down Bc he is ďfightingĒ staff.

    This poor kid broke my heart. I was helping also, and I was trying to hold and protect his operative leg. He was kicking and pushing off the bed with it. He had Herculean strength it seemed! I could feel his bones moving around and crunching in there! It was awful. In this chaos, his IV came out to complicate matters. Further frustration arose because the doctor came to assess the situation, but he was a scared resident who didnít know what to do. That means we have to wait for him to call his supervising resident and then the doctor, etc., and nobody wants to make a decision or do anything! Meanwhile, the poor kid is still going crazy and Iím sure in horrible discomfort.

    The first order was for Haldol 5 mg IM (shot in the muscle). What a joke!! This treats psychosis. This kid is in pain. He needs pain medication. Anyway, I go out and talk to the resident. With these guys, they donít know what to do, and theyíre scared. I have been a nurse longer than this resident physician has been alive. I know what to do. I know what the patient needs. I tell him the kid needs a good old IM shot of Demerol and Phenergan 50/50. It will guaranteed take care of his pain and get him comfortable and calmed down. The resident is cautious. The patient is almost 250 lbs.

    Anyway, we finally get the orders we need, and as expected, heís a happy kid again in an hour with no fighting. I restart an IV on him, and I get the resident to order scheduled pain medication so he stays medicated, and we donít have to deal with this avoidable situation again. Meanwhile, I have 7 patients of my own who I need to take care of Bc this was not my assigned patient.

    More stories to come.

  • #2
    Originally posted by SixFive View Post
    I rarely get to go out this stint in Las Vegas since we are raising our young niece and nephew now. Only played poker three times since we started back to work in August.

    This is is still a heck of a place, and healthcare is in huge need of reform. Thatís how it is everywhere though...

    We have a patient who is 25. He is autistic, and they have classified him as a suicide risk BC he jumped off his second floor balcony. He is severely delayed and can speak, but he is like a three year old child. He broke his right lower leg, and he had to have a big surgery that left him with an external fixator. This means he has a metal device on the outside of his leg with screws down through his skin into his bone to stabilize the fractures so they can heal. Bearing weight or putting any weight through this leg is a huge contraindication while that device is in place.

    Behaviorally, this young man has shown no signs of behavioral problems or suicidal ideations. However, one night, he became agitated. Yelling, pushing, hitting, and KICKING with this injured leg. Security was called, everybody runs in the room, and of course that makes the situation worse. Looking over his medications, itís now 10pm, and he hasnít had any pain medications since 6 that morning! Typically, the patient asks for pain medication, and we give it to them. However, in mentally disabled patients or those who donít normally communicate, you use alternative pain scales or better yet your common sense. Obviously, the kid needs pain medicine BC he has metal rods and huge metal device sticking out of his leg. Anyway, imho, his pain has made him agitated, he canít properly communicate, and now there are four security guards holding him down Bc he is ďfightingĒ staff.

    This poor kid broke my heart. I was helping also, and I was trying to hold and protect his operative leg. He was kicking and pushing off the bed with it. He had Herculean strength it seemed! I could feel his bones moving around and crunching in there! It was awful. In this chaos, his IV came out to complicate matters. Further frustration arose because the doctor came to assess the situation, but he was a scared resident who didnít know what to do. That means we have to wait for him to call his supervising resident and then the doctor, etc., and nobody wants to make a decision or do anything! Meanwhile, the poor kid is still going crazy and Iím sure in horrible discomfort.

    The first order was for Haldol 5 mg IM (shot in the muscle). What a joke!! This treats psychosis. This kid is in pain. He needs pain medication. Anyway, I go out and talk to the resident. With these guys, they donít know what to do, and theyíre scared. I have been a nurse longer than this resident physician has been alive. I know what to do. I know what the patient needs. I tell him the kid needs a good old IM shot of Demerol and Phenergan 50/50. It will guaranteed take care of his pain and get him comfortable and calmed down. The resident is cautious. The patient is almost 250 lbs.

    Anyway, we finally get the orders we need, and as expected, heís a happy kid again in an hour with no fighting. I restart an IV on him, and I get the resident to order scheduled pain medication so he stays medicated, and we donít have to deal with this avoidable situation again. Meanwhile, I have 7 patients of my own who I need to take care of Bc this was not my assigned patient.

    More stories to come.
    Good stuff. Keep em coming.
    Long Island

    Comment


    • #3
      great work SixFive


      I am a living and breathing recipient of great hospital care in the past.

      and so many times it was a nurse who stopped,listened and reacted to my needs.

      I make it a point to thank all the staff who help with my visits for whatever necessary.

      Your stories say alot about you youngman...all good..
      We move forward with you or without you!

      Comment


      • #4
        Thanksgiving toilet

        Thanksgiving Day is a day I have always loved. Family, food, and most importantly, a reminder to think and ponder about what we have and our blessings. I like to count my blessings and always be thankful, but our lives consume us, and we sometimes forget how blessed we are.

        This year, I had to work. It was my first week back on day shift. Nights is a killer both to your body and family. Itís just so unnatural to be awake all night. Anyway, I have a patient who is in her 40s. Itís my second day with her, and her diagnosis is pneumonia. Her real problems though are all social in nature. She has two small children at home and two adult children. The young adult children call her frequently on the room hospital phone. I can overhear the conversations a bit while Iím in the room, and I know that neither of them work, both are girls, and one of them has a drug problem. The patient (Jan) cries frequently especially after speaking to them.

        Jan lives with her boyfriend. He also makes her cry after they speak on the phone. She handed me the phone to speak with him so I could update him on her condition. Patients have me do this regularly. Mostly itís Bc they donít understand or speak English well, but sometimes the situation arises where the family doesnít believe the patient. This boyfriend is a clown and very controlling. Heís probably abusive too. This is important Bc itís my job to offer the patient services or intervention by the appropriate personnel if I think there is abuse. She wholeheartedly denies this though, and when she gets a discharge order, she wants to go home. This boyfriend is caring for her children and often bitches at her for being in the hospital blaming her for how wild the children are.

        Her first concern is that she canít get home Bc her bus ticket is expired, and she has absolutely no money. She goes on to tell me that she lives in a very dangerous neighborhood. Her bathroom doesnít even have a toilet! She told me the landlord will not fix it, so for three months now, the family of 6 has been using a bucket for toileting. When was the last time you were thankful for a toilet? For me, it was Thanksgiving Day.

        I made sure Janís Oxygen level was stable, I had already obtained the breathing treatment machine for home breathing nebulizers, I assured her new prescriptions were sent to her pharmacy, and I did extensive teaching with her. I decided to take her out myself in the wheelchair. I donít have time for that Bc itís terribly busy, but i like to do it when I can. I can get a breath of fresh air mainly and get out of the hospital for a minute. I tell Jan we are taking a small detour, so I wheeled her down to the cafeteria. The hospital graciously gave us a Thanksgiving Day ďmeal ticketĒ. I fulfilled mine in a to-go box and delivered to Jan. She thanked me, and she said she was going to share with her children since there was no food at home. I then took her to the emergency room security office and handed them the cab voucher I had obtained for her. I also gave her a small amount of money that will mean far more to her than me. She thanked me profusely and hugged me, and I in turn thanked her.

        Count your blessing and be thankful for working toilets, shelter, food, electricity, and all the conveniences we certainly take for granted.

        Comment


        • #5
          Originally posted by SixFive View Post
          be thankful for working toilets, shelter, food, electricity, and all the conveniences we certainly take for granted.
          Yep.
          .
          .

          CANADA IS HOCKEY!
          HOCKEY IS CANADA!

          and of course.............GO LEAFS GO!!!

          No whammies, No whammies, No whammies......STOP!!!

          Comment


          • #6
            Great stories Sixfive, thanks for sharing

            Comment


            • #7
              Glad u all like the stories.

              41 year old woman comes in the hospital. She has this raging, infected abscess in her antecubital fossa (bend of her arm). She doesnít know what happened and thinks it might be a spider bite. An ultrasound test confirms what we all know already... she has a broken needle in her arm :eek:

              She needs surgery of course to cut out the needle and also to clean the wound, break up all the loculations of pus, and debride any dead tissue. After the surgery, she has an epiphany. She remembers what happened! She and her husband were at a strip club. One of the strippers there was shooting up and stumbled into her. She figures that at this point, the stripperís needle went into her arm, and the force from the fall made it break off. That must have been what happened :rolleyes:

              I always tell patients that I treat everybody the same no matter how poor their decisions, and telling lies only makes the treatment take longer. She must have really thought us all morans at the hospital

              Comment


              • #8
                Originally posted by SixFive View Post
                Glad u all like the stories.

                41 year old woman comes in the hospital. She has this raging, infected abscess in her antecubital fossa (bend of her arm). She doesnít know what happened and thinks it might be a spider bite. An ultrasound test confirms what we all know already... she has a broken needle in her arm :eek:

                She needs surgery of course to cut out the needle and also to clean the wound, break up all the loculations of pus, and debride any dead tissue. After the surgery, she has an epiphany. She remembers what happened! She and her husband were at a strip club. One of the strippers there was shooting up and stumbled into her. She figures that at this point, the stripperís needle went into her arm, and the force from the fall made it break off. That must have been what happened :rolleyes:

                I always tell patients that I treat everybody the same no matter how poor their decisions, and telling lies only makes the treatment take longer. She must have really thought us all morans at the hospital
                Or the spider was carrying a broken needle when it bit her.
                Long Island

                Comment


                • #9
                  Wall shits

                  So, Iím working in the ER yesterday, and my job is going to be taking care of patients who are admitted, but there are no beds to put them in. There are around 30 in the ER, so the plan is to move some out of their ER rooms and into the hallway 😑 BC we all know that the ultimate hospital experience is to be taken off your hospital gurney in your own private room to sitting in a chair in cramped hallway to receive your care.

                  Anyway, this is the decision, so I only request that the charge nurse put patients there who are ambulatory, not confused, and continent since Iím not going to be able to change beds or give a patient a bedpan in the open in front of everybody. The first patient I get I know well which is a terrible sign. Sheís 40, and she is always at the hospital for sickle cell crisis. Basically, her red blood cells are abnormal, and this can cause severe pain especially in the joints. Easy enough, just give her pain meds and fluids, right? Nope... this lady is all but an invalid by choice. She refuses to get up or walk, and to complicate matters she is blind, so she just screams like a baby whenever she wants something. This patient certainly doesnít meet the standard I have politely requested, and I know sheís going to be a huge problem. She is on a gurney at least. I get several other patients who are fine, but two of them have hot gall bladders. They both need surgery, and they are both in pain. I do my best to keep them comfortable in their chairs in the hallway. Thatís exactly where I would want to be if I was nauseous, had diarrhea, and in terrible pain :rolleyes:

                  Iím in the middle of calling the surgeon and coordinating with the OR staff when Ms. sickle cell starts yelling and going ape shit. She has to pee. I tell her she needs to walk to the bathroom (I know she can walk BC she lives at home and by the way she can move around on the gurney), but she says she canít. I remind her she is in the hallway, and I canít very well put her on a bedpan. She keeps yelling, so the charge nurse sends me a nurse apprentice who graciously wheels her into a just emptied room to assist with the bedpan.

                  After I get my two patients off to surgery, I get two more to replace, and patients come and go as rooms open up in the hospital. The cycle of putting patients in the hall from ER rooms to my hallway chairs is relatively smooth, and I only have one family member who complains. I empathize with he and his wife, but thereís nothing I can do about it. Iím not making these decisions nor am I assigning beds.

                  Ms. Sickle Cell is always complaining of pain, and I medicate her as I can per my orders. The transporter comes to get her, but she says her arm hurts, and I see her IV access has failed 🤦🏻 This is a huge problem because she has been in the ER and hospital so much she has terrible venous access opportunity. Starting IVs is my thing, and if anybody can get her, I can. I know I canít send her to the floor with no IV, so I tell the transporter to cancel while I get to work on that, and then Iíll rebook her transport when I get it. Restarting her IV is an exercise in futility. I canít get her. I communicate with the attending and ask if we can just leave the IV out because the patient is just in the hospital for pain control and was unable to fill her home pain medications. I didnít mention that this is her 10th trip to the ER this month, and she was admitted and discharged 5 of those times. The physician says ok to no IV, I request transport again, but then the physician changes her mind. I tell her I need a midline BC I canít get an IV, I put in the order, and transport arrives.

                  Awesome, Iím finally able to get her out of there! The transporter arrives, I give him the paperwork, but then he asks me for a mask. I ask why, and he says, ďbecause the patient shit on the wallĒ. I was like I walk over to her gurney, and sure enough, she has had a gigantic blowout with poop on the walls and a big puddle on the floor that has seeped out all the way under the gurney into the hallway 🤦🏻 FML...

                  I get some blankets off an empty gurney and throw it on the puddle of liquid poop in the floor to contain it. We canít clean her up there as already discussed, so I find a room nearby that is empty Bc the patient has gone for a test. I scoot that gurney over and make room so we can wheel in Ms. Sickle cell. The transporter and another staff member help me clean her, change the bed, and clean the gurney. Housekeeping comes to clean the hallway and wall, and she goes to a room upstairs.

                  The ER begins to empty, and by the end of the day, I just have one patient. I suppose it was a pretty good day overall although at times super frustrating and overwhelming.

                  Comment


                  • #10

                    Comment


                    • #11
                      Originally posted by MadJack View Post
                      don't know how they do it...day after day...
                      We move forward with you or without you!

                      Comment


                      • #12
                        Originally posted by Old School View Post
                        don't know how they do it...day after day...
                        Nope. Neither do I.

                        Comment


                        • #13
                          Originally posted by Old School View Post
                          don't know how they do it...day after day...
                          Originally posted by MadJack View Post
                          Nope. Neither do I.
                          Employee discounts at the cafeteria?


                          Comment


                          • #14
                            Originally posted by SixFive View Post
                            Glad u all like the stories.

                            41 year old woman comes in the hospital. She has this raging, infected abscess in her antecubital fossa (bend of her arm). She doesnít know what happened and thinks it might be a spider bite. An ultrasound test confirms what we all know already... she has a broken needle in her arm :eek:

                            She needs surgery of course to cut out the needle and also to clean the wound, break up all the loculations of pus, and debride any dead tissue. After the surgery, she has an epiphany. She remembers what happened! She and her husband were at a strip club. One of the strippers there was shooting up and stumbled into her. She figures that at this point, the stripperís needle went into her arm, and the force from the fall made it break off. That must have been what happened :rolleyes:

                            I always tell patients that I treat everybody the same no matter how poor their decisions, and telling lies only makes the treatment take longer. She must have really thought us all morans at the hospital
                            keep up the good work..

                            Comment


                            • #15
                              Originally posted by freelancc View Post
                              keep up the good work..
                              I don't think he likes the Vegas hospitals. How are the hospital(s) up your way?

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