Tuesday, March 16, 2010

I'm Back...I think.

Yesterday I hit the ground running. Nurse J met me at the door and said, "I need you to come up here and see about Ms. G, she is talking out of her head." Just as I rounded the corner at the South Nurses Station, nurse P says, "Hey, you need to see about her, as she pointed to Ms. L, she's got a cough and then go down and take a look at Mr. F, his eye, well, go down there and you'll see." Then nurse J reports another case I need to see as the family is concerned. Then another nurse from the 400 hall reports that, "Ms. C is not doing well. She's more congested and is getting anxious because she's having a hard time breathing and the granddaughter (who is a hospice nurse) is requesting that we increase the frequency of her Roxanol dosing."

Roxanol--it's immediate release morphine generally used in end-of-life to keep the patient relatively free of pain or help calm them when they are struggling with breathing. "Air hunger" is what we sometimes call it.

After I see all the "acute" cases the nurses have told me about or written a note to me in my book (a spiral notebook just for nurses to communicate problems or potential problems to me), I go back up to the nurses station and pull out the charts (hooray!! they are all here!!--that's another story) and begin my progress note and write the accompanying orders. Before that's done nurse J comes up and says, "Oh, did you see the UAs yet?". So, I pull out Dr. H's folder and pull out the labs and unsigned orders. It's enough to make your head spin sometimes but I begin sorting it all out and before I know it, the patients on this side of the building have been seen, the orders have been written and it's time for me to move to the other side and start the process over again. You see, there is a North and a South Nurses Station. This is what I do daily. Every day presents a new challenge and that's what I love. Monday is my "like a box of chocolates" day--I never know what I'm gonna walk through the door and get. Over the weekend "stuff" happens. Residents get sent out to the hospital because of an acute illness, or a fall, or they start developing symptoms of a problem and need to be seen so that the potential problem may be "nipped in the bud". Tuesday is "lab day" and blood work drawn in the early morning usually returns with some abnormal results that need to be addressed, and Wednesday is "day off", Thursday is "catch up" day for all that may have happened on Wednesday when I wasn't there, and Friday is "Regulatory and lab" day. I usually perform my required visits per medicare guidelines, that is every patient or resident of the facility is seen at least one time a month for management of chronic health problems such as hypertension (HTN), diabetes (DM either I or II), kidney disease (CKD), chronic obstructive pulmonary disease (COPD) and others. It entails a physical assessment of the patient, reviewing their labs, medications, vitals, weights, bowel and bladder, and activities of daily living and determining if their current medical regimen is working to keep them healthy. In addition to the monthly visits, I also see the "acute" problems that pop up. Like the ones mentioned above where the nursing staff is reporting that a resident is "talking out of their head" or having "burning" when they urinate. Some acute problems are fairly easy to figure out, others not so much.