Monday, July 20, 2009

Eye seee youuuu

Yesterday before work I said, "If they float me again, I am going to cause a scene," but then I saw they were floating me to the ICU, which still pissed me off, but I shrugged my shoulders and went to the 2nd floor. I didn't even bother going back to my floor for the rest of the day since I brought all my stuff with me.
The unit is so much better in infinite amount of ways. First, the nurses are super nice, which makes it even better. Second, even the doctor's treat you better since I'm sure they couldn't remember if I worked in the unit or the floor. They have more respect for unit nurses.
I had two patients.
The first was a male who came to the floors for recurrent UTIs and developed respiratory distress and was sent to the unit on Bipap. He was now doing fine on 2LNC,and was almost going to leave the unit the day prior, but supposedly he began coughing when he was eating, so they made him NPO, held all his meds, and ordered a swallow study to make sure he wasn't aspirating his food. However, since it was ordered late on the weekend, it wouldn't be until Monday. So, the pulmonologist ordered an NG tube for tube feedings.

The nice charge nurse went with me to drop the NG since he is almost 400 pounds and I thought he might fight, which he did. We actually got it and we both know it was in the right spot, but since he was sooo large, it showed absolutely nothing on the KUB! Aggravation!! We both agreed it was there. We then tried a dobhoff, but he was fighting too much, so we stopped. You can't force someone to do something. I paged the MD on call and he basically just said try to encourage the tube and meanwhile, we put him on D5 half with 20 of KCL.

My second patient was in for pneumonia with a history of breast cancer with mets to the bone and liver. She was not in good shape. She developed TTP or Thrombotic thrombocytopenic purpura , so she had to receive plasmapheresis! I have never seen this before since they don't do it on the floors. It was pretty cool. I didn't have to do anything because the nurse from Florida Blood services worked the machine.
This lady's plasma was DARK. Plasma is supposed to be straw colored, and hers was more like hematuric urine. They removed something like 3500ml and replaced it with nice new plasma.

Meanwhile, she had a Hgb of 6.8, so I transfused 2 units and by 1630, she was back up to 10.2! woo

(The last three days at work, I have managed to hang blood every time...)
Here is a picture of the plamsmapheresis:

ps: I don't really consider wikipedia a reliable source, but for blog purposes it comes in pretty handy


april said...

I remember my first NG tube I put in.. it was my first week of clinical ever!! I got it in the lung at first because she didn't swallow but it all worked out in the end! haha

LivingDeadNurse said...

i get to learn that in a couple days...interesting blog