Helpful hint

So you’ve put in an naso/oro- gastric tube. Great! Did you verify placement? If so, how? Did you immediately get gastric contents back when you aspirated? Did you listen and confirm placement in the stomach? Did you use the CO2 detector that some institutions have?

I ask because I ran into a situation in which an OG tube was placed in the ER before my patient was sent to me. Helpful. Thanks. Except it wasn’t helpful at all. My new admission’s abdomen was quite distended despite the OG tube. I connected the tube to wall suction and got nothing out. I changed the canister and tubing just to make sure it wasn’t something wrong on that end. Nothing. I listened and couldn’t quite say with 100% certainty that I heard it in the stomach. Hmm… Not sure I want to use this…

And then he vomited. A lot. And kept vomiting while I held the yankauer in his mouth to keep him from aspirating.

Nope, that OG wasn’t in.

So, I took it out and decided to try my luck at placing an NG instead of an OG. As soon as the tube hit 60 cm in depth contents start pouring out. No need to auscultate that! Hooked it to suction and in about five minutes I got a full liter of contents out of him. Oh look, his abdomen isn’t as distended now…

I say all of that to say this: verify placement! However you choose to do so, make sure you KNOW that the NG or OG is in the stomach and not curled up in the back of the throat. Have someone verify it behind you if you aren’t sure. If all else fails, take it out. I would rather you send me a patient without a tube than send me a patient with a misplaced tube.

Alarm fatigue 

I am legitimately over it. We have new GE monitors and they beep for EVERYTHING! Apnea is a triple beep but an arrhythmia isn’t. It doesn’t read the respiratory leads well so everyone is either tachypneic or breathing 6 breaths a minute.   There is something beeping every minute it seems. It’s getting to the point that we are starting to ignore the alarms because there are so many of them. 

This is what they mean when they refer to “alarm fatigue”

Story time 5

I rarely, if EVER, read comments on social media. I know better. The amount of hatefulness in the comments is unmeasurable. However, I ran across a post on Instagram showcasing the singer Halsey's thoughts on birth control and why is should be considered health care. She even went on to list the medical conditions that birth control was able to help.

I read the comments.

For the most part the comments were full of women in support of her tweets and sharing stories of their own on how birth control has helped them.

But it wasn't all support. Oh no. There were a few in the comments that wanted the world to know that we, THE ENTIRE FEMALE POPULATION, were stupid for not just taking care of our reproductive issues the "natural way".

Yep. That's the fix. Change your diet and drink a special tea and that'll handle that severe endometriosis and those ovarian cysts you're dealing with.

But there was one lovely person in the comments that couldn't just be happy with condemning your use of meds. Oh no, Cassy_chevy had to condemn YOU!

Awesome. Let's bash any and every person that decides to have a different opinion.

So there you have it ladies. YOU have no idea what YOU are doing with YOUR body.

Hello nightshift, goodbye normality

I am a nightshift nurse. I have been my entire nursing career. It’s what I am used to and it’s been great for me. Key word: been. I used to love being a nighshifter. You couldn’t get me to work a dayshift if you paid me extra. 

That’s changed. I’m old now. I’ve been a nurse for 7 years, that’s like 21 years in human time. Nursing ages you, quickly. I’m tired. I’m always tired. That’s the problem with nightshift, it goes against your natural rhythms. I’m not supposed to be up wiping ass at 0241 in the morning and yet here I am doing just that. I can’t just have one shift off in between nights anymore either. It’s impossible for me to get anything done because I’m so exhausted that I sleep the whole day away. I’m lucky I live in a house and not apartment because I cannot tell you how many times I have been up cooking and cleaning at like, 2330 at night as if it’s normal. When I have a stretch of days off, I fall back into a normal rhythm, up during the day and down by 2200-ish. That first shift back after a stretch off is BRUTAL. It’s getting harder and harder to adjust back to the nightshift life. I think I may be reaching the end of this “nightshift nursing” thing. Then again, my mouth is far too vulgar for dayshift so… 

Story time no.4

I’m driving home from another night shift of shenanigans but what’s new. 

I have recently made a conscious decision to start drinking more water throughout the work night. I did not make the conscious decision to pee before leaving work 😒.

So here I am, at the rest stop (because my commute is 1 hr 15 mins and 75 miles one way) peeing in a fly ridden restroom. That’s not what bothers me. I just saw a woman walk out of a stall, walk past the sink without washing her hands, and just walk right on out of the bathroom. 

So, you’re just not going to wash your hands? No? Oh, ok. 

I walk out behind her to see her at the vending machine getting a bag of chips, because nothing tastes quite as delicious as Doritos and bacteria… 

Universal precautions: yes you should actually care.

You hear it constantly. Universal precautions. In fact, you probably hear it so often that you tune out the term. I don’t blame you, I am sure management has beat it into the ground. There is a reason. You have the potential to kill a patient. NO, I am not being melodramatic! What is on your hands actually has the potential to kill your patient. Besides that, you have no idea what the hell your patient has until you test them for it. How many times have you admitted a patient and come back the next day to see them on contact precautions for MRSA? Far more times than you can count I’m sure. You are doing this for them, and you.

So what exactly are universal precautions? Well, according to OSHA it’s the approach to “treat all human blood and certain human body fluids as if they were known to be infectious for HIV, HBV and other bloodborne pathogens.” In simple terms, treat ’em like they have something until you know they don’t. Trust me, it’s safer this way.

You know what to do.

  • Treat all bodily fluids as if they are infectious.
  • Gloves on before you touch your patient.
  • Eye shield if you are going to be messing around with the gross body fluids your patient decides to involuntarily share with you.
  • Hand sanitizer going in and out of the room REGARDLESS of whether you have touched the patient or not.
  • Put on that hot ass plastic contact gown when you are going inside a contact room.
  • If you have to share equipment between patients, wipe that shit off before going to the next person.

Let’s imagine you have a fresh transplant patient that is, of course, immunosuppressed. You hear a call bell, and being the fabulous nurse you are, you go and help this other patient that is dying of thirst and needs ice before the world ends. You walk in with the ice, and before you leave you make sure to give him his call-bell that has dropped on the floor. You didn’t feel the need to wear gloves because you were just getting him ice for the 30th fucking time tonight. You don’t hit the hand sanitizer because there wasn’t one beside his room. You go check on your transplant patient. You’re just going in to get a temp and turn them, that’s it. Once again, you skip out on the gloves because it’s just a quick turn. No big deal, right? Then a day later the VRE swab that was sent on ice man when he was admitted comes back positive. Great. You and your coworkers were alllll up in there. Except it gets worse. Your transplant patient is getting sicker, WBC’s are climbing, patient is feverish, now hypotensive. Cultures are drawn and guess who has gotten themselves a VRE infection too? Yay for easily spread bacteria! Despite the best efforts of your team, the transplant patient doesn’t make it. Was it you?

Dramatic, yes. However, shit like this happens. In my current unit we recently had an outbreak of CRE that could be traced back to, among other things, inadequate hand washing from staff. Not something we were proud of. It was totally unnecessary.

Don’t be that person. Don’t be the one that gets another patient sick, or even take something “special” home to the family. You know how to prevent this, keep up the good work.