Desperately Seeking Dilaudid

Dilaudid, aka hydromorphone, is an oral and IV pain medicine that is about 10 times stronger than morphine. It's a drug I'd never heard of before going into nursing, but one which is asked for by name in hospitals around the country...

Pain is obviously subjective, and everyone has different pain thresholds and manifestations of pain. But giving pain medicine scares me sometimes because it can cause respiratory depression (and nausea, which isn't scary, but still). This is especially true when my patient rates their pain as a 10/10 as their eyeballs are rolling back in their head, and insist I "push" the medication faster through their IV because it "works better". It's hard not to sound condescending when you explain that pushing the medication faster will get you HIGH, but no matter how fast or slow it's pushed it will "work" the same (ie. reduce pain). I feel like a bartender sometimes except I don't have the option of cutting off my customers. The whole interaction can become very manipulative on the part of the drug-seeking patient trying to pull one over on the stupid nurse.

I am by no means saying that my patients don't experience pain, and I have never withheld pain medicine because I personally felt someone didn't need it. The objective with pain management is to bring your pain to a manageable level, and that might mean not alleviating it 100%. We want you to be able to get some sleep while not slipping into a coma, for example. There is a fine line between Dilaudid and Narcan, and it's a road I would prefer not to travel.

I'm Still Here

It's been too too long since I've stopped by here. Is anyone still out there? I started a new job about three months ago and have been overwhelmed, stressed, and adjusting to all the changes that come with a new hospital and a new type of unit. My feet are hurting and I'm tired.

My patient population has changed dramatically and I find most days that 2 to 3 of 4 of my patients have cancer. I'm beginning to feel like there are more people out there who have cancer than don't.

The hospital I work at is reserved for the "sickest of the sick" and ours are the patients that are too complicated to be treated elsewhere or that need fixing from previously complicated or botched surgeries.

I miss my crazy old patients from my last job, but I'm learning a lot about new surgeries and conditions, as well as how to become the most anal retentive nurse on the planet ...because that's how you've got to be on this floor to survive. 

Alone

I had some time last night to spend a few minutes holding one of my patients' hands and I thought of this picture, she was so weak and small. I'm not sure if she understood what was happening or that I was there but I hope she felt something. I did.

Remain Calm

I made it through the first day of work with NO crying!

Newbie

This week marks my one year nurse-aversary and the start of a new position! Just when I was finally getting comfortable and confident in my work... I've been deported from my personal comfort zone.

I was lucky that everyone got along at my last job and that everyone was NICE to each other. I'll remind you that, sadly, this isn't always the case in the world of nursing. Why do nurses eat their young? I don't know. Maybe it's because we're hungry from missing meal breaks. Maybe we're crabby because we haven't had time to pee and have been holding it for 10 hours... Maybe it's because being a nurse is extremely stressful. Whatever the reason, I pray to the patron saint of nurses that I'm able to maintain a blood pressure that is within defined limits and that, above all, I don't cry.

A Lesson in Etiquette

Yo! Could you please get off your cell phone for like 5 minutes so I can assess your ass and/or give you some drugs? (... and by "your ass" I mean the familiar term for "you" not the actual anus, rectum, butt or butt cheeks although those are also possibilities) 

That's how I feel patients who won't get off their cell phones when I enter the room to care for them need be spoken to. This is a hospital for the love of all that's good and holy, not a club, chat room or bus stop. I demand some respect!

Sundowning

There are few things that make me sadder than seeing a confused old man in a pair of these mits. The look of hopelessness and confusion in their eyes as they ask you why you are putting these on them is enough to make you want to cry. We use these to prevent patients from pulling out their IV's, foley's and other bodily tubes.

Patients who sundown can potentially win themselves a pair of these gloves. They remind me of the mittens Micky Mouse wears which makes them even more depressing.

I had never heard of sundowning before becoming a nurse, but as I understand it, it is dementia that kicks in abruptly in the afternoon/evening and then goes away again in the morning. You might recognize this phenomenon when suddenly that elderly patient who you've been having such nice conversations with all day is now calling you a tooth fairy (in the best of cases) or trying to break your fingers (in the worst).