nursing...

wow.. so.. i had a crazy night last night.

one lady had been off her tube feedings for at least a day due to her DHT falling out. the docs hadn't replaced it, nor had they replaced the nutrition that she had been getting from it. they hadn't changed her scheduled insulin either. interesting. she did have D5 running, but during the night they ordered some K runs which took it's place for 4 hours. (another loss of the regular amount of sugar she'd been getting). i called the night docs about her lantus (long-acting) and they asked me just to give half of it. good thing i called. so i gave half of it. midnight comes around and her glucose level was 65! so we tried to get her to eat some crackers and drink something sweet. she did. and then threw up some of the crackers. nice. checked her glucose again 30 min. later...48!! called the docs and got half an amp of D50 which brought it up to like 117. good enough for me. no more insulin for her.

at the same time this is going on...i have this burn patient in another room who's getting tube feed as well. he's NPO. emv 11. so HE has a FS of 355!! I treat it with the scheduled and with the ordered sliding scale, right? right.

SO...six comes. time for more medication and more finger sticks.
i just figured i'd hold the scheduled insulin for pt #2 because i figured i'd treat his probably high glucose level at the same time as i administed the scheduled stuff, right? wrong....

patient number one? ....65. more crackers. more nausea. more sweet drink. i think she eventually came up but it wasn't til i was 'off my shift.'
patient number 2? THIRTY-FIVE! .... D50. MD to bedside. FS 160. will continue to monitor.

It wouldn't have been so bad maybe if there wasn't another pt feeling nauseated and another having a BM and i still had a dressing change to do and vitals were due and we only had one tech and were preparing for day shift to come on. ridiculous.

someday maybe i'll feel like a good nurse.