TurboNurse

So yesterday turned out to be quite interesting.

I feel like I totally messed up.  There were some antibiotics due at 1 along with a dose of caffiene and then another dose of a different antibiotic due an hour later.  Well here it is 2:30 in the afternoon and I have yet to hang any of the antibiotics (first one was due at 1). 

So I get back from lunch and was talking to the doc about what she was going to order for the kiddo and she mentions she is going to order a vanc (anitbiotic) lab and then I have my oh crud moment and realize I have yet to hang them when they should have been finishing up at the time I was talking to the doc.

I felt so down on myself and was so mad at myself that it took me a while to figure out what to do.  I can't believe I missed that!

I was so on top of it with my other kiddo!  I was so proud of myself that I got a fluid change done immediately and was just totally on top of it.

So after all this happens and  get my first dose of antibiotics in, it was time to retape the kiddo's ET tube (breathing tube that is used when someone is on the vent).  We had mentioned to the RT that morning that it needed retaped because it was all gunky and gooey.  Not really a good thing but it happens and is normal.

RT comes over to retape and my preceptor and I were both by the bedside because the main RT person was being so rough with the kiddo that he kept bradying down and desating.  A brady is not a good thing because it means that the heart is slowing down.  In his case it was slowing down because a reflex called the vaso-vagal response was being triggered which happens.  What is not supposed to happen is to let the kid go like this for 3-4 minutes!  My preceptor and I were both at the bedside telling the RT that things are not going well and we need to change something.  It got so bad that we grabbed the bag to bag the baby but RT wasn't budging.  The oxygen sat dropped to 45% (normal is 85-95 for our kiddos) and I saw it go even as low as 34% and RT wasn't budging.  I was beyond pissed!!!!!

Luckily the kid didn't code or go too too bad during the procedure but what happened should not have happened.  He obviously wasn't handling it well and needed some breaks but RT just wasn't seeing it.  The care they gave was very dangerous and did cause actual patient harm.

The baseline of the FiO2 (percent of oxygen the vent delivers) for this kid was 25%.  To give you an idea of how awesome that is, room air is 21%.  Needless to say the kiddo was doing fantastic and was on his way to being extubated.  Until this.

We had to turn the FiO2 up to 100% during the procedure just to get the sats back in the 60's.  When the procedure was over and he was retaped, we were able to bring the vent down to 85% but if you remember, his baseline was 25%.  This is something that is NOT normal and should not have happened.

Because we were still having problems keeping the kids sats up, we suctioned him because we figured secretions got mobilized during the tape change.  When we suctioned him, we got frank blood out of his lungs due to the trauma that was caused because the RT used excessive force on this kiddo.

So there was obvious harm done to the patient.

We got a STAT chest xray to make sure the tube was still in the right place and that it hadn't slipped lower.  We got the results back and the tube needed to be retaped because it was in the wrong position.  So my preceptor goes to the RT who did the first retaping and told her that the tube needed to be retaped because it was not in the right position.  This RT says flat out that she is not going to do it.

The docs all knew what was going on because as soon as we saw the frank blood coming out of his lungs we paged them.  We also had a very difficult time calming the kid down after the procedure.  We contained the kid withour hands for a good 30 mintues after the procedure and still nothing.  While the doctor was there we also asked if we could give him a bolus of morphine to help him calm down because he was in obvious pain and discomfort.

It was just such a mess and I was so upset by the whole situation that I couldn't manage to write it down yesterday.  I had to wait to calm down.

Other than that incident, my job is going very very well.

This was my best week overall where I felt like more things are starting to fall into place.  I feel like I'm standing more on my own two feet and have started to take the initiative in the care of my patients.  I'm not afraid to page doctors and ask them questions.  I'm not afraid to speak up during rounds if something comes up that I think needs to be addressed.  I'm talking to families and updating them with more ease and I'm giving report much better and more on my own.

I stll have so much to learn but things seemed to come along quite nicely.  I'm hoping after my nice stretch off (am off for 6 days in a row!!!!  yeah!!) more things will start to fall into place.

Oh yeah!  I forgot to mention that I also got my first successful IV start yesterday (this is why I missed my meds when they needed to be given)!  I just started trying for IV's the day before so I have not had much experience with doing this on premature babies.  One came up on a baby that wasn't ours but the nurse who had this kid came over and asked us if we wanted to try.  Of course I jumped right on it!  I actually got it on my first stick on the kid but the catheter kinked so we pulled it out and tried the foot.  I got the foot on the fist stick as well.  I still need to learn how to tape but I got the hardest part down on my third stick overall (I tried twice the day before).

I'm just so glad that things are clicking and I'm feeling more comfortable standing on my own two feet.