The training wheels are off!

Look Ma! No training wheels. I (and all of my patients) survived my first week off of orientation. I was in the observation (OBS) unit the first night. The OBS unit is intended to house patients who need to be observed for a few hours (less than 24) to make sure they are indeed getting better and ready to go home. With the high level of occupancy in the hospital at this time, the OBS unit often ends up being a holding pen for patients waiting to go upstairs to a regular room. I had several patients (about four at a time), some went upstairs, some went home, and a few stayed the night. It was busy, but not too bad. The biggest problem with OBS is that you feel a bit like you have been sent to outer Siberia. It is a bit cold and lonely.

The next two nights were out in the main ED with a regular hallway. Taking a hallway means you have 4 rooms, and you care for the patients who rotate through. You see a wide variety of patients and conditions, although you see mostly respiratory patients at this time of the year. I did get two items accomplished.

My first day on a hallway saw my first infiltration. My patient was a five year old with no muscle tone. Her veins were difficult. I was quite pleased with myself when I got the IV on the first try. It seemed like a good one with excellent blood return and it flushed easily as well. The patient needed fluid bolus, so I hooked it up. After the first bolus, she needed another. I checked the IV site, which looked good, and started the second bolus. Near the end of the second bolus, the doctor asked for another bolus and more lab tests. Being the ever dutiful nurse, I unwrapped the IV site, hoping to draw blood from the line already in place. Imagine my surprise when I noticed that my patient’s arm was bout twice the diameter it had been prior to my intervention! Amazingly, because of the lack of muscle tone, the arm was still soft and not painful to the patient. The estimate was about 100 ml of fluid in the tissue surrounding the IV site. For those of you who have never experienced this, just know that any extra fluid in the tissues usually caused a hard swollen area which is usually painful. So, I had to remove the IV and start another. The patient’s mom was very understanding, telling me what a good job I was doing and how glad she was to have me for a nurse. I suppose this should have made me feel good, but I was really wishing she would get a little upset, because her kindness was making me feel even worse…

The other item I got out of the way happened on my second day on a hallway. I was helping another nurse hold a patient for a nasal wash. In this procedure, saline drops are placed into each nostril, and then a suction tube is inserted into the nose to the back of the throat and mucous is collected. We often refer to this as a “booger-ectomy”. You might imagine that the kids do not care for this procedure, and can put up a bit of a fight. So, as the “helper nurse” I was in charge of holding the hands and head still. This is usually done in the “touch-down” position, with the hands above the head near the ears. All was going well, the patient was old enough to cooperate a bit, and then she gave a good cough. The cough is actually not an uncommon occurrence, but this one was quite moist, and a bit of it managed to hook around my glasses and land directly on my eye-ball. I had on gloves and a mask, but no further eye protection. My glasses should have been enough… And to make matters more interesting, the patient was positive for strep throat and influenza B! Fortunately, I had antibiotic eye-drops in my locker for my last round of pink-eye.

So, lessons learned:
- Wear eye protection, even if you have glasses.
- Check, check, and triple check all IV sites
- Don’t get too sure of yourself
- I can ride without the training-wheels!