My Sparkle Speck Friend

When I first moved to this panhandle area two and a half years ago or so, I was so alone.  I felt lost and scared and empty.  I prayed every night for God to send me a friend, someone that would at least talk to me sometimes and that maybe one day would be a little diamond in my life, a soul sister like the ones I had left behind.  After six months of eating in my car alone, sitting on the outside of conversations, and crying at home in my lonely room, God answered my prayer with Meg.  Meggie Boo Boo.  My Meggie.  She's one of the funniest people ever invented.  She knows when I'm sad and knows how to cheer me up. She's a kick booty social worker and a fan-freakin-tastic cook.  But now she's moving away to greener pastures and her family of darlings ten hours away.  It's sad.  So sad.  But I know our friendship will never end.  We just aren't made that way.  Ten hours is nothing to our little souls.  Ten hours is do-able.  Forever my soul sister, no matter the distance!

To soften the blow and to send my meggie off in style, I wanted to have a dinner for her on the last full moon before she left.  Why a full moon dinner? Because I am a hippie at heart and I love food.  Good luck meggie boo bear!  You're a shining star off to fill the worlds of Houston with your own particular special light.

It's time to say goodbye, but I think goodbyes are sad and I'd much rather say hello. Hello to a new adventure.
Ernie Harwell 

Lavender Lemon Cookies

pizza pan doubling as cookie sheet

These cookies are the perfect summer treat.  Cool, tangy, refreshing: you just can't beat them!  Paired with some sweet tea and I can't think of a better evening front porch snack.  

Lemon-Lavender Cookies

1/2 c. unsalted sweet cream butter, softened

1 c. granulated sugar

1/2 tsp vanilla extract

1 whole (organic!) egg

1 T. lemon zest

2 T. fresh squeezed lemon juice

1 T. organic dried lavender flowers

1/4 tsp salt

1/4 tsp baking powder

1/8 tsp baking soda

2 c. all purpose flour

Instructions

Pre-heat oven to 350 degrees.  Grease a cookie sheet, or a pizza pan in my case.  Cream the butter and sugar together in a large mixing bowl. Stir in vanilla, egg, zest, juice, and lavender flowers.  Stir in all the dry ingredients until mixed into a dough.  Careful not to overwork!  Roll the dough into balls and place on the cookie sheet with about two inches of space between each ball.  Bake for 10 minutes or until the bottoms brown.  These cookies will stay a pale yellow-beige.  If you wish, sprinkle the tops with powdered sugar or a little more lemon zest when they come out of the oven.  Enjoy with a cool glass of sweet tea.  

* I have found that one large lemon provides the necessary juice and zest.  Be sure, if you can to buy organic since you're eating the actual peel! 

Night Nursing, Part 2

Here we go, night nursing, part two! 

Every patient must be checked on every two hours, and charted on.  It is ok to back chart in my facility, so I typically just carry paper and pen with me to note things that I might forget, like pain levels and IV pump numbers (Yes we have to enter these in as well).  If a patient is on a PCA, which is a Patient Controlled Analgesic, or the “Pain button”, I have to clear it out and see how much is left in the machine, how many times they have pushed the button, how much has been delivered to them since the day shift nurse cleared it, ect.   These machines are all programmed specifically for each patient per doctor order.  If they run out, I have to set a new one up, which requires going to the charge nurse for the PCA pump keys and having another RN sign off with me.  I document the things I cleared off on a PCA flow sheet that is kept with each patient’s paperwork.  If my patients are on telemetry, or heart monitoring, I need to call down to the telemetry unit once per shift to see what they are running.  If they are running something unsavory, the battery is low, or if a lead is off, the unit will call up to the floor to tell me.  Then I check to see if I have any medications due at that time.  If not, I can perhaps chart a little, depending on the craziness of the night. 

I might need to admit a patient if I have an empty room, which can easily take an hour.  Then their medications have to come through pharmacy into my computer before I can give them.  If one patient is acting crazy I have to address that.  (yelling, cussing, hitting, confused, not breathing right, chest pain, ect). 

 By now it is about 11pm and I have to run down to the cafeteria if I want any food because they close now.  I am usually one of the last people there.  I put my food somewhere on the floor, usually in the break room, and see if my patients need anything.  Remember, any medication I need is in one of two machines on the floor, and needs to be scanned in, so it is a process.  If any IV pumps are beeping or feeding tube pumps, I need to trouble shoot those.  Around midnight I go grab all six of my patients charts and note my orders with a red pen against the computer.  I do a 24-hour check since I am the night shift nurse.  This means I see what is ordered for the patient and see if it matches what is ordered in the computer, or see if I have done it.  For example, if a patient needs labs drawn in the morning, I have to write for that order in the computer so that lab knows to come get their blood.  Or, if they are having a procedure the next day, it is my job to get the paperwork done.  Then I check on all my patients again and give midnight medications.  You can give a medication 30 minutes before it is due to 30 minutes after it is due.  Then I take the charts back to the main nurse’s station, where the charge nurse is, and put them back into their spots.  Then I try and chart.  I really try to have all my head to toe assessments and 2 hour assessments charted by midnight.  This may seem late to some seasoned nurses, but remember, I am new.  As long as I have physically done the assessments on time, I feel like it’s ok. 

After those things are done, I check on the patients every two hours, give medications through the night, and chart.  At four, labs are drawn and chest X-rays are done.  Sometimes I have to draw the labs, sometimes law workers do it. Also at 4, the intake and output records for the last 24 hours are totaled.  A big graphic sheet is printed out for each patient with vitals and intake and outputs listed, included drains and IVs.  I will go and physically put these in the patient's charts for the rounding doctors to look at during the day.  Everything is available on the computer, but some doctors still prefer the paper charting.  Hopefully at some point I've gotten to eat, but that is rare.  I will check the surgery schedule if any of my patients are going to have surgery that day to see if I need to get some pre-surgical vitals on them.

Around six I usually go wake everyone up and see if they need pain or nausea medication, to go to the bathroom, or anything else.  I look to make sure their IV bags are full and their IVs are still working.  This way the day nurse doesn't get left in a mess.  A lot of medications and insulin are due at seven so I'll check blood sugars.  If something is to be done that day like a catheter pull or dressing change, I'll try and do that too.  By this time, the day shift has come on and I give report.  I usually leave around 8am and go home to sleep.  

4th of July

I had an amazing Independence Day!  I had to work on the 3rd, so after work I drove to my parent's house 3 hours away and stayed two nights.  I worked the night of the 5th, so I slept what I could during that day after I got home.

It was truly relaxing!  Marmie and Daddy have just moved so it was fun to help them set up their house a little.  Then my friend Cindy came and we celebrated together.  There were small town fireworks and an impromptu trip to the lake.  Fun!  I was sad to leave.

Patriotic Pizza

Selfie! 

I think my dad looks like a wizard here. 

Marmie <3

Pepper's belly rub of joy

Life of a Night Nurse, Part One

I am going to have to break this up because it is quite long and in depth. 

This is what a typical night shift looks like for me:

I arrive at the hospital at 6:50 to swipe in and get my nursing assignment.  Around 7:05 or so I go out to find the day nurse that has covered my patients and get report on them.  Report can vary, depending on if it is my first day in that week or not.  If not, then I do not need a full report unless a patient has been admitted during the day while I was sleeping.  A full report consists of the patient diagnosis, doctors, history, what their IV is running at, where their IV is, any complications, if they are in a lot of pain or experiencing a lot of nausea, if they have any upcoming procedures that I need to get consents for, and things of that nature.  Then, after receiving report on all six patients, together I walk around with the day shift nurse and meet them.  Then she or he leaves and I’m on my own.  

The first thing I always do is log onto the computer charting system and document that I have received report from whoever and that I am assuming care.  This covers the hospital in case something should happen.  Then, if when I was meeting one of the patients they tell me they want pain medication or nausea medication, I will go pull that out of the Pyxis.  The Pyxis is our medication system.  It is one of two big machines on the floor.  You go to it, enter your ID, scan your fingerprint, and find the patient.  Then you pull out whatever medication you need.  It pops open one of many drawers and tells you what pocked the medication is in.  Sometimes you have to provide a count of how many are in the drawer to begin with, especially with pain medications.  Then you take the medicine and log out of Pyxis.  If none of my patients specifically requested a medication, I’ll pull up all my patients on the medication system at my computer and look and see who has 8 o’clock or 9 o’clock medications.  I usually start with the patient that is the most acute or that has a procedure coming up.  I will go pull out their medications and go to their room to begin my head to toe assessment.  I listen to their lungs, heart, bowels, feel their feet for equal pulses, roll them over to look at their skin, look in their mouths, touch them, talk to them, and ask things like, “When was your last bowel movement?  Have you been coughing?”  I also check their IV site and fluids running and their dressing site, any incisions, ect. This takes me about 15 minutes.  Then I scan their medications with a barcode scanner. Every pill, every vial is bar-coded.  Then I scan their armband.  Then I can administer medication.  Some medicines are simple pills but a lot are “IV Push”.  This means that I either draw up sterile water into a syringe, inject it into a vial of powder to reconstitute it, mix it around, re-draw it up, and then push it through a port on their IV tubing over a certain amount of time, or draw up a liquid in the syringe, dilute it with sterile water if necessary, and do the same thing.  Also, some medications, specifically antibiotics, are in little bags.  I hang this “IV Piggyback”.  They have a secondary tubing that fits into a port on the IV pump and have to be separately programmed.  This is just like IV push except it takes longer so I have the pump do the work. For example, Piperacillin goes in over 4 hours.  Obviously I can’t stand there and slowly push in 100 mL over 4 hours.  Some medications, like blood pressure medications or pain medications, require me to input a vital sign.  These have been recently taken by a nurse tech and are written on a paper in the room.  If I am giving insulin or heparin or lovenox, I need another nurse to come and cosign with me.  I pull up the labs to show them that the dose I’m giving is ok, and then scan their ID badge.  Also, if I have given them a narcotic, which I usually do, I have to save the remaining medication to waste with another nurse, unless I use the full dose.  The doctor has ordered what does to give.  After medications,  I ask if they need anything, which they usually do (water, blankets, go to the bathroom), address their needs, and wash my hands and leave.  I do this for all six patients.  This takes me a while, usually a few hours.  I try and give all my medications through ten o'clock during this time.  By the time I can sit down and chart, the first patient needs to be checked on or might need something.