Welcome to Med-surg

Three night shifts in a row. Included patients / situations:

  • 1 colitis, 3 small bowel obstructions, 1 lap-appy, 1 active C-diff
  • 2 pneumonias, 1 lung cancer (mets in the liver and pancreas)
  • 1 cellulitis, 1 MRSA
  • 1 whipple
  • 1 new onset Afib with RVR
  • 1 code blue, 2 code sepsis, 1 patient sent to the unit, and another received from the unit

Never a dull moment. #alwayslearning

ABGs are my nemesis

Oi vey. In nursing school ABGs and acid/base balance drove me nuts. This weekend my charge nurse rightly commented that ABGs are the calculus of nursing, and as we were discussing it my former preceptor came to join in, noting that she’d never really understood ABGs. Big surprise, right? So on this particular evening my patient was headed in a downward spiral, Continue reading

ATTN new nurses: Trust your gut.

New admit from the ED. COPD, CHF, CAD, history of AMI, stroke. Admitted for shortness of breath. When she arrives on the floor shortly after midnight she’s alert. Conversant. We go through all the new admit tasks and I get her settled. She has potassium replacement running, and an empty bag of magnesium she’s already gotten. And the doctor’s orders for LR @75 an hour are in place. She’s exhausted so I tiptoe out and let her sleep. When I go back to reassess her an hour later (note: always do reassessments on your new admits!) she’s moaning now and then. Lethargic. Continue reading


An uneventful shift is always the best kind of shift. But what really stinks is when the events wait until shift change to happen. Know what I mean? New patient. Admitted around midnight. Fell asleep just after admission and slept through shift report. The techs did their vitals while we were doing report, and my new patient had a blood sugar of 35. Continue reading

Yet another brain

This is the brain I use for night shift. I write down meds due at the corresponding time, and time-specific tasks, like d/c lipids drip, d/c foley, accuchecks, dressing change. I bubble in circles when I complete tasks, and use the extra space to make other notes to myself like wife’s name, takes meds with cranberry juice, or whatever.


5-patient nights brain

You can do this. 

He had chronic pain for more than 20 years. Smoker. He carried around more narcotics than your average drug dealer. And he was post-op day 1 from extensive spinal surgery with one of the best surgeons I’ve ever worked with. I knew he could overcome this.

The morning I met him he was in the fetal position. Continue reading