Problem Patient and the worthless CNA…nurse

I am a fairly new nurse on a Telemetry floor, I work days. There is a saying at our hospital that the unit is easier than our pod to work and I tend to agree.
The other day I started out with 6 patients (our limit) and we had a CNA, but she is so lazy it should be a crime. Having to work with her is like working alone, no wait….I would rather work alone. When 10 AM vitals roll around……she is most likely talking, sitting, eating, and ignoring every RN that says get your butt up and do your job….and of course reporting this does absolutely nothing. She even has this horrid lazy look about her that makes you just wish you could slap her. Some nurses wait to get their VS from her and give heart meds two or three hours late, I just go in and get a manual BP and look at my rhythms and rates – it eats time, but at least it keeps me on schedule as much as possible and keeps my babies from having a stroke from HTN in the meantime.

On this day one patient has been chosen from above to be my problem patient. He has been there since last month, is a repeat offender from another long stay, he gets BGs out the ying yang (his wife coddles him and gives him “sugar free candy” all day even though I pointed out the carbs listed on the back of the package and explained how it contributes to high blood sugar levels), gets antiinfectives q4h because of a Strep D infection from his CABG x 5 with a LIMA and both SVG 1 month prior, has a high BUN and CR from the antiinfectives (they finally d/c his gent and left him with amp to try and help that), is on 3 liters of O2, is gaining weight every day (is on a fluid restriction) and can’t pee worth a toot, oh, yes, and don’t let me forget, he has suffered prostate trauma from two catheter insertions (the worst one from a doctor during the night) and had gross hematuria, but thankfully is catheter free for me today and voids clear yellow – when he voids! And the best part is…..drum roll please…….the doctors decide to discharge 5 of my patients. I worked and I worked, but my last discharge left at 6 pm and to my surprise even he and his family were nice about it – angels were working overtime. And somewhere in the middle of all this I got a direct admit with AFib and as we talked his HR went into the 150’s so I had to call and get a Cardizem drip started.
Back to Mr. Problem….I pushed Lasix twice, 80 mg a pop, and you know what he gave me???? A total of 400 ml of urine (and his bladder is nondistended). If I got that I would have a 20 lbs weight loss… I paged and paged and finally a nurse heard my plea (I gave her the full picture – she was feeling my pain) and Demedex 50 mg push was ordered along with some K. His lungs just keep sounding worse and worse, but his sats were holding. And to top it off….I had a doctor come up that night for him (not a cardiologists) and asked me what I thought we should do……I told him “something cause I’m seeing hemodialysis in his future”. It was kinda cool though…..new nurse, old doctor, and he asked me what we should do. I wanted to laugh – but it made me worry for the patient just a little.
I went to work three days later (this weekend) only to find out he had finally been transferred back to CCU cause he fell out in his room and had a stroke (not his first). I saw his wife yesterday and she said they pulled 3 liters of fluid off his lungs while they were at it.
Yesterday was much better…I started with 4, discharged 2, and got a transfer from the unit…..I was so caught up and had tons of time to teach my patients about all their procedures….I printed carenotes for them like crazy. Even had time to do all kinds of stuff for the other RNs – I love days like that.
The worst part is every time I think I’m having a super busy day, I think of my other friend there, but on another floor. She is a new RN and most nights she is the only RN with 16 patients and a super lazy LPN beside her. And then I think my floor really isn’t so bad.

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