Friday, September 21, 2007

Washcloths, Melodic Minor Scales, and Plate Techtonics

The patient had some kidney problems so the doctors had ordered Bicitra a couple times a day. It tastes nasty, like aspirin dissolved in quinine. The patient blubbered a little when sucking it up through a straw. The front of her hospital gown got a wet spot on it. There weren't any washcloths in the patient's room so I had to step out to get one, maybe along with a fresh gown.

"I'll be back in a flash," I told the patient.

My phone rang as I moved to the door and it was Transportation wanting to take another patient off for a test, so I stopped there to get them ready to go. They had Heparin running and the bag of solution was nearly empty. I had to replace that because their test might take a while and I didn't want it to run out while they were gone.

My phone rang again while I was in the medication room and it was PACU calling report on a post-op patient that went down that morning for surgery. Rather than hold them up and call them back later I just took a few minutes right there to get report. Then I sent the other patient off with their fresh bag of Heparin.

I heard the patient in room 13 calling out for her mother and I was worried that she might be getting tangled up in something. She was 95 years old and a touch demented. Of course her mother was long gone but when this patient got (more) confused she became fearful and appealed to her loved ones who had died years ago.

She was soiled so I cleaned her up and repositioned her. Then my phone rang again and it was one of the residents wanting to know if a stress test report had become available for one of my other patients who was admitted for a myocardial-infarction rule-out. I checked the fax machine and asked the unit secretary about this but the preliminary report had not come yet.

By this time, the post-op patient was being wheeled back into their room so I followed them in and started to look them over. They said they "felt fine" but I talked them into taking some pain medication anyways. I do not always medicate patients for the pain they are having presently; I medicate them for the pain I do not want them to develop in an hour or two.

Their drains and dressings looked good, they were alert and taking oral fluids but their blood pressures were a little low: 82/52. But they were also generally puffy and edematous. Not a lot of urine in the Foley bag, either. Aside from their surgical problem, which was renal in nature, they had aortic stenosis. The doctors wanted to see systolic pressures over 110. I called the medical hospitalist on their case; he was at home, and he suggested that I get orders from the cardiologist.

We took a few more pressures and these still hovered in the 80's. When the cardiologist called back we talked about the low BP's and edema and he told me to cut back on the intravenous fluids, which were running at 150 milliliters per hour, and to start a Dopamine drip at 5 mics. He said he really wasn't too worried about the pressures but thought this might help.

For a moment he considered sending this patient to Intensive Care but if we weren't going to titrate the drip there was no need to transfer the patient.

I was expecting the Dopamine order and had told another nurse about that a moment before the cardiologist had actually called back. We set it up, double-checked the rate, and got it going. Soon we were getting systolic pressures in the 102-106 range. Close enough for jazz. They were putting out urine too.

One of the family members had called during all this and basically harangued me with "what are you going to do about her blood pressures" and "you should call doctor-so-and-so (who was a urologist!) right now" and otherwise putting the rush on me, as if he didn't think I had enough fast-twitch muscle-fiber or something. Fuckhead.

The patient was feeling a little nauseous so I gave her some Zofran and a few minutes later that problem had subsided.

My phone rang again and it was one of our monitor techs to tell me that the post-op patient just had a little run of SVT. I explained the nausea, which probably went along with that, and told them about the Dopamine drip too.

Some of the night shift people were beginning to arrive. One of them, Diana, knew the post-op patient from the night before and I gave her a five-second snapshot: "they didn't get it all in surgery and there's Dopamine at 5 for some low pressures." Then I promised to fill her in on the details after she clocked in.

I took a few minutes to call one of the more sane relatives of the post-op patient and updated them on things. They said they would call the family member who had verbally drilled me to give him the news, so he wouldn't feel any need to call me again.

My phone rang and it was the monitor room telling me that the patient in room 13 had her leads off. As I walked to that room one of the other night shift nurses said that they were ready for report. I settled demented lady down and grabbed my notebook so I could read off some of the details of things that had occurred during the day.

Then the rest of the oncoming nurses cornered me for their reports.

About fifteen minutes later I went to the linen cart and got a few washcloths, towels, and a fresh gown for the patient that had spilled a little Bicitra.


I freshened them up. I went home. Kissed he family unit members, walked the dog, practiced scales, and watched a bit of a documentary about plate techtonics.


Eric said...

The hospital where I previously worked utilized taped report, which worked well. I find that the last hour of my shift can make/break the first hour of the next shift, and I always questioned the safety of the verbal report, that removed everyone from the floor for an hour twice a day. My last year as charge there, we used one cassette tape for each patient so you could tape report without worrying about who will get your patients next shift. It worked well, until someone decided a face-to-face would mean fewer forgotten details (I found the opposite to be true).

Do you use Hanon's "The Virtuoso Pianist" book of exercises? Definitely a love/hate relationship with those but I would do anything to avoid practicing scales.

Onehealthpro said...

WOW! And thank you.

Bohemian Road Nurse... said...

Bless your heart, now that's what I call sum-good-dang nursin'!!!!

shrimplate said...

I was not trying to sing my own praises. I just meant to illustrate, in very real terms, exactly how long it can sometimes take to go get a washcloth.

That was how it happened that day. I felt sorry for the woman with the Bicitra on her gown but I couldn't get to her in a timely manner.

Because I was at work.

Anonymous said...

you're in phoenix az, right? i lurk and love your blog. if i'm ever hospitalized again, i hope you're my nurse. no one EVER gives nurses enough credit for being the air traffic controllers they really are.