Thursday, December 15, 2005

Full Moon Confusion

It was definitely easy to tell a full moon was due this week.  Sunday night was a busy, busy night for me.  I had 5 confused patients & it seemed like they were all competing for the title of "most confused." 

In 5th place - a woman that seemed to think she was staying at the Hilton & had her own personal nurse to tend to her every need.  She was in the hospital due to pneumonia.  The noises she made were so was embarrassing for women-kind.  Add to that her nose picking & pressing the call light every 5 minutes....amazingly she was the least of my worries that night.  Most annoying, but not most confused. 

4th place goes to an elderly man in with a possible small bowel obstruction.  He kept taking off his heart monitor & when I'd go back in to put it back on him, he'd state "I didn't take that off, someone else did."  Ummmm, ok.  He was a sweet man....continuously made this humming sound, even when he was sleeping. 

3rd place went to my c-diff patient.  I don't know if he had a little bit of Sundowner's going on or what.  He started out pretty alert & oriented at the beginning of shift, but as the night went on, he seemed somewhat confused although he would deny it.  Anyone in nursing knows that c-diff is not a fun diagnosis...enough said.

2nd place goes to an elderly woman in with a hip fracture.  She started out sharing a room with my needy patient.  It didn't take me long to see that if I didn't separate them, a yelling match was about to ensue.  They both referred to each other as being "the crazy one."  So I move this lady to another room...she was as sweet as can be.  I fully anticipated she would go to sleep for the much for anticipation!  Instead the tech found her wandering the she ambulated with a fractured hip - I'll never understand.  Ok, back to bed......put on the bed alarm.  Well, she continuously tried to get out of bed.  So next up was a posey vest...didn't want her falling & hurting herself further.  She seemed ok with the vest - probably wasn't even aware it was on.  I check on her a little later.....she has pulled out her IV.  That's ok, she already has a second IV...switch the fluids to that & tell her not to mess with it.  Recheck her...I see her scratching at the other IV.  Ok, time to restrain the hand that can reach the IV.  She was still ok with that...but, she was working on getting out of the wrist restraint & Posey with the free hand.  She wasn't swift about it, but I knew it was a matter of time before she was free.  So I restrained the other wrist...that's when she flipped out.  This sweet woman sure did have a nasty mouth on her.  Needless to say, she spent the rest of the night yelling & much for anticipating she'd sleep.

The most confused award goes to my younger patient.  It really is a bizarre story & I have thought often about it & try to wonder how it would feel to be in her condition.  She was a woman in her mid-40's...moved to Florida from Jamaica sometime in the last 2 years.  She had a really bad headache on Saturday...took some excedrin & went to bed.  Woke up with a headache on Sunday....painful to the point of crying.  Her adult children decided to bring her to the hospital...she came into the ER totally alert & oriented...answered questions appropriately.  They gave her some pain meds for the headache, she took a nap in the ER while awaiting tests to be run.  When she woke up - her short term memory was gone.  It was basically amnesia..she did not remember ever coming to America.  In fact, I couldn't even convince her that she was in Florida.  She truly believed she was in Jamaica & that I was someone she met in the Cayman Islands.  Even the neuro doc was stumped...all her tests were normal, but the memory was gone.  I'm sure having an elderly woman screaming & yelling in the bed next to her didn't help with becoming reoriented either. 

Needless to say, my night flew by Sunday night. Before I knew was time to go home...yay!  I requested not having all of the same patients again the next night - it was too heavy of a workload for one person.  So they gave 3 of my patients to another nurse.  I kept the needy one & the possible small bowel obstruction.  I'm glad I the other nurse had her hands full.  I helped her out quite a bit, but was glad the responsibility was out of my hands. 

The patient with c-diff developed an itchy rash in the middle of the night, which turned out to be "Red Man's Syndrome."  I have never heard of it before...but it's a reaction to the antibiotic Vancomycin = one of the big guns when it comes to antibiotics.  The reaction can get so bad that the person stops breathing - eeekkk!  She got him some benadryl & by the time she administered it, the morning labs were in.  His H&H was dropping...something like 8 & 24.  Not good.  More calls to the doctor for her. 

The woman with the hip fracture managed to get out of her posey vest & fell getting out of bed.  She didn't have any apparent injuries, but required a call to her doctor as well as filling out an incident report.  Back into wrist restraints she went & the yelling began.

The woman with amnesia was trying to leave the hospital.  She was convinced there were 2 men in the room trying to put her in a body bag.  We had to talk her down & make her believe that wasn't happening.  So add hallucinations to the amnesia. 

I thought to myself...ok, it's been a crazy 2 days, Tuesday night definitely has to improve.  I once again made a request not to have the needy woman back.  I could only take so much of her demands.  My request was granted...I got a new patient load on Tuesday.  I still had the man with the small bowel obstruction which was fine. 

I also had a gentleman that was transferred from ICU earlier in the day.  He had internal bleeding when he came into the hospital.....had surgery & was on the road to recovery - except when he'd go into V-tach every now & then.  Since he wasn't symptomatic with it - we didn't treat it.  Still though.....I don't like seeing runs of V-tach.

I had a woman in her mid-30's in with syncope.  Seems she was under a lot of stress at home due to her teen daughter.  All of her test results were normal.  I believe they were going to discharge her & treat her with an antidepressant.  I talked to her & told her that as stressful as it is watching a teen make mistakes - that sometimes they have to learn the hard way.  Her daughter is 18....teens make dumb decisions everyday...hopefully they learn from them.  She agreed with me, but it was apparent she was stressed. 

Along with my 4th patient...a woman in her late 50's in with chest pain.  I could tell immediately there was some stress going on at home, just wasn't sure how much truth there was to her statements.  Many times through the night I had to tell her to try to stop thinking about what is going on at home & focus on taking care of her own health.  What put it over the top was this morning...right before the change of shift...she came out of her room & basically started yelling at one of the other nurses.  My patient was convinced the nurse was making fun of her & that she could hear her talking about her & laughing.  It was bizarre.  I got her back to her bed & the woman was shaking & began crying.  I wasn't sure what to do.  I didn't want to argue with her that the other nurse wasn't making fun of her when the patient was so convinced this had happened, but I also didn't want her having a mental breakdown.  She grabbed my hand to hold & sat there rambling on about things.  I could tell there was no way to talk any sense into her, so I asked "What can I do to make it better?"  I felt for her, but she was obviously overreacting & there was no way to prevent that. 

Actually...before that outburst...another nurse got a new admit.  Literally a woman that would not stop screaming.  Really nice to get an admit like that at 5 am when most of the other patients are sleeping.  She would not stop screaming.  We had to restrain her hands because she kept trying to punch & grab us.  We also had to get a foley catheter into took 5 of us to hold her down. 

So any thoughts of putting in a night of overtime tonight were quickly put to rest.  Too many signs to just stay home.  I hope this isn't how the next month will be...but it seems like we've gotten quite a bit of confused patients lately. 

On a sad note, a patient that I had taken care of about a month ago passed away last week.  I saw her name in the obituaries.  It made me sad.  I don't usually remember too many patients offhand, but she was one that stuck in my memory.  I'm sure I probably wrote about her in here...she was my patient that had the nosebleed that wouldn't stop & a high heart rate that the doctor didn't want to address.  I knew she was transferred to the ICU, but I was really hoping she'd get better & go home to continue her happy life.  It gets to me that she passed away...especially around the holidays.  :(

Speaking of the holidays, I do believe the majority of my Christmas shopping is complete.  I still need to get a few things, but it's nice knowing I'm just about done.  Now it's time to buy myself  I need to decide what it is I want.  I'm leaning towards a new computer...but no rush.

Hope y'all are getting your shopping done.  Have a good weekend!


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