Thursday, March 16, 2006

Let's Push Them Out the Door

I put in my 3 days at work this week....3 days in a row.  I had a variety of patients.  Luckily no one was critical or progressively getting worse.  They all were getting better...which means they get discharged & I get all new patients.  I prefer to keep patients I'm already familiar with...who doesn't? 

I like to think that I connect pretty well with my patients.  I was told in report that this one patient of mine was out of control, would not follow safety instructions, they put him in a Posey vest & wrist restraints, etc.  I was warned by the other nurses what a handful he was & to expect to spend a lot of time in his room.  What a way to start off my first night.  I have come to learn though...that this is not always an accurate picture.  There are times where I am told "so & so is a difficult patient"...only to find that they were pleasant & cooperative with me.  Maybe I'm the "patient whisperer"...sort of like what the horse whisperer is for  Nah...I'm not that conceited.  Back to this patient I was describing...I went into his room to assess him & found that he was not the person previously described to me.  He was a charming gentleman...who at times may have been slightly confused, but overall...very pleasant & cooperative.  He thanked me often for treating him so well.  By my third night, they had transferred him to med-surg...which is good for him.  It means he is getting healthier & ready to leave the hospital soon.

I had another patient that was supposed to be discharged on Monday.  Turns out her potassium level was 2.9 "after" receiving 80 meq of potassium during the day.  The doctor was informed & the discharge was put on hold.  It's a good thing, because the next day they did a surgical consult regarding possible gallstones & sure enough, she had them & had surgery on Wednesday afternoon.  She came back from surgery/PACU around 6:30 pm.  On the chart, she had discharge orders from both her primary doctor & the surgeon.  I was surprised.  Ummm, hello...she just had surgery a couple of hours ago & is still out of it due to the anesthesia & pain want me to send her home in this condition?  Not to mention that her potassium level was 3.1 & had not been addressed and also the patient did not want to go home in her current condition.  I called the doctor, he ordered potassium PO & send her home.  It seemed too soon for my comfort, but ok.  I gave her the potassium, only for her to get nauseous & throw it up.  Well, that bought her another night at the hospital because now she needed potassium given the IV route & that takes 4 hours.  She was happy to stay.  Which also makes me wonder about these patients that don't want to leave the hospital.  95% are eager to get out of there as soon as possible.  Except the two patients I had...this one & another one that had a heart cath done...they didn't want to go home.  I felt like I was pushing them out the door.

My heart cath patient....her heart cath was positive...but since she is in no condition to have surgery to resolve it, the doctor wrote out some meds & then said "Ok to discharge."  I had to wait until 10:30 pm because she needed to remain lying flat after having a heart cath.  I questioned...shouldn't I make sure she is stable "after" getting up & moving around.  Nope, patient is allowed up at 10:30 & send her home.  I felt awful because this is an elderly couple that probably wasn't even use to staying up past 9 pm, much less be driving around after 11 pm.  But they had no choice...she was finally left at 11:15 pm. 

I got a new admit this morning...basically a drug seeker using the excuse of having chest pain.  He's worn out his welcome at other hospitals & now ended up at my hospital.  He stated all of these pain meds that he was allergic too...they were the less potent pain meds & obviously he was probably immune to their effects.  Every 4 hours he was claiming to have chest pain so he could get the pain mediciation.  I'm not one to judge these patients...if the patient wants pain meds & the doctor has ordered it...I am not about to ignore his claims of feeling pain.  I'll give the pain medication.  Because as we all learn in nursing school...only the patient can tell you that they are exerpiencing pain.  He was so dramatic though, that it wasn't even funny.

Oh well...I had other patients, but I'm getting sleepy & heading to bed.  Take care!


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