Wednesday, March 29, 2006

Still Deciding

Thanks to everyone that has sent me email or left comments in response to switching this to a private journal.  It's nice to know that you enjoy reading what goes thru my mind & the experiences I have in the nursing field.  I'm still trying to decide whether to make it private.  One reason I'm holding back is because some of you do not have aol accounts & when I switch to a private setting using an "aol" journal - I can only make it accessible to those that are also on aol.  That leaves out those of you who don't use aol as their internet provider.  So it's a toss-up between finding a different journal/blog web site that will allow a private setting that includes any email address or cutting off those of you who don't have aol from ever reading my journal again or simply leaving it under a public setting & hope that nothing I'm writing about could be used against me in the future.  I'll figure it out eventually.  Anyone have any ideas??? 

In the meantime, I will reflect on my last 2 nights of work.  Sunday was a rough night & definitely a reminder that psych nursing will NEVER be my thing.  It's also a reminder that for those who say "psych nursing will never be my thing" that you will indeed encounter many patients in a regular hospital setting that do have psych problems so pay attention in psych 

I had 4 patients that night.  My first patient was in with respiratory distress & respiratory insufficiency.  She weighs over 400 lbs & of course that can make it difficult to breathe.  She was given some Atarax before my shift started & that drug made her sleepy...she pretty much slept through the night - just the way I prefer it.

My second patient was a gentleman in with chest pain from a few days ago.  He was completely stable, but boy oh boy did he like to talk.  He was another one that slept pretty much the entire night - again, just the way I prefer it.

It freed me up to deal with my other 2 patients.  My third patient was a woman in her late 70's in with nausea & vomiting.  She had an NG tube although by the time I had her, the NG tube was clamped & only to be used if the vomiting returned.  Thankfully it didn't!  I was told in report she had received Dilaudid & Phenergan in the morning & has been confused ever since.  When I went in to assess her, she had pulled out her IV.  She was also pulling at her foley catheter & trying to get out of bed.  As much as I don't like a situation like this, I had to use them.  I applied the soft wrist restraints & of course she didn't like them. 

During all of that commotion, I got a new admit.  A woman in her late 50's with chest pain who got the pleasure of sharing a room with my confused patient = yet another reason all hospital rooms should be private rooms.  Someone alert & oriented should not have to share a room with a disruptive, confused person...however, our hospital was full & we had nowhere else to put her. 

My confused patient began to talk a lot....I mean A LOT.  Rambling on about all sorts of stuff that made no real sense.  My alert patient assured me that it was ok...the woman talking didn't bother her at all.  So we think that maybe if we turn off the tv & the lights...maybe she'll go to sleep.   Nope....she began screaming & yelling.  I tried talking softly to her, tried to reorient her...she didn't believe she was in the hospital...she said we were at my house & she didn't like my house.  Ummm, ok.  With that I put a call out to her doctor to let him know that she was in a confused state of mind & I needed something to calm her down & perhaps help her get a little bit of sleep.  He gave me an order for Ativan IV.  In most cases, this is a good solution, but with older patients you are pretty much playing russian roulette.  There is a chance it will do what it's supposed to do which is relax the patient & make them sleepy.  There is also a chance that it will do the complete opposite which is to cause them to become even more agitated.  Guess what my result was. 

She went from talking A LOT to talking very fast A LOT.  Her thoughts/sentences were making no sense & she would not stop talking at all.  She began kicking at us & attempting to get out of bed even with the wrist restraints we added ankle restraints.  I felt bad...I don't like restraining people to this degree, but if I didn't...she would have harmed herself.  Luckily my PCT wasn't busy & sat with this woman for over an hour trying to calm her down so I could get some of my paperwork done.  We were hoping the Ativan would kick in & she'd be off in dreamland soon, but NOPE...wasn't happening. 

After about 3 hours of this woman continuously talking, she drove her alert roommate to the edge & over.  It wasn't long before they were arguing & calling one another names.  The confused one was saying some really awful things to the alert one.  I felt terrible about this & tried to find a way to get relief for the alert one.  There were no other rooms available.  I offered her the ICU waiting room as there was no one in it that night, but she refused.  I put another call out to the doctor to update him & to get an order for some other type of medication.  He ordered Haldol IM.  I prayed it would work, but apparently God was busy that night as this changed her mood from not so nice to just plain mean & nasty.  Nothing was working.  I thought for sure she would tire herself out & at the very least stop talking for at least 5 minutes...but that didn't happen.  She would not shut up at all.  I've never seen anything like it.  12 straight hours of talking.  I was amazed that her O2 sat remained at 95% with as much talking as she was doing. 

I was glad when I saw the day nurse show up.  At about the same time, the patient's doctor showed up also.  Often times when the doctor shows up, strange behavior disappears & I was hoping this wasn't the case.  I wanted him to see what we had been dealing with all night.  Nothing changed - she continued to act very bizarre.  The doctor ended up transferring her to the ICU as he knew that her behavior was very abnormal from how she usually is.  He diagnosed her with delirium & suspected that perhaps she was going into sepsis.  They attempted to do a brain CT, but nothing they gave her would sedate her enough to stay still for the test.  She continued to talk all day & they had to keep her in restraints.  I am curious to see if she was septic or what was causing her to behave like that. 

I felt terrible for my alert one should have to deal with that.  Luckily the next night, there was a new admit...another older lady that was as quiet as a mouse. 

Not much to really report about my second night...nothing much was going on & the time ticked by so very slowly.  I'm not complaining though...nights like those are welcomed & preferred to stressful nights. 

I went to my nephew's baseball game tonight - he was pitching & they won.  He's got another game tomorrow night & also another one Friday night...I'll be going to both games.  He only has another month or two left of baseball & then he graduates.  I can't believe he's all grown up.  When did this happen?  In fact, today was my brother & sister-in-law's 19th wedding anniversary.  We were reminiscing about what we were doing 19 years ago.  Boy, does the time go by fast.  I had just turned 18 & was spending my weekends at our condo at Daytona Beach...ahhh, so long ago.  To relive those days would be

Anyways, I'm not scheduled to work until next Tuesday.  I love the flexibility that I have with my work schedule.  I may pick up Thursday night...we'll see.  :)


tendernoggle said...

Wow! I feel for you,hon! lol
Once, a while ago, my mom was admitted to the hopsital and that evening she started acting very strange..she was 77 at the time...she pulled out er i.v.'s more than once, talked crazy things...etc. The nurses there called it "sundowner's" syndrom or such! Said that elderly patients tend to get it when admitted....all I know is that I was sure glad when she got over it!

melissagandy05 said...

I just ran across your journal. I like it. I am currently a nursing student and I like reading about your experiences. It gives me an idea of what to expect. I am completely terrified by the way! I do have some experience with psych patients. I worked in long term care for a couple of years. More than half of them had dementia. I had one resident who sounded a lot like your patient. Mine talked a hindred miles an hour. If you asked her a question , you better be prepared, because you are going to be there for a while. She had no history of smoking, but yet eventually she had to be put on oxygen. I secretly thought it was because of all of her talking lol! Well good luck with the journal. I hope you don't move it to private, because I wouldn't be able to read it, but thats up to you. Later, Melissa.