Friday, June 2, 2006

Not totally convinced

I only worked two days this week...I don't know why, I should have worked three...but I didn't, I only worked two.  They weren't even difficult shifts...we had a tech both nights, we didn't even get one single admission.  One night I only had 3 patients, the next night just 4.  It was an easy time I will pick up an extra shift.

I think the main reason I didn't was because of what happened towards the end of my second shift.  I had a woman in her late 60's/early 70's that "had" a PICC line.  I say "had" because she partially pulled it out.  When I called the doctor to inform him (she had a dopamine drip running), he asked "Why would she do that?"  Hmmm...good question.  I wasn't convinced that this woman was as confused as she was portraying herself to be.  I had taken care of her both nights & had also taken care of her roommate last I was somewhat familiar with her baseline status.  The first night I had her, her husband sat at bedside tending to her every need...totally doting on her, which is sweet to see that such men exist BUT not sweet when she was expecting me to turn into the doting person when her husband went home.  It's not that I don't like to dote, but there are limits.  I'm very giving to my patients...always asking if there is anything I can do for them, get for them, etc.  This one claimed to be nauseous after her husband left even though she was getting Reglan every 6 hours.  I asked her if she wanted some ginger ale, crackers, cool wash, no, no.  Ok, what would you like me to do?  Her reply "I don't know, I'm not a nurse" in a real whiney voice.  Ok, well here's a wash basin, if you get sick...try to make it in there & not on the bed.  She never actually got sick, just kept spitting in it (ewwww).  She didn't sleep all that much, but was alert & oriented. 

The next night...the doting husband & the doting son are at bedside...just staring at her.  She is now laying there...barely moving, barely opening her eyes, barely speaking.  Hmmm, what's going on?  Is she deteriorating?  I know she was sick....she was supposed to be transferred to another hospital for a TIPS procedure...which is basically a shunt placed in her liver (at least that's what I was told).  The transfer was on hold because of the dopamine drip running in her PICC line.....a PICC line because she was an impossible stick.  Even the PICC line team couldn't insert the PICC line....we had to have the radiologists do it.  Eventually the husband & son go home...yet another reason I think we should have all private rooms.  9 times out of 10, it is better when a family member stays overnight with the patient...especially a patient that prefers to be doted on.  So they leave & all of a nearly unconscious patient is now awake & attempting to get out of bed.  She went from barely moving to sitting up & getting her legs danging over the side of the bed.  Hmmm....burst of energy???  I tell her that she needs to stay in bed...that she's too weak to be getting up on her own & that it's nighttime....time to get some much needed rest.  She agrees with me...lays back down, waits until I leave the room & again tries to get out of bed.  I go back in, get her situated in bed, assess her to see if she is truly confused.  She knows who she is, where she is, what year it is, why she's in the hospital, etc.....yet will not follow safety commands to stay in bed.  Is that considered confusion?  Selective confusion???  The next time I find her sitting up, I think "hmmm, this is a good time to apply a posey vest."  Because I know if she were to truly get out of bed, she'd end up on the floor & I really did not want that to happen or go through the incident report online that takes forever to fill out.  I tell her the posey vest is for her safety, she agrees with me & lays back down.  Even though she can't get out of bed, it doesn't stop her from attempting to slide out with her legs.  I put the side rails up, she attempts to put her legs over them.  Ok, time to add in some ankle restraints.  That totally takes care of any escape out of bed attempts.  I thought for a minute or two about wrist restraints, but talk myself out of them because she hasn't made any attempts to pull at her foley cath or her PICC line.  In fact, she can barely move her right arm due to a fracture years ago & the PICC line is in her left AC.  I check on her practically every hour, she is still attempting to get out of bed, but is unsuccessful...she's not getting any sleep.  I would have thought she'd be exhausted, but nope.  I go in at 5 am to give her the next dose of Reglan & find her PICC line pulled out about 4 inches.  Ugh!  I turn off the Dopamine drip & consult with a couple of other nurses as far as what to do.  Does she need Regetine?  We don't know.  There are no signs of infiltration, but there is also no blood return.  I call the doctor, he doesn't know what to do either other than "Stop the dopamine."  Ok, obviously I already did that.  He tells me to follow whatever my supervisor wants to do in this situation.  Fine, probably can get more done with a nurse handling this than a doctor.  We decide to get a stat chest x-ray to find out where the tip of this PICC line is before making any other decisions. 

That's where my story ends...a  The radiologist wouldn't be in until 8 am to read the stat x-ray & since I didn't pick up another shift...I don't know what the conclusion was.  I will try to find out on Sunday when I return to work.  I have learned my lesson though...if they are behaving in a confused manner (even if you aren't totally convinced they are truly confused & simply want attention) to the point of putting on some restraints....then put them all on for safety....especially someone with a PICC line. 

I haven't heard another word about my calling in sick threat to be written up.  I spoke with a couple of other nurses that called in sick that day also & none of them got treated the way I did.  I think the person I spoke with was stressed out & took it out on me.  I hate when people do that.  It's just wrong.  It was a reminder though that I never want to work in administration...neverrrrrrrrrrrrr.

I'm just biding my time, gaining more experience & confidence before leaping off into the world of travel nursing.  There are places to go, people to see...but not until the time is right.

Now I will end this entry on an uplifting note....24 hours from now I will be sitting in an arena being entertained by Tim McGraw & Faith Hill!!!!!!!!!!!!!  That's right...the much anticipated & awaited concert is tomorrow night...woo hoo!!!  I cannot wait!!!!!!!!!!!!!!!!!!!!!



am4039 said...

hey wait what happened to the patient, lol that's not fair. Enjoy the concert, in sounds like you need to chill.

jshav123 said...

Hey!  I read your journal faithfully - let us know if you find out what happened to your patient - lol.  Have a great time at the concert!  I'm so jealous!  :)