Thursday, September 7, 2006

"Code Gray"

Another work week finished up by Wednesday - this is why I prefer to work Sun, Mon & Tuesday nights....so that I've got the rest of the week off. However, due to our new manager, I am being forced to work every other weekend for the next 2 months (at least). Well, unless I finally get motivated enough to leap into travel nursing...I'm still working on it...lol...that's my excuse! So for now, I will try working at the end of the week rather than the beginning. Who knows, maybe I'll like it. I am going to get back into playing volleyball with my friends on Monday nights.

I went into work Sunday evening only to find out I wasn't on the schedule...again...grrrrr. The charge nurse told me she would keep me, that I could be the unit secretary until 11 pm & then she'd send one of the agency nurses home & I could take over that nurses patients. Being the unit secretary on a Sunday night is beyond boring...because we rarely see a doctor in the building (other than the ER doc) on a Sunday evening. I got a call from the charge nurse about 20 min later saying one of the nurses didn't show up & I could take her patients. So I go to that floor & the clinical leader is telling me about one of the patients: "He's out of control, he is threatening to hurt people, rip off body parts of anyone that gets near him, swearing, yelling" and she followed it up with "Whatever you do, don't go into that room alone." Lovely...I'm thinking I should have just gone home when I found out my name wasn't on the schedule. This guy sounded like a lunatic!!!

So I get report from the day nurse & she tells me he just started acting like that when they tried to get him to go from the chair back to bed. He didn't want to go back to bed. Guess what - as far as I was concerned, he could sit in that chair all night long if he wanted...especially if it made him happy. He came to the hospital because he passed out at the nursing home & they wanted to rule out a stroke.

I had 3 other patients in addition to him. I had a male with a hematoma in the abdomen, he also had expressive aphasia (he had a stroke yrs earlier & was unable to speak...he could make noises & a couple of words like yes or ok, but that was about it). Another patient with an infection in his leg as a result of a fem-pop bypass. He also had a MRSA infection in his blood. He was really sick & weak. My last patient was a man that had a right knee replacement who was also confused...but at least he was pleasantly confused. They put him in the room with the lunatic. Nothing like having two confused people in the same room, right?

My assessment of the first patient was done from afar. He was yelling, he was moving his arms & legs and he was asking appropriate questions - he also knew who he was & where he was. As soon as I came in the room he was saying "Oh noooooooooo." He was afraid I was going to make him get back into bed. I assured him that he was welcome to stay in the chair if he wanted. He had wrist restraints on, so it's not like he was going to go anywhere or fall. He kept demanding to have his pants & shoes. The tech & I finally gave in...handed them to him in which he put the pants halfway on (since he couldn't stand up) & he put on his shoes. It was kind of comical to walk in & see that...but hey, he was happy....so I was happy. I managed to get him to take his pills, we gave him a snack & before I knew it....he was telling me jokes & stories. He didn't want me to leave the room! I was kinda cracking up inside comparing the description I had received of him & comparing it to how he was behaving now. Later on in the night, he pulled out one of his IV's. So the tech was giving him a bath & I got him some warm blankets, wrapped him up & he was so very comfortable & just smiling. I was thinking "Wow, I really have the right touch! He's nothing like they described earlier."

Welllllllllll, I threw that thinking right out the window the next night. He had turned back into the lunatic. This time instead of wrist restraints, the day nurse simply had a posey vest on him. I wasn't comfortable with that because he looked like he could slip out of it at any time. He started yelling at the change of shift. The day nurse told me to get his evening dose of Seroquel (antipsychotic medication). I got it, but I was pretty convinced no one would be able to talk him into taking it & I was right about that. When I got back to the room, the day nurse had called a Code Gray (an emergency request for extra manpower). I don't know why she did that because he was still fully restrained with that posey vest on. About 15 people showed up...mostly men. A Code Gray generally works to settle down an out of control patient, but in this case, it made my patient even more confused & agitated. I felt bad for him. Eventually most of them left & I was told to forget the Seroquel, give him Haldol IM (injection). So there was 4 of standing there looking at him while he yelled at us - we were trying to figure out how we were going to give him a shot. They were telling me to put it in his thigh, but I knew that was not going to work. I decided to get behind him in the chair & they would hold his arms & I'd inject him in the arm. I was worried he'd flail around & I'd end up jabbed with the needle...but he was so busy yelling at them, that he didn't even notice me behind him nor did he even feel the injection (what can I say...I'm good...lol).

We then make a decision to move him closer to the nurses station because there were only 2 nurses (me & another) on this unit. We try to tell him what we're doing & he just continues yelling about who knows what. He was already in a chair that had wheels on it, so as they started to push him to the door, he was trying his hardest to stop them by pushing back with his feet on the ground. They turned the chair around & then raced him down the hallway into the new room. It may sound awful, but I could not stop laughing....it literally looked like some type of race they were competing in & the poor patient...the look on his face like "What are these women doing to me?" It was priceless. I decided to leave him alone in the room & watch him from the nurses station...hoping he'd calm down. The respiratory therapist went in to give him a breathing treatment & the patient told him he was f'n useless & to get the hell out. The resp therapist came out saying he gets the same treatment at home from his wife. It was funny.

I'm noticing that now my patient has taken off his gown & is making a really good attempt at getting out of the posey vest. I say to the other nurse "I think we should put the wrist restraints back on him because if he gets out of that vest & is loose...who knows what will happen." So I call my clinical leader to assist us & while we're in there...he's yelling...then starts trying to punch & kick. I called another Code Gray. From that point we moved him (with a lot of assistance) from the chair into bed & put restraints on both his wrists & his ankles so he couldn't punch or kick us. I called the primary doctor to get him something more for his agitation. I really felt bad for my patient as he knew he had no more control & gave up yelling at me & was saying "Please let me out." I can't even imagine all that was going through his mind. The primary doctor asks me what the neuro doc said. Well, I didn't think to call the neuro doc as stroke had been ruled out and the conclusion was this patient had dementia. He gives me an order for Ativan. I call the neuro doctor to see if he wanted anything different....instead I got a lecture that agitation is not a neuro problem & that I shouldn't have been calling him. He orders the same thing & then asks me why this patient hadn't gotten his Seroquel. Ummm, what part of "This patient is out of control & very combative did you not understand?" So he tells me to give the Ativan & just give him the Seroquel later when he calms down. Well, that Ativan knocked him out the entire night. Not another word out of him...he slept through vital signs & even when the lab tech drew blood. I was relieved that at least he was at rest.

That second night was an easy night...both myself & the other nurse only had 2 patients each the entire night until 5 am when we each got an admit. It was a different story on Tuesday night....same nurse & I...only this time we had 5 patients each & no tech....grrrr. Well, we did get a tech around 2 am = Gina, but by that time, we really didn't need any help & she'd disappear for long periods of time anyways. It was the beginning of shift that was so busy & where we could have used the extra help.

My patients were not too bad to take care of...I liked them very much, but their medical conditions scared me. I think at any other larger hospital, half of them would be in ICU rather than PCU. I just had this uneasy feeling that at any time, they could take a major turn for the worse. That was the main reason I didn't go back tonight for overtime. It's not bad when you have 1 or 2 patients that are critical, but when 4 out of the 5 have major issues....the stress gets to me....especially when it's respiratory issues.

One patient was my new admit from the night before...he is at the hospital quite often for respiratory distress. He was on 5 liters of oxygen & sooooooo out of breath. His respirations were labored, you could see his abdominal muscles were doing all the work & he was shaking non-stop. He said he felt fine, but he definitely did not look fine. Another patient was one that just had a new tracheostomy. I don't like trachs...at all. I don't like any "ostomies." I don't know what it is, but I feel pain in my throat area when I see trach. This guy was coughing non-stop & I was worried something was going to get stuck in his trach. I called the respiratory therapist in to have her assess it. He did have a big ol mucus plug (ick...just the word mucus kinda grosses me out...see, even nurses do get grossed out) in the trach. Luckily. the respiratory therapist cleaned it all up even though technically...the nurses are supposed to do it. Which makes no sense to me...why can't the respiratory therapists do it? It is a respiratory issue.

Another patient was a new admit with congestive heart failure. He was a sweetheart, we got along great. I knew he was aggravated from being in the ER for so long & they were super busy down there so none of the patients were getting any food. He was starving, so I made it a priority to get him some food. He was happy. A little shortness of breath, but overall ok for the most part.

I still had the patient from Sunday with the hematoma in the abdomen. He was easy to care for as he mostly slept. I also had a female that had breast cancer & a right mastectomy. She was in the hospital because of nausea, vomiting & diarrhea from chemotherapy. This poor lady had the worst skin breakdown I've ever seen (not including pressure ulcers). The skin on her thighs & peri area was pretty much non-existent...it was so red & so raw & cracked, she cried when she moved her legs. I had to clean her up since she was having diarrhea & my heart was breaking listening to her cry from the pain. I talked to my clinical leader & we decided it would be best to put a fecal bag on her so the diarrhea wouldn't continue to hurt her where the skin was so raw. I tried my best to calm her & make her feel better, but I don't think it was really working. Even the inside of her mouth was all broken down & sore. The poor lady...so sad.

My confused man had been sent back to his nursing home. I don't know how those nurses that work at nursing homes do it. They really are special people to be able to endure dealing with alzheimer's & dementia....not just endure it, but also be able to develop a good relationship with their patients.

Someone commented earlier about my post with the ER nurse. I never intended to make it seem like I am anti-ER nurses or anti-ER department. I know they are super busy down there & don't have the same priorities that I do. I am against nurses that don't do the basics - which is to at least know your patient's labs & why they are at the hospital. As well as against doctors that also don't follow up with critical lab values. 671 is an extremely high glucose level & for it to go unnoticed by every medical professional that saw him before I spoke up about it...it's just wrong. We are lucky he had no ill-effects as a result.

This has been a good week....I've gotten so much positive feedback regarding my journal....thanks y'all. :)

A new season of Nip/Tuck has begun = strange, strange show, but I can't stop watching.

I had dinner this evening with one of my best friends...Maria. We met when we were about 13 yrs old & have been best friends ever since. It's kinda neat to look back & see how many people come in & out of our lives and value those that are here to stay for a lifetime.

5 comments:

am4039 said...

got my alerts back on, so I'll be catching up with you can't wait.

dragoneyes1164 said...

I recently found your journal and I love it so far. I am also a brand new nursing student so I guess this is what I have to look forward too. Yay my alerts are back on!!

Shann

siennastarr said...

That "someone" was me..  :)   I understand completely where you're coming from as far as a doctor or nurse not knowing things they should when giving report to the floor, I was just saying that it's so funny how there is always these types of issues that go on between floor nurses and ER nurses.  I'm not saying they aren't real issues... because I'm sure they are, from both sides of the fence.

I'm glad that you are getting positive feedback in your journal.  You're very interesting and easy to read, and if the person reading you knows medical terminology, it's even better! :)  

Do you ever visit other peoples journals and leave comments?  You will find that you get a lot more visitors to yours if you visit the people who leave their link under their comment.. :)  

Have a good week, Jen..

Jackie
http://journals.aol.com/siennastarr/Hopefloats/

molly146012 said...

Great  entry..have a nice weekend :)  Molly

tendernoggle said...

Hi,
wow you have had a busy week, huh? Do you know that you could probably write a book about all these experiences you are having as a nurse?
I would buy it and i am sure a lot of otheres would too!
love ya,
carlene