It's been a long, tiring week. I worked Monday thru Thursday night. It had been a somewhat decent week until last night - mostly because we were without a patient care tech. Of course that happens on a night when I could really use the extra help as I had two very needy patients and another in critical condition...luckily my fourth patient slept practically the entire shift & needed nothing other than medications.
My needy patients...one had a cardiac cath that day & was brought back to the floor at shift change. Why do they do that? It's the worst time to bring patients to the floor. She had orders for complete bedrest until the next morning. This was my first night caring for her, but I was familiar with her as I had taken care of the patient in the other bed in the same room the last 3 nights & this one would complain about how come I wasn't her nurse also. I had to explain it each time. I could tell she had anxiety issues, but luckily they didn't come out on last night's shift. She loved her call light though.
My other needy patient was a man in with CHF. I was told he was very easy to care for...which as in most cases, it ends up being the opposite. I had antibiotic IV medications to give him & of course his IV wouldn't work. When it came time to put in a new IV, he refused. Refused to have an IV, refused any medications via IV. I tried to explain to him the advantages of IV medications as opposed to meds you take by mouth. He didn't care, he didn't like needles. It still surprises me how many adults are afraid of needles. Anyways, I called his doctor & got the medications changed to pills. Which then later complained that they made his stomach hurt. Ummm, didn't I tell you the advantages of IV vs. by mouth?
He had a dressing change for a foot amputation that was scheduled for 10 pm. Since I had no patient care tech & was running around trying to keep everything in order, I didn't get to do the dressing change until 11:45 pm. I documented exactly why it was done late - that we seemed to be short-staffed and without a patient care tech. Which was a semi-lie because they sent nurses home & called a few off....we always use a nurse as a PCT if we don't have enough PCT's. So there was no excuse other than to save on $$$$. I probably shouldn't have charted it exactly that way, but let's say hypothetically one day I'm called in & asked why it was done so late...I wouldn't be able to remember other than my charting notes. It's pretty self-explanatory. This guy was on the call light most of the night. That can be time consuming in itself.
The patient that had me worried was an older woman in with respiratory failure, GI bleed and anemia. She received orders in the ER at 7 pm for 3 units of fresh frozen plasma now. She got to the floor around 11:30 pm and not one unit had been hung yet. So much for emphasizing the word "now." When she got to the floor, she was pale, her lips were bluish-purple, her lungs were wet...her breathing sounded like one of those coffee makers that percolates. She was a DNR, but that doesn't make it any easier for me. One of the ICU nurses walked by & stopped & then asked me if the patient was dead. Huh??? Don't say that! She looked that awful. She belonged in ICU, not PCU...but somehow she was mine for the night. I hung the first unit of FFP...I didn't run it as fast as I could have because I was afraid of fluid overload. I had no order for Lasix (diuretic) inbetween the units...so I ran the FFP between 100-150 ml/hr. An additional order was if her hemoglobin drops below 8.5, transfuse 2 units of red blood cells. Sure enough, the lab results were back...she went from 8.9 to 8.1 in just a few hours. Ok, hmmm, do I continue giving the 3 units of FFP or interchange the RBC units inbetween the FFP units? I discuss it with my clinical leader & we decide that since it seems she does have an active internal bleed somewhere, it would be better to give all the FFP first so when we do give the blood, the FFP will hopefully slow down the bleed in order to benefit from the blood transfusion. On top of all that going on, she had some liquid stool that had that icky C-diff smell & she was unable to let me know when she had to go. The one night I could have used a patient care tech was a night like this...go figure.
I managed to keep her alive through the night & was so glad to see the day shift nurse take over her care. I had a patient earlier in the week that came into the ER...a patient with a DNR from a nursing home. She not only coded in the ER, but went into asystole...long period of asystole (flat line). I guess since the nursing home didn't send over the DNR paperwork, the ER had to code her. She came back from the dead, the family consented to a pacemaker & she was back to normal. Weird how things turn out.
I'm very tired...heading to bed. Tomorrow I make the plane reservations for my vacation in Hawaii. I am going first-class. Hey, if it's supposed to be a trip of a lifetime, I'm making sure it's done the right way. I got some vacation time approved at work...so I could be away for 5 weeks if I wanted. I'm still deciding on whether to go to Portland & Seattle after Vancouver. I'll figure it out tomorrow, I'm too tired to think about it right now.
Have a good weekend everyone!