This past week at work was really good - which basically means it was really easy. My patients were stable, considerate, polite, alert & oriented - which is always a plus.
My first patient was in with pneumonia and respiratory failure. Only in her late 50's & already a DNR (do not resuscitate). She needs a lung transplant, but is not a surgical candidate because the doctors don't think she'd surivive the surgery. It's sad because it was something the doctor had to discuss with her during my shift...to make a decision should something happen while she was in the hospital. It seems like the most pleasant people are the ones with the terrible diagnosis/outcomes.
My second patient was admitted with vertigo rule out TIA. Turns out it was vertigo and she just needed her Meclizine medication increased. After that she felt fine. However, she spent an extra 2 days in the hospital because the neurologist didn't want to discharge her until the test results were in writing on the computer. For some reason - it was really slow to get the results...which was fine with me - she was a pleasant patient to take care of.
My third patient...hmmm...how to describe her??? Her first question to me was "How will you know if I pass out while in bed?" Who asks stuff like that? I did not yet realize this woman's history. She was admitted with syncope. It's been going on for over 4 years. She had a big workup done at a major hospital which showed no medical basis for what she claimed to be experiencing. What she experiences is feeling shaky, staring off into space, fainting...a variety of different things. While in the hospital - she only experienced these situations while medical personnel were with her. Twice in the ER, once when the admitting doctor was in the room with her, once when a nurse was with her and once when the neurologist was in. The neurologist assessed her during one of her fainting spells - he lifted her arm up over her face & let it go. If she were truly unconscious - the arm would have fallen on her face. Instead it went over her head & barely touched the ground. They were all convinced she was faking - there were no changes neurologically, physically, cardiac wise, vital signs were stable. She did seem a bit on the dramatic side to me also. Most of the time people who are admitted to the hospital - they can't wait to go home. Even if they are feeling miserable, they just want to be at home as soon as possible. Not this one - she insisted on staying in the hospital. She was still there when I left, but I think the plan of care was to refer her to a psychologist.
My fourth patient was strange. He was a nice enough guy, but 95% of the time that I was in the room - he had the sheet & blanket over his head. Not just on top of his head...but covering his entire head & face. He even watched tv like this! One time I walked by & he was sitting up on the side of the bed with the usual sheet & blanket covering his head. It was bizarre. He was in for a variety of things - congestive heart failure, anascara and right upper quadrant pain. He did have gallstones, but he wasn't a surgical candidate because he recently had a heart attack and he had this huge wound on his foot that wasn't healing. No surgeon wanted to touch someone with that type of history. The wound is from uncontrolled diabetes = poor circulation. What's weird is that he didn't even come to the hospital for treatment of that wound. He was just covering it up at home - as if it would heal on it's own. It was gigantic!
My fifth patient showed up around 4:30 am. I felt bad for her. She was in her early 30's & her mother died last week at our hospital. The patient was grieving which lead to chest pain. She looked so sad. It made me think of how I'd feel if I lost my mom & then I quickly put that thought out of my mind. I know it would be nearly impossible to go thru that...even though we have to. This patient didn't have any chest pain during my time with her. I think she just needs to find some positive ways to release this stress of losing someone so close.
On top of it being an easy week -there were nursing students there for two of the nights also. That made it even easier! The instructor was someone that graduated with me - I have no idea how she became a clinical instructor so quickly.
I have another long week ahead. I feel like all I do is work lately...grrrr. I took Shay to my parents house for them to watch her this next week. Here's her latest pics!