Saturday, February 28, 2009

Precaution

I received a patient the other night from the ER. His diagnoses were acute cholecystitis, left hip fracture and chest pain. When the ER nurse arrived with him, we obviously needed more than just the 2 of us to transfer him from the stretcher to the bed. My fellow co-workers all seemed to be in their patients rooms, so I waited for someone to appear. The ER nurse was not quite as patient as I was. In fact, she seemed rather anxious & at one point claimed her & I could move the patient. Ummm, he's over 200 lbs with a hip fracture...I'm not hurting my back cause you're in a hurry. She continued to be a bit jumpy - even going as far as calling down to the ER in hopes of someone from down there coming up to assist. I couldn't figure out why she was in such a hurry - because most of the time, they enjoy getting a break from the ER.

After about 2 minutes, I was able to round up my fellow nurses & we transferred the patient into our bed. The ER nurse was gone in seconds. As we turned the patient to get the extra blankets/sheets out from under him, it was soon apparent why the ER nurse was in such a hurry. Often times we have patients come to the floor that have had a bowel movement & for whatever reason (laziness or lack of desire to help clean someone up), the nurse seems to think that's ok. I, personally, think it's disgusting to allow someone to lay in their own waste. I don't like cleaning it, but that doesn't stop me for doing so.

My patient, however, did not have a bowel movement. Instead, he was covered in urine. When I say covered....I mean COVERED. So much so, that there were towels tucked in all around him - so that tells me the nurse knew exactly what was going on....as opposed to "Oh, he just did that on the way up here during the transfer." Not only that, but this gentleman was totally alert & oriented. I asked him why he had so much urine in the sheets & he replied "I can barely move with this hip fracture and no one downstairs would help me with the urinal." Ugh...sad. He wasn't a complainer either. In fact, he was apologizing to me. I reassured him that he had nothing to be sorry about - we have to go to the bathroom, don't we?

Needless to say, I wrote that nurse up for neglect. I don't care how busy you are....you don't leave someone swimming in their own urine. Why they didn't immediately put a foley catheter in him is beyond me. He's a hip fracture patient, he would have one placed prior to surgery anyways. He was in the ER for 8 hours....they had plenty of time to put one in. Ridiculous.

That wasn't my only problem with this patient. He had a hip fracture and what do they order for pain??? One darvocet every 6 hours. Are you kidding me???

His second set of Troponin came back positive. Granted it was just slightly above normal....his was 0.61, normal is 0.49 and below...but it was still positive. Not to mention his rhythm had those rabbit ears that looked like the letter M. I'm not sure what the clinical name is for it, but when I asked my clincal leader what it meant....she replied "Death." What????? She said the M pretty much means morbidity. What??????????????

So I call the cardiologist & explain to him what is going on. His reply......"Ok." That's it. "Ok." And he hangs up. Not quite the response I was looking for, but not completely unexpected either as this cardiologist tends to be like this most of the time.

I call the primary doctor....for a few reasons...one of which is the positive Troponin, another for stronger pain medication & last to discuss the patient being allergic to one of the antibiotics he prescribed 6 hours earlier while the patient was in the ER. I get new prescriptions for the pain & the allergy, but I'm told "Oh really" in response to the cardiac information. "Oh really?" As if I'd just told him the latest gossip on Brad Pitt & Angelina Jolie. Again, not quite the response I was looking for....but considering this doctor was snapping & yelling at other nurses left & right, I felt rather relieved with his calm "Oh really?" response.

I wait a few hours & then call the surgeon who was planning on taking this patient's gallbladder out in the morning. I obviously woke him up even though I waited until 6 am to call (what time do doctors usually wake up???). I tell him about the positive Troponin thinking he may want to postpone the surgery until the patient is cleared by cardio. Instead he asks me what the CPK and CKMB results are. I read them to him & he says "That means he has a 1% chance of having a heart attack, doesn't it?" Ummmm, what?????? I didn't know what he was talking about & replied with "I guess." He goes on to say he thinks the hip fracture is causing a false positive Troponin result. Ummmm, what????? I have never heard of such a thing. Has anyone ever heard of this?

My patient was such a sweetheart & would not complain at all. I kept checking on him & asking if he had chest pain because I felt like he was the type that wouldn't tell me even if he did & with his crazy heart rhythm, I didn't want to be surprised. Needless to say, I went home that morning wondering about this patient of mine & what his outcome would be since none of the doctors seemed all that concerned.

I found out later he was transferred to ICU as a "precaution." Uh huh....why couldn't they have done that earlier so I wouldn't have to worry? I'm glad nothing bad happened to him, but I'm also glad I followed my instinct to make all of the doctors on his case aware of his situation....even if I repeatedly didn't get the response I was looking for.

I've enjoyed another day off of doing nothing. I could get used to this lifestyle. I will attempt to clean & do some laundry later today...but that's it. I've needed this downtime for myself. It's my last week of being 39. Next Saturday I'll be 40...eeekkkk. Where did the years go?

4 comments:

Amanda said...

Happy almost birthday. I hear you on the bad transfer experience. The other trick we get is they send the patient with the IV pump turned off (becasue the line has blown, they didn't feel like putting in a new one, and the pump was beeping)

Trip levels are sometimes high after car accidents in out trauma patients and we were told that extreme stress d/t injury can raise it. Not sure if it is true though. Off to google......

Julie said...

I hate getting patients like that. Usually the first thing they want to do is his the bathroom. They need a bathroom down there. Poor man. Take 2 minutes to put a foley in.

dx_acutefelicity said...

Thanks for the well wishes! Reading your blog makes me hopeful that there are still nurses out there who aren't completely jaded by the medical establishment and still care about their patients. I hope I can be as good as you some day! :-)

Pamela said...

That poor man! I can't imagine leaving a pt like that. No way!! I would have been livid! I hope that writing her up does some good.

You are such a good nurse!