By nursekc on September 11, 2012
I’ve been on my own for about four months now & every night is an adventure. I will never forget the events that unfolded the very first night I flew solo…
I had six patients. #1 was in for a GI bleed & he was receiving 2 units PRBC’s (packed red blood cells – aka a blood transfusion). He was losing blood faster than we could put it in & his blood pressure kept dropping. At the most stressful point in the night, his blood pressure was 84/40.
#2 had a complex history. He was in pre-op for a fractured humerus consult when his oxygen levels plummeted into the 60’s (normally 95-100). He was admitted to my floor for his respiratory issues, but he had a GI consult for some nausea & vomiting. On a side note, he had a working colostomy from surgery years ago…this becomes an important tidbit later in the story.
#3 was in with altered mental status and kidney issues. Her electrolytes were all out of whack. Her potassium was sky-high so day shift gave her a dose of Kayexalate…a medication that lowers potassium by emptying out the bowels faster than you can get to the toilet. The day shift nurse was smart (or evil) & gave the medicine right before shift change. The patient wasn’t real steady on her feet. I tried to reinforce the importance of pushing the call light so someone could come help her to the bedside commode. Needless to say, every time I walked by her room she was out of bed, attempting to get out of bed, or already on the bedside commode…by herself.
#4 had an extensive history of diabetes & respiratory failure. She had an insulin pump that controlled her blood sugar. She was on supplemental oxygen & receiving breathing treatments to aid with her breathing issues. She also suffered from an existing back injury which she took narcotic pain medication for.
#5 had an especially painful issue with his intestines. He could receive IV Dilaudid (heavy-duty pain-killer) every 2 hours PRN (meaning he had to ask for it). He also had uncontrollable diarrhea related to his intestinal issues.
#6 was in with kidney issues, nausea & vomiting. The kidney issues were likely related to the vomiting, which by the way, the poor man couldn’t stop doing. All the anti-nausea medication in the world wouldn’t have done him any good. I’d give him some Zofran or Phenergan & he’d be ok…for about an hour.
The evening started out fairly routinely. I completed all my assessments & was just about to sit down & chart when 1’s first unit of blood was done. So I rushed down to the room, flushed the IV with normal saline, took his vital signs & started setting up for the 2nd unit of blood. I heard my name being paged so I hit the call light to call the desk. 5 was ready for his pain medication, & 6 was throwing up again.
I sent a CNA to get the blood for me while I drew up the appropriate pain medication for 5, & nausea medication for 6. By the time I was done in both rooms the blood was ready for 1. Blood is a time sensitive product. We have 30 minutes from the time it’s picked up from the lab to the time we have to start running it into the patient. And you must have two nurses verify & sign off. Then the primary nurse (me) has to stay in the room with the patient for the first 20 minutes to make sure they don’t have an allergic reaction.
I had just started the 2nd unit of blood when I heard my name being paged again. 4 was ready for her pain medication & 2 was having difficulty breathing. I had to stay with my patient receiving the blood…especially since his blood pressure had just plummeted…but it’s never a good thing when someone says they’re having difficulty breathing. I called the charge nurse & asked her to check on 2 for me. 4 was going to have to wait about 15 minutes for her pain medication.
Once I felt comfortable leaving 1, I went to check on 2 & the respiratory therapist was in there giving him a breathing treatment. I got the pain medication for 4 & was on my way there when I spot a naked bum flying from the bed to the bedside commode, leaking poop the whole way there… I called for reinforcements (and housekeeping). 30 minutes later I was finally on my way to 4 when I got paged again. 2 was breathing easier but was nauseous & 1’s blood pressure was lower than low.
I paged the doctor about the blood pressure & pulled up the nausea medication for 2 while I was waiting. On my way to give 2 the medicine the doctor returned my call & gave me new orders for 1. So I entered in the orders, went to 2, gave him the meds & was paged again. 5 needed more pain medication & something to slow his diarrhea, & 6 needed something for nausea.
The entire night played out like that…over & over being paged & pulled from here to there; trying to fix one crisis after another…it was exhausting! I believe I STARTED my charting that night around 3am which is about when everyone finally settled down.
When it was time for me to do my final round that morning I started with 1. He was looking much better after the blood transfusion & his vital signs were stable, but he was still pooping a decent amount of blood. 2 was finally sleeping well so I decided not to wake him just yet. 3 was worn out from the night of pooping, but her potassium was back down to normal. 4 wanted her pain medication. 5 wanted his pain medication. 6 needed another bath, new linens, & more nausea medication. I was almost finished in 6 when I heard my name paged…I was needed immediately in 2.
As I run down the hall I immediately started to worry: what if he's not breathing? What if he can't breathe? What if he's thrown up & he's choking on it? What if? What if? What if? By the time I got there & found out that his colostomy bag had exploded all over the place, I couldn't have been happier. I was just thrilled that the man was breathing! Who cares that we were up to our elbows in shit!
Talk about a memorable night...
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