Thursday, November 19, 2009
104 and GOING STRONG
I walked into the room of my 104 year old patient who had sprained her ankle. She was bright eyed and chipper explaining her injury and very "with it". I asked "What does it feel like to be 104"? She looked up with a grin and said "There's not much peer pressure". I want to be just like her when I grow up.
Tuesday, November 17, 2009
NOT THE SMARTEST DRUNK IN THE BAR
It was a sub-zero February morning. The car slid, more than drove to work. I inherited a drunk left over from nights. The story was he was drinking heavy at the bar...OK...he was afraid he was sooo drunk he would fall off his bike, so he tied himself to it with a rope. OK... He's drunk in a bar at 3am on a sub-zero February night and riding a bike? Obviously he has no license and figured this would work. UNFORTUNATELY while riding home on the icy streets he hit a curb and wiped out onto the road. EMS received a disatch for "Man down in the middle of 8th Street tied to a bicycle".
Medically he was unscathed. But we needed to let him sleep off his BAL until he proved safe to be discharge out into the public again. I took report on a few more patients then went to check him out.
He was not in his room! The siderails on his stretcher were still up and his clothes were still on the chair. Hmmmm a drunk Houdini? I reported the findings and security went to look for him, albeit unsuccesfully. 30 minutes later we received a call from a very angry Mother. "How in the hell could you just let him leave in his pajamas in the snow?!! He could of froze to death! She went on and on and on...
I exlained to her that all had checked out well medically and we were just letting him sleep off his drunk. (This was before HIPPA invaded our world) I finished with "He decided to climb the rails and slip out without telling us". "Well the least you could of done is fed him breakfast". Hmmmm it was way too early to give her the "accountability lecture" so I said "If you would like to bring him back I'm sure we could find him a tray" Sometimes it doesn't bother me at all to have the other person hang upon me.
Wednesday, November 11, 2009
The worst walk of his life...
I was taking care of a young CAB patient (coronary artery bypass)who was
Post-Operative day 5. Other than high cholesterol he had no prior cardiac history. He should have been off oxygen, walking around, and ready to go home. This guy just didnt look good. "Puney" is what we call them, they just look puney. His skin was yellowish pale, he was a bit anxious, still required a little oxygen and had been in and out of Atrial Fibrillation for days(not uncommon after this surgery).
What we tell many patients is " Once your up and walking around the whole hall you can go home". This guy really wanted to go, although I dont think he had a good understanding about his progress or lack there of. So I attempted to wean him off the oxygen and I got him off. He rested all day and we talked about him walking in the afternoon. He was ready, so we went. He was short of breath (SOB)as many of our patients are when they really begin to get up and move. I asked him to turn around about 1/4th of the way down the hall, I could tell he was pushing it. He said " NO, NO I'm going all the way around , I want to go home."
We made it back to his room and he was out of breath. I sat him down and got a pulse-ox to check his oxygen saturations. He was low (81%). Following protocol I put the oxygen on him by nasal cannula and let him sit for a few minutes. He was still low (84-86%). Suddenly he started saying " my leg is numb, I cant feel my foot!".
I asked him to flex and extend his foot but he couldn't. I grabbed a fellow nurse and we got him into his bed. We checked for a pulse. No pulse in that foot. He had a great pulse in the other foot. His oxygen was still low. I knew this was serious, his foot was looking bad. I requested the physicians assistant to examine him and he said we needed to call the doctor. I paged the doctor.
My patient was getting worse. He was anxious and breathing really hard. I placed a nonrebreather on him but and his saturations were still in the 80'S. We tried for a doppler pulse while his leg grew bluish and mottled. He was starting to grimace as the doctor came in. Then he started grunting and sweating in pain. The doctor examined him and decided he probably threw a clot that lodged in his leg
(blessed it wasn't his brain). He needed an emergency embolectomy and was rushed to surgery. The team really pulled in for me that day. I had four senior nurses at my side helping me do everything. They were awesome and I love them for it. I felt safe and on top of things. He left for surgery and I finally sat to chart the event and ponder the outcome.
A week later I inquired about him to one of the doctors. He said he was positive for HIT (Heparin Induced Thrombocytopenia)and threw clots to his heart and leg. Heparin is utilized during these surgeries and some people develop HIT. The fact that he was also in and out of atrial fibrillation didnt help. Basically he showered clots. He is blessed to be alive! A venous clot in his leg, an arterial clot to the right atrium . The leg was saved by the embolectomy. In addition, the patient qualified for an Argatroban drip and spent an additional week in the cardiovascular ICU. He is so blessed he didnt stroke , throw a PE ...die. I felt so blessed that I picked up on his condition and the team took great care of him.
WOW, I helped to save a life. This is what nursing is all about. I became a little less intimidated to call a doctor about an issue knowing it may save a life, and in this case it did. He recovered and told me later that he remembered me turning to his believing wife and saying " pray!" as we rolled out to the OR. The nurses helped, the doctors helped, medicine helped, and the prayers definately helped. THE ROOKIE-
Post-Operative day 5. Other than high cholesterol he had no prior cardiac history. He should have been off oxygen, walking around, and ready to go home. This guy just didnt look good. "Puney" is what we call them, they just look puney. His skin was yellowish pale, he was a bit anxious, still required a little oxygen and had been in and out of Atrial Fibrillation for days(not uncommon after this surgery).
What we tell many patients is " Once your up and walking around the whole hall you can go home". This guy really wanted to go, although I dont think he had a good understanding about his progress or lack there of. So I attempted to wean him off the oxygen and I got him off. He rested all day and we talked about him walking in the afternoon. He was ready, so we went. He was short of breath (SOB)as many of our patients are when they really begin to get up and move. I asked him to turn around about 1/4th of the way down the hall, I could tell he was pushing it. He said " NO, NO I'm going all the way around , I want to go home."
We made it back to his room and he was out of breath. I sat him down and got a pulse-ox to check his oxygen saturations. He was low (81%). Following protocol I put the oxygen on him by nasal cannula and let him sit for a few minutes. He was still low (84-86%). Suddenly he started saying " my leg is numb, I cant feel my foot!".
I asked him to flex and extend his foot but he couldn't. I grabbed a fellow nurse and we got him into his bed. We checked for a pulse. No pulse in that foot. He had a great pulse in the other foot. His oxygen was still low. I knew this was serious, his foot was looking bad. I requested the physicians assistant to examine him and he said we needed to call the doctor. I paged the doctor.
My patient was getting worse. He was anxious and breathing really hard. I placed a nonrebreather on him but and his saturations were still in the 80'S. We tried for a doppler pulse while his leg grew bluish and mottled. He was starting to grimace as the doctor came in. Then he started grunting and sweating in pain. The doctor examined him and decided he probably threw a clot that lodged in his leg
(blessed it wasn't his brain). He needed an emergency embolectomy and was rushed to surgery. The team really pulled in for me that day. I had four senior nurses at my side helping me do everything. They were awesome and I love them for it. I felt safe and on top of things. He left for surgery and I finally sat to chart the event and ponder the outcome.
A week later I inquired about him to one of the doctors. He said he was positive for HIT (Heparin Induced Thrombocytopenia)and threw clots to his heart and leg. Heparin is utilized during these surgeries and some people develop HIT. The fact that he was also in and out of atrial fibrillation didnt help. Basically he showered clots. He is blessed to be alive! A venous clot in his leg, an arterial clot to the right atrium . The leg was saved by the embolectomy. In addition, the patient qualified for an Argatroban drip and spent an additional week in the cardiovascular ICU. He is so blessed he didnt stroke , throw a PE ...die. I felt so blessed that I picked up on his condition and the team took great care of him.
WOW, I helped to save a life. This is what nursing is all about. I became a little less intimidated to call a doctor about an issue knowing it may save a life, and in this case it did. He recovered and told me later that he remembered me turning to his believing wife and saying " pray!" as we rolled out to the OR. The nurses helped, the doctors helped, medicine helped, and the prayers definately helped. THE ROOKIE-
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