Sunday, November 2, 2008

4 beds...A day in my life

A day in my life at work as an RN:

I thought I would share a quick snippet of a day with you all (whoever reads this, apparently I don't have a site meter? If someone would help me with that, I would appreciate it. However, I am not sure I actually have any readers).
Anywho, this is a picture of a moment in my day. A picture that changes constantly as patients come and go,and needs increase and are met.

Background: It was a busy day, 30 people waiting in the waiting room, all the hall beds full. We are short again, every nurse has 4 beds plus the hall beds. We had 1 tech for all 80 beds, so pretty much all he did was transport patients upstairs. Our acuity was through the roof, again, so all of us were running around, so nobody had much time to help each other.

So, with that background, here is a snapshot of my 4 beds:

Bed number 1:
Exceedingly cute little old lady (92 years old!) who lived by herself! Cute LOL daughter present as well. She had bilateral pulmonary embolisms, with one being a saddle emboli. She was fairly dyspenic, with saturations in the upper 80s on oxygen. She still needed more blood drawn, the resident wanted something or the other; and she needed report called to the step-down unit upstairs. Oh, and she kept having R on T phenomena that resulted in runs of V-tach without a pulse. Code cart was between her room and room 2.

Bed number 2:
Another cute little old lady with her partner of 60+ years by her bedside. You could feel the love between the 2 of them. He carried out her every wish, while she just held his hand and stared into his eyes with love. This LOL was extremely sick, with a dissecting aortic aneurysm from her aortic valve down to her renal arteries. She had come in with sudden onset of "ripping" chest pain radiating to her back. Classic for this presentation. She had a known small abd aortic aneurysm that was supposedly stable at 3.1 cm.. Today, she had an aneurysm measuring 7.5 cm down her entire aorta. She diminishing pulses in her left leg, and very poor perfusion throughout her body as it was shutting down to compensate. She also had a BP of 180/86 and the MD refused to lower it cause "I don't think this is acute". Herald a continuing argument with the MD to try and get this LOL some immediate help before she died. She also needed another EKG, some fluid, and some more blood drawn. Oh, and reassurance to that loving husband. When the surgeon finally showed up (he took his time since the ER MD told him this was "non acute"). When he finally showed up, she got immediate BP lowering, and rapid transfer to the OR to try and save her life.

Bed number 3:
Extremely obese patient who cannot walk due to a weight over 500 lbs. Seems while having a relationship with her husband (also over 400 lbs), she fell out of bed. He managed to avoid falling on her, how I will never know. She had some small lacs that the PA student was suturing, and some bruises that would heal. No broken bones, fortunately. Oh, and a extremely needy husband who would walk into my other patient's room to drag me out and ask about getting a taxi ride home. Before you flame me, I treated them with care and compassion. Also, being overweight myself I did not judge her for her weight.

Bed number 4:
Patient with Guillan-Barre syndrome after the flu vaccine. She came in with leg weakness that over the course of 4 hours spread to include the entire body. She became unable to swallow, and was developing respiratory failure by the time I transferred her upstairs. After much care and time from me, the annoying judgemental PA who works with the hospitalist team comes to see her and write admission orders. The PA decides that this presentation "is entirely psychosomatic and she just needs to get over it. Please feed her now with a full diet. I am calling the shrink, and she needs a regular bed (not even with tele!) and cancel the ICU bed". Herald another argument with her, and a call to the attending in charge of the hospitalist team that day. The attending comes to see her eventually. Meanwhile, I am getting chewed out for not feeding this lady, not insisting she walk to the bathroom, and continuing to place the foley against the PAs orders (but with the ER MD's orders). Finally, the attending shows up and concurs with the Guillian-Barre diagnosis. She goes back to being headed to the ICU, gets immediately placed NPO (just like I did! sorry, miss PA!), she gets a central line, respiratory gets called, placed on Bipap, etc, etc. She got intubated shortly after arriving in the ICU. She also had a million things that needed doing and several family members who needed help understanding the rapidly changing care plan.
(also, before you flame me, I love PAs. Most are excellent care providers, and I am excited to see them show up as they are often better than the residents. However, this one new one needs to learn a few things before being let loose on her own).

So, that is a moment out of my day. I generally love my job, but it sure can get challenging sometimes!

1 comment:

Anonymous said...

Yeah, you do have readers (at least 1 anyway). I got here through Kim's blog. Thanks for letting us peek into your day.
RN in NY