Appreciate....my daughter had a hard time enunciating that word before....one word that touches a heart, tries a tear, gives a lump in the throat. As we walked from the school bus towards home, she asked, "Mom, how's work?" "Oh, it's not that good, I was too busy last night." Then, she said, "That's alright, Mom, I know you've done your best." Oh, how encouraging and wonderful were those words reverberating in my ears coming from a 6-year old. She has a sense of maturity. Whenever you feel down, she's there to give you encouragement.
So, as I pondered how my night really was, I was blinded by the tasks....too many things to do, too little time. But one thing for sure, words of encouragement could just let you go on and on and let you carry on with your tasks as you try to catch up on things. And it's good to hear that from anybody, from a co-worker, and most especially from your patient, even if she's just using the sign language.
My co-worker last night said, "Naomie, what have you done? You have a magic touch!" (I was then thinking of King Midas). Me too, was so thrilled with my patient last night. She's been with our care for a long time in the intensive care unit. She's an End-Stage Renal Disease patient, with a multiple medical history and issues, who had surgery, became septic, was intubated and got trached. I had her when she was so confused, getting out of bed, on fall precaution and on Levophed drip. She wasn't on the ventilator yet. When I had her, she really had exhausted me. She had no restraints on and so I made careful, close observation on her. Then, I had her again, last night....she's on the ventilator already, with a triple drip-Levophed, Insulin (meaning I have to do blood sugar monitoring every hour using our Portland Protocol), and the Amiodarone drip-my favorite, using all the ports of the right internal jugular central line.
I received her really febrile with a temperature of 103.3 F and had bouts of diarrhea. She has also a nasogastric tube with a Glucerna going, and with a new right above knee amputation that's oozing. (Did I make a mistake of choosing Bed A over Bed B?-they forgot I was pregnant and they wanted to give me Bed B- a very, very heavy patient and 6'6" in height and on ventilator and all...with special participation of multiple organisms needed for Isolation Precaution). Hmmm, anyway, I'll just take this (Bed A) as a challenge..."whatever" was my word for the night.
And so, she's on restraints...not a favor....but more observation and monitoring and documentation. I started my night the hard way....febrile, poop, the drips....assessment was forever. Good thing, my other patient, which was on the other side of the unit wasn't that bad, she's more stable(?) maybe, because she's alert and oriented by three...but then, the blood pressure was fluctuating, in and out of cardiac arrhythmia, give the trigeminy a five with an underlying rhythm of Brady, and with a whooping Troponin level of 9.81! Hmmm, she's alert but an acute one while the other one on the vent is chronic. But both of them were critical, that's why they were in the intensive care unit.
Okay, first things first....titrate that needs to be titrated, address the febrile issue....tylenol needs help at this time, i needed to order a cooling blanket-another temperature monitoring to prevent hypothermia, needed to give way for my antibiotics, too...creating double ports to one of the triple lumens....we couldn't use her right arm for venipuncture since there's an AV graft for her hemodialysis. Think, Naomie!
Then, after the important ones were addressed, started cleaning her up. I thought this one's hopeless....we've seen people, come and go...but then, she started waking up....it's like she heard my thoughts....she started to communicate with her lips...I could hardly understand....i tried to make some humor to uplift her....then, I asked her, " Can you smile for me? "...she smiled....that was amazing! It's like I didn't believe she could follow simple commands...she was too confused before. And then, she started to talk again, but without sound, of course, she has a tracheostomy. I tried to understand her...but maybe I am just poor with reading lips. I told her to wait while I try to find the communication board where she could just point things so I could understand...I also tried to let her write the words...but she's too weak...until I figured out she just wanted to take the restraints off from her wrists.
I explained to her the importance of restraints at this time since she's not totally oriented, she's in and out of reality, and she signalled to me, she understood why she had to be on bilateral wrist restraints. From then on, she's trying to communicate, asking for ice chips was one of them....I indulged her with that, so little, just to keep communication open. For me, it was fulfilling to see her come out to some consciousness....I was wrong after all. Hope is still there.
Before my shift ended, her temperature went down to 98.7 F, she converted to Sinus Rhythm from Atrial Fibrillation, she's communicating, the blood pressure was stable, and her morning labs were not critical. That's why, my co-worker said, "What have you done to her? You have a magic touch!". And then, I realized...I've done my job after all! And I was on time. And it was fulfilling and amazing. I was just preoccupied with the amount of tasks I needed to do. But then, I had done it, I mean everything and it's well done. And that just made me smile.
Joined: Apr '08; Posts: 9; Likes: 5
Critical Care Nurse; from US
Specialty: 9 year(s) of experience in Telemetry, ICUAug 13, '08Sometimes we take doing a good job for granted. It's nice to have one of those shifts that make you feel like you've really accomplished something .