Okay, I'm going to talk about my night shift last night. I finally got my marbles back together (was badly incoherent when I went home this am). I am feeling very sarcastic, just to warn you.
Have had a pretty good week so far (not counting the toilet breaking incident and getting soaked). I even forgave one of the nurses for calling me at home Saturday am (on MY DAY OFF), to get me to settle a silly arguement between staff (
Uh they do pay people to take care if things like this).
Anyway, I started the shift, finding out that I was working with two strangers (myself being the only regular for 30 residents). One of which gives me attitude and has a chip on her shoulder because I once reported her for falling asleep in the shelves of the linen room (but that's a whole other thread). So any way, these 2 don't know the unit, don't know the routine, aren't used to working with people with dementia -- but getting this sort of staff on the unit is not rare.
So I'm all alone (the 2 others are on the 2nd locked wing). I have a lady who is quite ill (diabetic, urosepsis, vomitting, poor intake in last 24 hrs). I'm trying to measure her intake and output. I can't figure out why her foley is not draining and is bypassing bigtime. She is lying in wet sheets with a stage 4 ulcer on her coccyx. Miss Attitude CNA swore to me that she had changed and turned her while I was on coffee (Uh huh, I wonder what else she didn't do?)
I look at her catheter and I can't believe it. Whoever had catherized her 2 days ago had used a 3 prong foley (meant for continuous irrigation (this shouldn't even be on the unit) and the extra port is OPEN TO THE AIR. has just been open and draining urine onto the sheets as if it is a regular foley that someone had forgot to hook up to a drainage bag (or plug for that matter).
I have no help to recatheterize her. I should have help, but their rounds have ended (suspiciously) early and the other nurse has gone for coffee. Pt. will not stay still for procedure. Is thrashing around with hands and legs. I call supervisor to come and help me.
I hate to catheterize. I don't do it often enough to be good at it. So I'm self conscious as well as still angry from events leading up to this. Catheterzied resident without incident. Supervisor leaves. Call-lights start ringing.
30 min later am back in original room. Need to clean her up and change soiled linen. Notice that coccyx dressing is saturated with stool and urine. Open it up . I want to cry! Wound looks terrrible! Has been progressing so well. Smells so bad. Was so clean last week when I was looking after it. Periwound skin is broken, haematomas all over the wound bed. Very. very macerated (I guess, it's been soaking in urine and stool for 2 days). Did dressing as best as I could without tray or assistance.
Sat at desk and documented.
Thanks for listening. What makes this worse is I'm really emotionally attached to this woman and have been trying so hard to heal up that wound for the last few months. Wanna cry. Maybe life will look better tomorrow.
Things will be better into perspective after some more sleep.