I'm just alittle bothered by a statement that was made about me when I was on our last rotation on Surgical floor. We were PN students, and we all had two patients. I had a 82 year old man admitted for urinary retention who cut off his foley at home. My other patient was a 19 year old gunshot wound victim. He apparently shot himself in the leg. Ok, there's the backround. Being a PN student, I wanted to absorb every little thing that there was to learn. I am very anal about details, rules, and all that. My gunshot wound vic was given morphine at about 1430 and then was asking for more pain meds at 1515. I asked to give him hydrocodone. Checked respirations. 16, ok. Pain scale 8/10. Gave him the med. The primary nurse that I was assigned to told me to keep an eye on him. Checked on him 30 (1630) min later, pain scale 7/10. Asked for more meds. Checked respirations, 14. Speech was alittle slurred. I was starting to wonder if he was getting too much. I notified my instructor of this. I told her that I thought his pupils were pin point 2 mm. She went in to check on him, and she agreed. She told me notify her if he wanted more pain meds, within the time frame of course. Now, I know about patient pain management importance. I was just concerned. After shift change, the new nurse on duty pushed morphine again, about 1930. After that, his speech was very slurred, eyes pin point, resp 12. Primary nurse seemed to be okay with it. Instructor told me to chart what I saw, just to cover my tail. Before I reported off, the primary nurse gave him hydrocodone again before I left. around 2100.
Okay, with all that said, the primary nurse said that I would not make it as a surgical nurse, and I needed to calm down and get some experience under my belt so I dont freak out with the little things. I am hurt by this. I know the importance of around the clock pain management. I know that all these doses were given within the normal time frame. But was I wrong for keeping a really close eye and to learn from the patient the effects of these medications?
Also, my urinary retention patient had his foley removed after a cysto and he hadnt urinated in 5 hours. IV fluids were 125 of NS per hour. PO fliuds were 800 ccs. I know the standard wait is 8 hours before you to call for and order to straigt cath. But, since his was ADMITTED for urinary retention, I was alittle concerned. Lower abd was more distended than earlier, when it was so flat it was almost concave!!! He didnt urinate before I went home, and no one was overly concerned. Later on I heard that the nurses including the primary nurse said I was over reacting. Maybe I was, but is that bad, esp being a student learning the trade of nursing?
Where is the line between attentiveness and over reacting?
Dont flame me too bad!!
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Re: When is it too much? (long)
Yes it's important to be attentive. Here's where the nursing standpoint comes in. I only graduated in May, so take this with a grain of salt. Although 2 patients to you probably seems overwhelming, your primary nurse probably had 5-6. You have probably total care on those 2 patients, which is a little overwhelming so I can see that. But you were attentive to notice little things that ARE important. What you did by making a big deal out of it was put a little bug in the nurses hat to keep an eye on them. In a textbook world it would've been VERY important to get the urinary retention man I/O caths ASAP because the threat of infection. In textbook world it would've been extremely important to VERY closely monitor the patient with a gunshot wound and his respiratory depression.
: there are some nurses who only feel good about themselves when they are able to make fun of someone else. Thankfully, not all of us. I can't tell if you "overreacted", i.e. chasing after her and screaming " aren't you going to do something!!??!!"- but unless you did you were just doing what your supposed to do, learning, or trying to.
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