Are you in a marathon today??

[firstinfamily, RN]

As most of you know I recently returned to acute care after a 5 year stint away from it(the longest ever). I am working weekend option 7p-7a and I had my first marathon this last Friday. Yes, we truly run a marathon when we are working, the analogy just makes such sense to me. We all have had that "horrid" shift at one time or another, I use to dread returning to work after having one of my babies because I knew I was going to have a bad shift eventually.

Well, wouldn't you know it came and I won!!! My elderly patient started having bloody stools right at the change of shifts!!! Oh yeah!! His H & H was already low and he was having a repeat about an hour after my shift started. Guess What??? it was lower than before and it was time for blood transfusions!!!! Now, us old nurses still remember the times when we had GI Bleeders that bleed out as fast as we were instilling the blood, so that nightmare was just beginning to happen to me.

He was a nice elderly gentleman, didn't quite understand what was happening, so I briefed him and told him I would be at his side all night long. I wanted him to sleep and I would let him know what was happening. He asked me to call his wife which I did and listened to the worry on the other end of the telephone. I reassured her that I would be with her husband all night and I would call her or her daughter to keep them informed. I hung the first unit of PRBC's and things were going better, then of course, a mahogany colored stool, about 100 mls. (like half of the unit of blood that I was infusing). I call the hospitalist and let them know and a second unit was ordered. Frequent vital signs, watching pt carefully, watching the IV site, blood infusing without difficulty, no signs of a reaction, listening to lung sounds. The pt wakes up and asks how things are, I tell him, a little better. He says he has to have another stool. I know what I have waiting for me. I try to comfort him and say "it's OK" He is able to help turn and we go through the motions of putting him on a bedpan etc. When he is done and I see what would be another larger amount mahogany colored stool, no clots, no bright red, good/bad. I am also learning the new (to me) computer entry for blood products and how to chart the vital signs in the computer while caring for my very unstable patient. I go down and get the second unit(no tube system here), talk a little to the Blood Bank Tech and let her know we will most likely be giving blood all night. She's a little flustered, but understands.

When the second unit is started I notice pts heart rate is starting to increase, blood pressure is still low, temp is OK. He is getting shocky. I hate this, I know what is going to happen. I get on the horn again with the hospitalists and tell him what is happening, I use my CUS words to tell him I am starting to feel uncomfortable with my pt, that I think it is unsafe to keep him on the tele floor, I think he needs more intense monitoring, review vitals, labs etc. Finally, I am told the Intensivist will come see him. Good. Intensivist came, he saw, he thought, he called the GI surgeon, they order more tests. I get to accompany my pt for a nuc med bleeding scan. Oh joy!! The test lasts an hour!! Are you kidding me!! One hour!! I do have 4 other patients that I need to see!!!! Oh yeah! And he is now an IMC pt. YEAH!! So, I call IMC, tell them about my guy and he is having a nuc med scan etc. He will be coming to your floor after the nuc med scan is done. The IMC nurse tells me, "You know he has some FFP ordered?" and I reply, "Yes, I know, he is coming to you after the nuc med test is done and you can give the FFP!!!" I must admit, I am a little angry!! I have been caring very closely for this pt and now that I have finally gotten him to be transferred the new nurse is giving me flack!!! (Don't push me!!) WE go down to the nuc med area, the nuc tech is explaining the test to me, I am looking and don't see any obvious bleed. The blood is almost infused, pt is still alert, no more stools!!!

End of story is that he went to the IMC after the nuc med test, my charge nurse, co-worker came to relieve me before the nuc med test was over so I could pass out my 0600 meds. Good Teamwork.I call the wife and let her know he has been transferred to another area of the hospital where he can be watched more closely. I go home totally exhausted and sleep like a rock. The next night shift I go over and visit my man, he had a total of 4 PRBC's 1FFP, he was found to have a bleeding peptic ulcer. What do you know??? And he was doing so much better. Had a one on one nurse, good for him. I felt justified, I felt I had won the marathon, I felt I was back where I belong, in acute care, so frustrating, yet so rewarding and what a high!!

[Silverdragon102, BSN]

Sometimes shifts can be hard, well done for making it through yours and giving someone the best you can give

[Fiona59]

Could you edit that wall of words? Paragraphs would encourage people to finish reading it

[HikingEDRN, BSN, RN]

Good job :) It's very satisfying to see a good outcome knowing that you played a major part. At times, one frustrating thing about the ED is that I've stabilized someone who was very sick but then I don't know what happened afterward. Usually I like my quick patient turnover but every once in awhile, a particularly intense situation makes me bummed that I am not in the position to learn how things evolved.