CAB Patient Observation

hrtprncss · Jul 24, 2006

LOL yeah tenn, usually if I run into problems it would be with the younger folks, the 250pounders, six foot something guys. They don't wanna get up, they don't want to walk, some want to smoke, some don't eat their ''heart'' diet and will have their gf's bring in mcdonald's. Sometimes I get slightly mean, but you have to be forceful or else some people won't get up and walk and you're the one who would get an ear full when the surgeon comes. If they don't do their IS, I just suggest IPPB, and sometimes they don't like that cuz our RT comes in when they're napping and they'd have to be woken for it, then they won't have a choice but do their IS. Sometimes bargaining works, sometimes you just have to get PT involve cuz u just can't do force them anymore, and you hope someone else can.

ALCCRN · Jul 25, 2006

Hehehe...Same where I am. The reason I always get for this from the more experienced nurses (I have 5 yrs CVICU) is that the younger patients have better nerve endings and can feel more. We usually end up giving toradol to our young ones (assuming no renal failure) and this works better than Morphine most of the time.

TennRN2004 · Jul 25, 2006

Hehehe...Same where I am. The reason I always get for this from the more experienced nurses (I have 5 yrs CVICU) is that the younger patients have better nerve endings and can feel more. We usually end up giving toradol to our young ones (assuming no renal failure) and this works better than Morphine most of the time.

Hmm...never thought about the nerve endings before, but it does make sense. I wonder though in a young diabetic if that holds true. You would think even that young if they've had diabetes for 10-15 years as some of ours do they would have some neuropathy and not be so sensitive.

We used to have tordol on our standing orders, but our surgeons voted as a group to have it removed. We have one surgeon who absolutely will not give it period. The others will when asked, I just don't think they think about it unless we bring it up.

SorenDrake · Jul 27, 2006

One of my first post-CVOH pts was only 40, and he was the worst!! He was so anxious and worked up, trying to wean the vent was very difficult. I finally just told him that there was nothing I could do to help anymore, HE had to be the one to do this, so just suck it up and stop it. He got off the vent that afternoon and went to step-down the next day. Boy did he complain about getting up and into that wheelchair though.

The fact that he was one of my first made me worry a bit, but my preceptor just reassured me he was fine, so I happily passed that info on to the pt! He was also one of the first to come back and visit/thank me after being discharged home.

CardioTrans, BSN, RN · Jul 29, 2006

The worst one we have had was an 18 yr old with pregnancy induced dilated cardiomyopathy. Boy was she a handful! :eek:

She absolutely refused to do anything that we asked her, demanded that her mother stay with her, even though we are a closed unit. She didnt get her way on that one. Constantly yelling, throwing tantrums. Basically acting like a 2 yr old. She finally moved out of the unit after we asked the resident to sit in the unit with us and just listen. We had transfer orders within 30 min of him being there, never mind the fact that she had been in the unit for almost 4 days.

She came back to the unit this past Thursday in severe distress, and is now on a vent, sick as crap, from non compliance. Whuddathunkit.

TennRN2004 · Jul 29, 2006

The worst one we have had was an 18 yr old with pregnancy induced dilated cardiomyopathy. Boy was she a handful!
She absolutely refused to do anything that we asked her, demanded that her mother stay with her, even though we are a closed unit. She didnt get her way on that one. Constantly yelling, throwing tantrums. Basically acting like a 2 yr old. She finally moved out of the unit after we asked the resident to sit in the unit with us and just listen. We had transfer orders within 30 min of him being there, never mind the fact that she had been in the unit for almost 4 days.
She came back to the unit this past Thursday in severe distress, and is now on a vent, sick as crap, from non compliance. Whuddathunkit.

I hate these situations. So sad. When you're giving/getting report you label them to each other and say she'll be back in a week b/c her resp status sucks b/c you can't get her to do what she needs to do. The patients just act like your feeding them a load of bull when you tell them what the potential complications are if they don't participate in their care. I've had a few you can "scare" into doing what they should do-usually the threat of the vent can be a motivator if you tell them that's where they're headed if they don't get on board with the plan and do all the things necessary to do well after surgery. I hate using the scare tatic, but I will admit I use it from time to time, sometimes successful, sometimes not.

It is so hard to be patient when they have crappy attitudes and pitch fits. We had a patient a while back who was the same way and demanded I call her husband. The husband freely admitted she walked all over him and always got her way, he was exhausted from trying to please her. I flat told her she was in the ICU, having a family member at the bedside was not a right she had if by having the family member there she would not cooperate with the staff. We had to bargain with her and give her treats like a kid -if you'll do this for us, we'll let you husband come in for an hour. it was ridiculous, but she was one who just wanted to see how far she could push. Once she realized you'd stand firm, she'd eventually shut up.

framps · Aug 8, 2006

20-40 year olds are definitely much more likely to complain after open heart surgery. I have noticed this time and again, although we're doing fewer and fewer younger folks. I was taught, and believe to be true, that younger folks have more bone mass and more nerve endings and thus feel more pain.

They are also scared, terrified, in fact. The 40 year old who undergoes open heart has often never had major surgery before, maybe never been hospitalized before. Now they are completely without any form of control in their life, in pain, terrified, and rely on us to meet their needs. Most 80 year olds have been through some sort of major surgery, have more life experience, will have less pain, and will be fuzzy from anesthesia and pump head. That's my theory anyway.

If you've ever seen someone you knew from outside the hospital become one of these younger scared patients... you realize that these people are not themselves. Some are as much psych patients as they are cardiac during the immediate post-operative period. Very challenging indeed.

steelydanfan · Aug 10, 2006

Consider the source.

Most 18-35 year olds in this day and age have been coddled to think that they are still children.

At 30 years old in this country, you have not yet fully "separated' from your parents.

And you wonder why they cannot actualize?

It is unlikely that a 40 year old in for an open heart has never been hospitalized before. Usually, cardiac pt.s with valvular or structural/inflammatory disease are in and out of the hospital numerous times before surgery is the final option.

Unless he is 450 lbs. in weight, having his first heart attack, and in that case, should not really be surprised that he has major heart disease.

Unless, of course, his parents/friends/ kept telling him that he was not obese, just "big".