A little long in the tooth, sorry...
The truth is stranger than fiction. And this week proved that to a point.
I worked an overtime shift last sunday, and it was worth it. It was my most pleasant shift. Then a 12 hour shift on monday which was also pleasant.
Wednesday's evening shift gave me a hint on what was to come.
But it was thursday's shift that really got bizarre. the first 5 hours of my evening 8 hour shift went smoothly.
But then, (insert musical cue here) around 9 pm my tech (who is also a nursing student) tells me one of my pt's has a change in MS. Pt is now confused. (Pt was confused with some periods of lucidity. She had dementia. Tech did not know this.) Go in to assess this patient, and they are agitated, as well as hallucinating. She thinks there are little Green Men running around the unit. (As well as the FBI, and the italian mob) When she said that, it just went downhill from there.
Call non-teaching for a order of Ativan. Walk back into the room, and now the pt is standing beside the bed trying to elope. Well, PA walks in, we both looked at eachother and said it simutaniously, "Sundowning". I call for the tech to watch her, the PA and I go and check the chart, and I then go and get my .5 of ativan IV, (She is now refusing all po meds, thank god for IV access.)
We walk back into the room, it now takes 3 people to hold down this little 80 lb. 90 YO lady. She is now trying to bite us while I am getting the ativan into her. The tech leaves, now it is just the PA and I. The ativan is just not working right now. After about 30 minutes the PA tells me to go and get more Ativan, I agree. Go and get it, I come back and the pt is out like a light. Forget the ativan. Get her into bed. I got to admit, I was laughing as I charted the hallucinations of little green men. No one could keep a straight face about that was.
My other pt, deaf, blind in one eye, can't use right arm, sever dementia, so on and so forth. Send her down to x-ray just before the bizzare episode with my other pt.
She come back at 10, just as we are calming down my demented pt, assess her and get her meds ready, walk in the room, and she has full use of her right hand. I send her down to x-ray with a paralysed right arm, and she comes back with a fully functional right arm. I go and check the charts, and everyone charted paralysed right arm. Daughter even told us her arm was paralysed. Problem was was now that she had use of her arm, she pulled the iv-line out. Is tonight a new moon?
You can't make this stuff up. I have completed week number 12, and it is all just so bizarre. The weirdness factor has definately gone up a couple of notches. And I wouldn't trade any of this in for anyother career.
This is very hard work. I am learning to think fast on my feet and also how to do what is best for the pt. One of my pt's hooked up to a PCA this week was waiting till the pain was unbearable before hitting the button. Now the PCA is not working because of that. Call the MD, and for 10 minutes we discuse what to do. My feeling was that the pt was going to still be in level 10 pain if we increased the pca dosage. (I lived in cronic pain for a number of years, so my pts in pain I sympathize greatly with because I've been there) I finally sugest to the doctor, lets give the pt 2 mg dilaudid now, to get the pain back under control, and if that doesn't work, we will then increase the dosage. It worked. Pt was so greatful.
And hearing those two words, Thank you, has more meaning to me than how my co-workers say I am doing, because it tells me I am doing the right think. I am already starting to have pts who are frequent fliers, as well as long term pts asking for me as their nurse. And MD's have constantly come up to me and tell me from what their pts are saying I am doing a good job.
I guess I am a good nurse. I am just trying to be the best nurse that i can be.
Oct 29, '05
Sounds like you're really enjoying this career. Good for you! Your days sound a lot like mine. Most of the time I enjoy my nights at work. If they can keep staffing at a good number (so that I have no more than 7 patients and the assignments are divided up evenly) I would be happy to stay with this floor. The last week or so has been going well. So well, I am regretting setting up interviews for other floors. We'll see if the staffing stays this way...
Oct 29, '05
Thanks for sharing. The patients are the reason I am here. You met your calling. Welcome!