I had a bad day!

[lil-hosp.usa]

Came onto a 7a to 7p shift and had just come out of report. My report had told me that I had on pt with alzheimers,up abliband had many repeated questions about everything from plueritic chest pain to the wash clothes for teeth( don't ask). Another pt was to be going home later from a resolved sbo, 3rd pt was having some vagal prblems when getting up to the commode had 2 episodes before I came on where went out and they had to put in trelendburg position. Pt 4 came in with A-fib with RVR and was going to be needing a cardiazem drip. heart rate was running in the 160 - 170s, 5th patient was in ketoacidosis and was on an insulin drip, 6thpt was very frail and recovering from ARF and pneu.

So when I get out to the fl;oor I get my strips from Telementry and go to my med cart when I'm called down to the pt with vagal symptoms. is non responsive mottled up to waist hands and arms are cyanotic. Pupils are non reactive but is breathing on own at 30 per minute. Unable to get a BP can't feel any radial or brachial pulse. Here apically 130 BPM and feel a femoral at 50 to 60. *** is going on! Call my charge nurse in and I already have in telendburg postion and am getting ready to open his fluids wide open. NRB mask at 15 liters is also place, can't get a pulse ox because is so cold. not even one of those ear adaptors work. Telemetry placed and shows the 130 BPM I got apically but unable to to get a blood pressure. My doctor gets there and orders cardiac enzymes, ekg AbGs and cbc and bmp. I get Dopamine up, and have an order for 2 antibiotics give those pt still does not come around although he does moan to a family member a half hour after dope up, but that was it. Pt skin cont to be mottled and cold adter an hour, bear hugger applied, WBC comes back and is 103,000 ABGs show a ph of 6.9 and I give sodium bicarb family are there it has now been about 3 hours and I haven't seen my other pts my charge nurse took their care over for the mean time. Pt family decide DNR and pt expires 3 1/2 hours after begin of my shift Take care of those arrangements then find out pt with diabetis wants to sign out AMA go down to chat and pt has IV pulled out and coat on am able to talk in to staying for one more dos of ATB unable to start IV charge nurse does get that going and MY7th pt in hospice expires. Two calls to ISOPO in less than 5 hours-not a good day! Then pt who wants to leave is yelling profanity out into the hall while on the phone and I go in in and tell him to keep it down and he tells me he wants to leave Call the doctor and I leet him sign out AMA Stupid people suck!! only been there 24 hours. At about 1 pm things slow down abit able to get charting caught up. Other nurse at this time has 8 pts I have 3. She asks if I feel guilty ---hell no!! was my comment. We call 3pm and later the witching hour because that's when we get alot of our admits from the clinics. In all we lost 4ptsand gained 5 back. One new pt had a hgb of 6.4 and received 2 ubits also on my shift.. ,,, I'm glad those days don't come around very often I'm beat!!!!!!!!!!! :eek:

[mom2michael, MSN, RN, NP]

Your story made me tired just reading.......:roll

Thank goodness this only happens to you once a blue moon or I would have to suggest running and running fast from there.

Take care - enjoy your day today and I'll cross my fingers that you won't have another day such as this one for awhile.

[luckylucyrn]

Wow at my hospital patients with that acuity level (insulin drip, dopamine) would not be on a unit with a nurse to patient ratio of 1:6! Those are ICU patients for us. The cardizem drip can go to stepdown where I work but only if VSS and on a set rate. I wouldn't want to have that kind of assignment!

[lil-hosp.usa]

we are a 25 bed facility without a ICU- we don't do OBs any longer--no surgeon close enough for emergency C-sect. We hang dope and cardiazem insulin heparin nitro to name a few. We have critical pts quite often but we also have the best doctors and great aides that help with ADLs. We can call our doctors any time if we feel the pt is going to dump on us and he will be over within minutes and we usually transfer to a bigger hosp. What's the saying improvise, adapt, overcome!!!