I had the night from you know where!

[christvs, DNP, RN, NP]

Oh my God, what a night I had on the 3-11 shift. I had 5 patients, 2 on tele, and wow, did they keep me busy! One poor patient had a D & C a few days ago, and they think she perforated something so all shift long she had horrible abd pain, so I gave her 4 mg IV morphine, but that didn't help one bit, so I saw her doc on the floor so I asked her for something else to give her and also can she write for some tylenol for her headache? So then after I tended to my other 4 pts I checked to see what was ordered, and there was nothing! So I called the doc who was like "Oh yeah! " So I gave her tylenol for her headache and then as for her abd pain , the doc (an intern) said she'd call me back after she consulted with her attending. fine. so then I see them on the floor but was doing something else so when I was done I came out to see what they wrote for her-nothing! HELLO!!! So I called the doc again and she said "Why do I keep forgetting that lady? Oops! " So I gave her SC morphine, which helped....but it was a one time order so when the pain med wore off I called the doc back again and she was leaving for the night so a float intern was taking over, who said she'll call me back. Of course she never did! But then she came up to the floor and wrote an order (although she never told me, I had to look for the order myself)...so I gave the pt IM demerol which really helped. But then the poor thing got nausea! So I saw she had Zofran ordered, but it wasn't in the pyxis, so I call pharm and they said They have to send it up one at a time cuz it's prn and in an IV bag. So the pt had to wait until they brought it up! (I told her about it so she wouldn't think I deserted her). THEN on top of all that, she was running low BPs, so I kept calling the doc to update her on that....so that was just my FIRST pt....I still had 4 others! The second one was no trouble really. The third one was also fine, but the bowel prep I gave her made her throw up JUST as my other pt started to get nausea and I got a phone call & another pt's family member kept looking for me! augh! Anyhow, the 4th pt was non-verbal & from a nursing home. She kept moaning, so I gave her ativan to calm her down, which seemed to work. But she kept curling herself into this tight ball...her head was nearly on her knees! So I kept re-positioning her every time I walked down the hall-I kept putting pillows between her head and the side rails, but she kept moving around back in that horrible tight position again. And she had a PICC in her too, which decided to not flush all of a sudden, and I didn't get good blood return from it-so we put in another IV in her. THEN the 5th pt did not speak English, she only spoke Viatnamese, so her family was not around when she came up to our floor, so we got an interpreter (who came up right when I started giving IV Lopressor on pt. #2! Of course._ Anyhow, the interpreter was very helpful, and I was able to do a full assesement on the pt and get a history on her. THEN the pt's son comes up and he is demanding "Why doesn't she have Oxygen on? why isn't her heart monitor on?" I already had her heart monitor on (he needed glasses!) and she did not need O2! Her sats were 100 % on RA and I asked him to ask her if she was short of breath at all and he did and she said she was fine! Oh my god! that was jsut the beginning of his demands though. Then he started in on "well she needs a blanket. And put a duoderm on her bottom. " Fine, I saw her sore on her bottom so I put it on, but I was getting very annoyed cuz earlier when the interpreter was with me we asked the pt if she wanted a blanket and she said no, the sheet was enough. Now the son decides he knows more! AUGH! Then he says there is blood in her Foley, so I look at it and there was a teenny-tiny amt, but it was mostly concentrated urine cuz she barely drank anything all day. Oh and he said she is having CP (he told me this while I was at the nurses station). So I got her some reglan and maalox-cuz it turned out she didn't have CP after all, just heartburn and some nausea. And I called the night float intern about the blood in the Foley & I think that doc was so new she had no clue what to tell me! She said we could try irrigating it, but the charge nurse didn't think it was necessary cuz there was hardly any blood at all in there! And meanwhile I'm still trying to give PM meds to eveyone else & deal with the abd pain pt....oh my! The amazing thing is that this pt's son was very rude to everyone but me for some reason. He was very polite to me and said thank you, but honestly he was driving me nuts! Talk about stressful! Thanks for letting me vent if you are still reading this far! And I've only been an RN for 4.5 months now!

-Christine

[bethin]

Yep, it sounds like you had one of those nights. It's usually the pts. family or visitors that drive you nuts. You have the degree, not them. I really hate when they answer for a family member who can speak perfectly!:angryfire The other day a family member came up to me. The pt. wanted a sprite. I went into the room and asker her if she wanted ice with it (our ice machine is on one end of the hall with the pantry at the other end). Family member says yes for her. I ignore him and ask the pt. again. When I look at the pt. when I speak means I want an answer from their mouth. Turns out though, the pt. didn't want ice so alot the family member knew!

Why exactly did the residents/interns keep forgetting about that one patient? That poor pt. probably felt that the doctors (not nurses) were deserting her! You did a good job though by not giving up on getting those orders.