gracie65 415 Views
Joined: Oct 20, '15;
Posts: 8 (75% Liked)
; Likes: 24
I don't have any good PCA "jaw drop" stories, but I do have an end-of-life one. Had a pt. who was admitted with respiratory distress and it became apparent shortly thereafter that they wouldn't last much longer. Pt. was now on continuous BiPap wear and their spouse and children had been constantly at the beside for almost 48 hours. The doctor pulled the family outside the room and explained that the end was probably near and since the pt. was still listed as a "full code," did they want to change that option. Without missing a beat, the daughter spoke up and said, "Well, we don't want to do anything to empty Dad's wallet....just keep it on the cheap." Both the doctor and nurse were in stunned silence. Pt. was put on comfort cares with husband by their side. That dauther disappeared and didn't even show up for her Mom's last hours.
We were working an awful holiday weekend. Within 4 hours we had 3 admits, all female, all over 300 pounds, and none of them could walk (medical conditions) and all were on psych meds. The most manic of the three was having a full blown panic attack when we tried to move her from her chair to the bed. She was sweating, crying (then laughing) and shaking in a full blown manic episode when she said, "I've stopped taking all of these psych meds because they're making me crazy!!" We all looked at one another and thought, "This cannot only be Day 1 of a 3-day weekend...."
As a "former" child diabetic (Type I, diagnosed at age 4) and now an RN, I really feel your pain on this one. Syrup or cake frosting were good choices as they can be placed in the cheeks or under the tongue, especially if he wouldn't eat anything. It could have been worse....up until I was 12 or 13 I had violent seizres with low blood glucose during the night. Scared my Mother to death. And when they happened, sometimes she couldn't get any juice/pop down me either. Thank God for Glucagon! I try and emphasize to my co-workers that when a diabetic's blood glucose is THAT low where they are becoming almost nonresponsive and really out of it, that anything liquid or semi-soft (like syrup or frosting) are the best way to go. If they're conscious, I say go with pop or OJ with some sugar stirred in. I STILL hear the adage "give them candy" or like Glutose is in our protocol but totally ineffective (I've tested it myself....4 times. Didn't push my bloos sugar from 48 to above 75 in 15 minutes). We need a revision of how we treat diabetics with severe lows in health care. I'm pretty sure the protocols used in most hospitals today were written over 20 years ago before the onset of rapid-acting insulins AND were not written by anyone who's ever HAD a low blood sugar. Making someone take only 15 carbs, wait another 15 minutes and then hope again it's "normal" is just cruel, especially when sweating, startving and losing your mind. Would we make a pt. with an MI wait an additional 15 minutes for Nitro? Or an aspirin? Sorry, kind of got off track on my soapbox, but yes, you did the right thing, and I'm sure it was VERY scary. Can you imagine trying to jab Glucagon or get IV access for Dextrose in a squirmy toddler? Glad you were able to get enough sugar in to make a difference. Another note: candy bars, anything you have to chew is fine if a low is coming on, but you have to chew the food, swallow it and wait for your body to release the glucose for it to be effective, and when someone is in a blood sugar crisis, time is EVERYTHING and you need something to act quick; either through buccal absorption, or liquid or worse yet, D5 injection or glucagon. And say a prayer for that child's mother, because raising a diabetic child is one of the most difficult things you can do. My Mom went above and beyond to take care of me, make sure I was healthy, worried incessantly about me, and risked her own health in order to do so. My Mom had Type I diabetes for 48 years until a stroke claimed her life last year......
I had minor surgery a year ago, and was offered 1-Norco 5/325 or a Motrin after I woke up from anesthesia for a pain rating of an "8." Seriously? I think with all of the recent concern over opioid overuse and abuse, pain control has become less of a "necessity" and almost like an unwelcome burden to the provider and facility. Our facility can't seem to get it together for a cohesive pain management protocol. We are told to only give pain meds if the patient is experiencing pain, and it had better be above a "6" for any narcotics. However, you can about guess when a surgery block is about ready to wear off, and I like to give my patients "preventitive" pain meds about an hour or two before, but because they're rating their pain at about a "2 or 3", by protocol, I shouldn't be giving anything more than Tylenol, and then BOOM! An hour later they are wincing and telling me their pain is a 6 or above. Just because the nation is in an opioid crisis doesn't mean that post-surgical pain just magically disappeared and that opioids and narcotics aren't proper ways to treat it! There needs to be thoughtful, reasonable discussion about how to treat people's pain without going overboard, but also being realistic. After ortho surgery, and being stuck on a table with saws, files, etc. being used to do your surgery, you're going to hurt like hell without any pain meds. Giving someone oxycontin would be appropriate. If they're STILL needing Oxy 3 weeks post-op, then something is terribly wrong, and THEN needs to be addressed but not post-op. This is one of the most frustrating parts of my job.
Whatever advice you choose to follow, my only advice is document EVERYTHING! Makes copies of all correspondence, note any phone calls made regarding this, the time, date and who you talked to, copies of any email, text or other correspondence, etc. You wouldn't believe the cases won or lost just soley based on paperwork or the lack thereof....
Was this author working at our hospital? Conflicts/stress with our boss has been the primary reason we lost 18 nursing staff last year. Of course none of them said anything about it in the exit interview because the HR person was "besties" with the toxic manager. Nice. So nothing changes. Even after one of those "engagement surveys" which just blasted nursing management, they still don't get it, or don't want to deal with it. The only way I keep my head high is the praise and thanks I get from my patients. Believe me, patients recognize a bad nurse, or one who isn't doing their job. I've also sought counsel from experienced nurses, ones who've been around, who are excellent at their jobs. If they think I'm doing a great job, then that helps my self-esteem. Because of circumstances I can't change jobs just yet, but believe me, I'll be getting off the toxic bus soon enough.....hang in there!
Had a mentally-challenged pt. pull out an IV and then defacate in the bed, so came into room with diarrhea AND blood flowing off of bed onto floor. Had to use Hoyer to lift pt. up, clean and change the bed, clean the floor (housekeeping not available), then use lift to get pt. into shower, then back to bed. We threw all the bedding away. Also had a morbidly obese pt. with definite hygiene issues "brag" about not showering for 12 days. Aide gave a bed bath and folds full of cheesy-fungus. Yak.
In my previous "life" before nursing, I worked for our state's attorney's association. Just a BIG hint to any nurses who are experiencing this. DOCUMENT EVERYTHING!!!!! Copy documents, warnings, notes, etc. of any sort that may help your case. Even document any praise you may get from other sources (volunteer work, patient comments, etc.). Also keep a daily journal of your experiences, even if you had a "good" day and nothing negative happened. This will take you MILES ahead of your defendant if you get that far. Nothing beats good documentation!
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