So I come on to work today...and noticed three of my four patients were in serious pain! One was so bad she was hyperventilating and just beggin me so badly to do whatever it would take to just put her out! Of course, none of this was in report...and I know it was certainly noticable!!!
One patient did have a PCA overdose, but they D/C's her PCA and didn't take it out or remove the syringe of Dilaudid. SO the doc thought she had adequate pain control till I saw him and explained that that was D/C'd over two hours before I got there! Her only pain relief for that time with a pancreatits??? 650 tylenol suppository! OH MY!!!!!!!!
The other one, the hyperventilation one was on report as "too anxious, too jumpy". By the time I got there..heck yes, but not for psych reasons....she was more distended than I have ever seen anyone, and her liver was going bad! Her IV actually blew out of its site by pure BP...I watched it!!!!!! It scared the death out of me...and she was so hypertensive and pulse nearing 200 that there was no way we were getting another in...I tried, another nurse tried..a ER nurse tried...all as we waited for the MD and the infusion nurse to show up.
She wound up in the ICU quick, and immediate surgery to deal with the amount of blood seeping into her abdomen! I caught it...but took time to get all in order before anything went forward! Needless to say the family and patient were furious, and not at me after I kept them in communication on what I was doing at all times to help! Man what a mess!!!!!
Then there was one more...admit came in at 0400, it was 0800 by the time I got to her and she had NO orders no nothing...because the other nurse didn't do anything or even assess the patient!!! I was playing catch up for three very ill and painful patients in total utter fast mode to the point I wanted to cry!
Oh yeah did I mention..one nurse short, no cna's!
If that nurse before me had done a good job, not only would I had been aware of this...but I may not have gotten all those pts in one assignment, but in good fashion between nurses! I know I did my best...but that was more than I should have ever had to deal with or be assigned! The nurse before me should have assessed and implemented things and at least gotten that full admit something written for me to know what was going on!
By the end of the day..which happened fast, I had two in the ICU only because the nurse before me didn't catch the probelms that occured on her shift, or told me what was going on...or my charge nurse!
A good report and assessment not only helps the PATIENT, but the nurse that comes after you......
Sorry for the vent here really, but wow...this was absolutely avoidable...and a good reminder of what can happen when you leave too much for the next nurse....
Specializes in Medical Telemetry, LTC,AlF, Skilled care.
Can you imagine admitting a pt and never doing an assessment or getting orders for them???? That is pure maddness! The poor pain management is all too common which is very sad. I'd like to think that if I was in the hospital for pancreatitis I'd have something more than tylenol to help with the pain
i don't know what to make of these sitiuations . is it a case of the previous nurse being too busy too lazy or what?
i've had admissions or transfers where the patients literally coded within an hour of me receiving them and i had been given no clue that they were that sick. the report given seems very routine and then the pt. comes up a train wreck and going downhill fast. and calling the supvr. did not help. i'm no longer in the hospital setting thank goodness. i sympathize what with all of you have to go through...
The previous nurse was indeed written up, and we had the Nursing Management Staff come up to interview me about how my day had gone. I was so exausted I was getting dizzy...so they got some additional help for me (Thank GOD!) and by end of shift things were a little more saine!
In all of this...I got all that admit paperwork done, got two people transfered to ICU, took care of my patients ADL's and got one bed made at least, took vs, charted, and got their pain issues under control, and did a transfer in the last 15 minutes of my shift and wrote down a report for the next nurse.
Wow...I am still tired! LOL (actually I started getting a sore throat after this...I am home ill now. I was proably getting sick, but yesterday stressed me too much and I finally got it full blown! UHGGGGGGG!!!!!! I hate sore throats and not being able to swallow without pain..grrrrrrr!). But don't ya worry...taking it easy with lots of warm fluids and rest! :) Should be better in no time!
Triage - and we all know how stress affects our immune system!
I've had things like that happen to me a few times, altho not to the extent that you did. Pain control is a biggie with me - and it infuriates me when I hear someone trying to rationalize NOT doing it.
The dumbest one was at the last LTC - I came in at 10 on a Saturday nite - we'd gotten a new patient that morning - she had GANGRENOUS toes - right about the time I walked into the med room, a CNA came in to report that the resident was having a LOT of pain, so I asked the off-going nurse about what she had ordered. Not a thing! She told me that the plan was to call the doctors office on MONDAY morning and get further orders!:angryfire
I don't think so - I called the doc at home - told him that his patient was having a lot of pain in those toes, and that he hadn't left any pain med orders. So he gave them to me. It was an oversight on his part, but that gal was going to let her suffer for two days, rather than 'bother' the doctor!!
This other nurse didn't have a lot of experience, but I knew how awfully painful that could be. Not bother the doc, HAH!!
I don't know whether it is because my own mom had been in the hospital, experiencing great pain at times, but I do find that because of her situation, I am a lot more sensitive to the silent suffers....just because a patient doesn't complain of pain, doesn't make it not meant to be. There are some patients that are afraid to speak up and be labeled a trouble maker, even though their complaints are extremely valid.
Triage, thank you for being the nurse you are...you are an inspiration to all of us that are embarking on this nursing journey.
I'm in no way trying to bash on night shift here, but a pet peeve of mine is when our night shift nurses (few and far between, the ones who do this) go through 12 hours without ever turning the lights on. Everyone looks pink in the dark, folks!
I took report recently from a nurse who told me that the baby's IV was "a little red, but you'll probably be able to see it better in the day. His hand is taped like *this*" (indicating by a hand motion that it was taped at a 90 degree angle to his wrist.) When I assessed him 15 minutes later, with the lights turned on, half his forearm was a giant red balloon, skin starting to peel off. And his wrist was taped flat ... it just looked bent because of how bad the infiltration was. A week later, and he still has a hard, red bump under the skin at that site.
I have to echo the OP wholeheartedly. Please, for the sake of the kiddos (or the oldens, whoever's under your care) ASSESS!
PLEASE people offer and in fact,, just give pain meds through the night. It takes to long for these folks to get control in the morning so its almost midday before we can even do anything with them.
And please give them the pain meds....with food so they don't spend all morning throwing up.
It's also nice to poke around under the covers to look for a JP drain that isn't there. "The doctor took that out yesterday" What??? How was an assessment done without noticing that. It's always nice to FIND a drain, port-a-cath, defibrillator, ostomy that wasn't mentioned in report. Sorta like hide and seek
It's also nice to poke around under the covers to look for a JP drain that isn't there. "The doctor took that out yesterday" What??? How was an assessment done without noticing that. It's always nice to FIND a drain, port-a-cath, defibrillator, ostomy that wasn't mentioned in report. Sorta like hide and seek
Yeah, I do wish the Med-surg nurses would get some inservice on what to do with a post-cardiac cath that's been turfed to their unit. Most don't, and most think they won't need it, but they do.
Check those groins, people, because you might see a nice lil bandaid, or a pressure dressing that should've been removed yesterday, or a raging hematoma that needs immediate attention.
.thumb.jpg.6eeb2c01c27cfd151d706238b7f6d6b7.jpg){kind=small}
nursesaideBen
250 Posts
Can you imagine admitting a pt and never doing an assessment or getting orders for them???? That is pure maddness! The poor pain management is all too common which is very sad. I'd like to think that if I was in the hospital for pancreatitis I'd have something more than tylenol to help with the pain