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clemsongal68 RN

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  1. clemsongal68

    To those that left critical care for this

    I was an ICU nurse for 7 years before I switched to hospice. As much as I loved a fabulous "save," what I seemed to see more frequently was the prolongation of dying...and the horrors it brought. The elderly with multiple comorbidities have very little reserve for recovery to even their baseline. I was very hospice naïve and we didn't see hospice until literally the patient was 24 hours or less from death, often related to a terminal weaning (removing the vent). Had no idea that hospice could help many of these patients manage their symptoms at home and not be caught in the revolving spin of monthly admissions because they were in a crisis. I love, let me repeat LOVE, the support hospice provides the patient and their caregivers. Yes, I'm not titrating drips or managing a vent anymore, but I still use many of my nursing skills. With abnormal lung sounds, I need to determine if the patient is having problems such as atelectasis, chf or pneumonia. I use my assessment skills all the time. We do a TON of education...not only on the dying process but how to manage symptoms. Wound care is pretty frequent, because as the skin is the largest organ, wounds are not unexpected as the body shuts down. Just because a patient goes on hospice doesn't mean that we only deal with morphine and Ativan. Many of their meds are continued as long as they can help with comfort. For example, a cardiac patient would have their cardiac meds continued. Do I still dream of my ICU days...yes! There were some great times! But I feel like I'm making such a bigger difference as a hospice nurse.
  2. clemsongal68

    Navy Corpsmen Caught

    Corpsmen are not nurses! They are enlisted sailors in the Navy. The nurses in the Navy are officers. Corpsmen go to a training program following boot camp. It is very basic and not at all the detail that RN education provides.
  3. clemsongal68

    How could you give up and do NOTHING?

    One of my most memorable patients was Pete*. 85 year old Pete had come from a nursing home with significant abdominal pain and vomiting. After a quick trip through the ED, he got himself a CT of the belly, a NG tube, some IV fluids and some pain and nausea meds. Admitted to the 4th floor, he quickly started going downhill. The ICU nurses at the hospital where I worked served as resources for floor nurses if they thought a patient looked like they were declining...a measure put in place in hopes to avoid a code. His floor nurse had called ICU asking for help, so I headed on up to see Pete. Running into his surgeon in the hallway, we spoke briefly before going in to see Pete. It wasn't good...at all. Now Pete was a tiny thing, probably 90 pounds soaking wet. It was obvious his appetite had waned significantly the last few months as he literally was skin and bones...except for the biggest brown eyes you could imagine. Eyes that mirrored his fatigue, anxiety and pain. So much was out of his control and he appeared a helpless victim in the war of disease. He was on a 100% nonrebreather mask when I first met him. His respirations were labored as he struggled to catch his breath. Yet, he clung to every word the surgeon told him...words such as small bowel obstruction, sepsis, cancer everywhere, poor surgical candidate, probably won't make it off the table. Powerful words. His sister beside him openly wept while receiving the news. Afterwards, the surgeon headed out and told the patient and his sister to let me know what they decided, for they needed to decide soon before it was decided for Pete (via a code). I sat next to Pete and held his hand. I told him that I would support him in whatever he chose. If he wanted to fight, we would take him to surgery and afterwards to ICU if he made it. That we would do everything we could to save him and would try to minimize his distress. Yet, I made sure I explained to him and his sister what "do everything" entails. It's not pretty...and it's not easy. It's certainly not like on TV! He needed to know that it would be an uphill battle, probably for weeks. I covered being on the vent and having multiple lines and tubes. He most likely would have to be restrained at times. The "do everything" was option #1. I also told him about option #2: comfort care. His doctor and I were recommending comfort care because we felt that Pete's body was dying. With the poor odds of him surviving surgery and recovery, we felt like it was more humane to just make him comfortable. Yes, the doctor and I knew it would result in his death, but we also felt that aggressive measures would still result in his death, yet with the addition of much suffering. But, ultimately the choice was up to him and his sister. You see Pete had never married...nor his sister...they had been best friends their whole lives. Pete didn't take long to decide...he revealed that he was so tired of hurting and struggling to live. He said, "I just don't have any more fight in me. I know I'm dying. I'm fine with it. " I updated the surgeon and called his hospitalist. A DNR (do not resuscitate) was signed and hospice consulted. A morphine drip was started with prn Ativan orders for any restlessness. The morphine did wonders. It truly is the drug of choice for air hunger. We were able to change his oxygen mask to nasal cannula for comfort. His respirations settled down, he was able to relax and go to sleep. As the evening passed, Pete's coloring changed: his hands and feet became mottled, reflecting his lowered blood pressure as the sepsis progressed. He started having periods of apnea...5 seconds...then 10 second stretches...yet he slept peacefully on. His sister sat beside him, having said her goodbyes as the morphine was started. By midnight, Pete slipped away, peacefully and in the presence of the one who loved him the most: his sister. Many folks would ask, "How could you give up and do NOTHING?" Yet, there was much we did do: we gave a kind and gentle man rest, a peaceful passing in the presence of someone who loved him dearly. We gave his sister support during his transition and the chance for hospice to follow HER for 14 months after his death. Hospice is not only for the patient, but very importantly for the family, especially that first year after their death. Believe me, it IS something! *Name changed to protect patient