"Always pick the toughest patient"

[twss2323]

This is advice I've read on here time and time again.. And it seems like sound advice, so I go by it. Obviously you'll probably learn more by taking care of a patient with CHF vs one with cellulitis. However, I'm starting to regret this week's choice. We have to write a care plan with the patho, analyze the labs, and all the patient's meds. We have 36 hours to turn it in, and that includes sleeping time. I also have a job and have to work on Thursdays.

This week, I chose the toughest patient. This person's admitting dx were neutropenia and pneumonia. Welllllllll...

The person has metastatic bone and prostate cancer and is receiving radiation for it, which caused his neutropenia. Because of the low WBC count, he acquired C. diff.

He also has CHF with chronic generalized edema. He has 3+ pitting edema in the lower extremities and 1+ generalized. Along with that, because of the CHF and pooling of fluids, he has atelectasis (I may have spelled that wrong but I'm too tired to look it up at the moment) that caused the pneumonia.

Now I have to write the patho of all of that, address all the abnormal labs, and write a care plan addressing all the issues. Yes, picking the toughest patient will cause you to learn A LOT, it's true. However, for the sake of my sanity, I may go with a mediocre patient next time.

This was just a vent, because I'm tired and not going to bed anytime soon because of this, so I needed to get it out, no better place than the lovely internet

[twss2323]

You all have good points... To the person who said you have to have yours done before you leave, there's no way I can do that. With our care plans and all the stuff we have to write up with it, I spend 14+ hours on them and I know classmates do too. I couldn't imagine having to do it before clinical is over...

[JBudd, MSN]

Just think, the next complex one may have similar co-morbidities, and you'll already have most of the leg work done!

[RunBabyRN]

You all have good points... To the person who said you have to have yours done before you leave, there's no way I can do that. With our care plans and all the stuff we have to write up with it, I spend 14+ hours on them and I know classmates do too. I couldn't imagine having to do it before clinical is over...

You get so much more waiting until after you have spent time with the patient, too. You can see the patient more holistically, which is SO important. I couldn't imagine trying to write up a care plan and write up without actually having CARED for the patient. I think those instructors are doing their patients a disservice. Like you said, OP, it takes several hours to write up a good report, and much of what I'm including is stuff I learned once I got to know the patient. You miss out on all of the psychosocial stuff, which is very much interrelated with their diagnoses. I had one that had HIV and cardiac issues and was admitted for a foreign body in.... places. But talking to him, his cardiac issues caused him to lose his job, he got HIV from his wife who cheated on him, and he didn't see anyone but his caregiver. He was so incredibly depressed, and I would never have learned any of this from his chart.

[jewel53]

You actually get to CHOOSE the patient's you care for during clinicals? Boy, am I out of touch! My instructors assigned patients with the assignment posted on the unit by 6pm the night before. Since we had to be on the unit at 7am the next morning, we would spend the entire evening (3 - 5 hours) reviewing the patient's entire medical record, including meds prescribed (including composing cards for each med), treatments, MD notes, nursing notes etc, etc etc. It always amazed me how much the instructor knew about each patient because they always were able to bring up something while quizzing me that I did not see in the record during my review.

[RunBabyRN]

You actually get to CHOOSE the patient's you care for during clinicals? Boy, am I out of touch! My instructors assigned patients with the assignment posted on the unit by 6pm the night before. Since we had to be on the unit at 7am the next morning, we would spend the entire evening (3 - 5 hours) reviewing the patient's entire medical record, including meds prescribed (including composing cards for each med), treatments, MD notes, nursing notes etc, etc etc. It always amazed me how much the instructor knew about each patient because they always were able to bring up something while quizzing me that I did not see in the record during my review.

We had this our first semester, but only then. After that, we were on our own, which was a more realistic method of having to learn about your patient. You can't always dive into the record, which is a shame, because there ARE mistakes sometimes in hand off, and major things get missed. I've corrected my notes based on a record before. If you don't get to do this every semester, like we don't, I suggest doing your best to obtain the record and skim through the history, procedure notes, labs, etc as best you can in between rounds to collect any data you can.

How does it take you 3-5 hours to go through the chart? It has never taken me more than an hour, except for a very complicated patient in ICU, which took 2 hours. Unless you're including the time it takes up afterward to look up your meds and write out cards and such, that just seems like a long time.

[Kuriin, BSN, RN]

Just think, the next complex one may have similar co-morbidities, and you'll already have most of the leg work done!

And this is why I keep all of my nursing care plans because you never know when you may encounter a patient with similar things.

[intothecosmos]

It was very brave of you to pick the hardest. When I went through Pediatrics, we got to chose which patient to do our med rotation on, but it was a floor where the kids don't normally get a lot of medications. We were supposed to pick a baby with IV meds, but there really weren't any choices for that, being RSV season, not many of them needed IV drugs. I could have gone with an easy patient that needed one IV medication, but that really wouldn't be teaching me anything. Instead I went with an older (teenage) CF patient with 2 IV meds and about 15 oral medications. I had to write out reports on each and every one of those meds, including the patho for that patient's disease, but I really learned a lot about CF in the long run and about proper med administration. It helped me, even if I only got about 2 hours of sleep the night before. I always made it my challenge to pick the worst or most complicated patient whenever I had the option. It wasn't going to help me at all to take care of a patient that didn't need actual care. I pity the nurses that opted for the easy ones. They are only doing themselves and the people they eventually have to take care of harm. Keep up the good work.

[CT Pixie, BSN, RN]

We weren't allowed to pick our patients. As well we had about 14 hrs to get patho, labs, care plan etc done. It was due the minute you hit the floor the next day. In those 12 hrs you had to figure in sleep (sure!).

I was always assigned the complex patients. Use to irk me! Some of my clinical classmates had patients that walked, talked, took care of themselves..had very little in the way of needs and were close to being discharged. I on the other hand had the really sick, tough ones with tubes in every orriface and lines going in them everywhere.

In the long run, *I* was the one who was much better off. I learned so much more. I kept busy and wasn't hiding or trying to look busy. I kow is horrid as your going through it but you will learn..I bet you that! As you said, you'll start thinking outside the box and putting things together.