worst clinical story please??

lovingtheunloved, ASN, RN · Jun 1, 2007

why do you stay?

Because I'm a sick, twisted person. Just kidding. Sort of. I work in a nursing home that specializes in caring for dementia patients and those with "behavioral issues." I absolutely LOVE my job. Those residents are precious people, and I enjoy finding ways to care for them. They really are a misunderstood population. Like my supervisor said to a new hire, we're all sick people, that's why we can work here.

As for the pain meds issue, what in the patient's history made the MD decide not to order something for pain? Like someone said before, dementia patients feel pain, and it's amazing how their demeanor can change with a little percocet.

ChocoholicRN · Jun 1, 2007

I had several of my worst experiences during my med-surg rotation, but i think there's one that really tops them all. This women had been in and out of the hospital a number of times. I can't remember exactly what she was in for. Anyways, she had the worst case of diarrhea ever, but not just regular diarrhea, it had pieces of carrots and corn and was orange and had the foulest smell ever, worse than c.diff (if possible). And the reason i know so much detail about her poo is because i was the one cleaning it up every 30 mins. People on the other side of the floor could smell it, and i was right there, front and center. But the most difficult part of caring for this patient was that she was refusing EVERYTHING. She refused fingersticks, insulin, medications, tests, labs, etc. And we had the doctor, med student, and myself all explain to her how anti-diarrheal medication works and it would help her diarrhea because she was complaining about it. She understood everything, but still refused to take it. Here's the killer...she wouldn't tell anyone why she was refusing anything, just that its very personal and she doesn't want to tell anyone. I tried, my instructor, the nurses, med students, doctors, everyone tried to understand why she was refusing everything...nothing worked. By the time we went back there next week i found out she had been discharged to some rehab facility. I felt bad that she felt she couldn't tell us why she didn't want treatment. Hopefully wherever she is know she is getting proper care and treatment and is doing well.

tcpmom · Jun 1, 2007

Because I'm a sick, twisted person. Just kidding. Sort of. I work in a nursing home that specializes in caring for dementia patients and those with "behavioral issues." I absolutely LOVE my job. Those residents are precious people, and I enjoy finding ways to care for them. They really are a misunderstood population. Like my supervisor said to a new hire, we're all sick people, that's why we can work here.
As for the pain meds issue, what in the patient's history made the MD decide not to order something for pain? Like someone said before, dementia patients feel pain, and it's amazing how their demeanor can change with a little percocet.

The guy was admited at midnight the night before from a psych hospital. His chart indicated a long history of psych issues so the feeling I got was the md was not very familiar with his case. They did give him tylenol, not much relief from it though.

lovingtheunloved, ASN, RN · Jun 1, 2007

What was his pain related to? Pain control in dementia patients is a huge soap box I tend to get on. I'll try and spare you though. :)

tcpmom · Jun 1, 2007

I had several of my worst experiences during my med-surg rotation, but i think there's one that really tops them all. This women had been in and out of the hospital a number of times. I can't remember exactly what she was in for. Anyways, she had the worst case of diarrhea ever, but not just regular diarrhea, it had pieces of carrots and corn and was orange and had the foulest smell ever, worse than c.diff (if possible). And the reason i know so much detail about her poo is because i was the one cleaning it up every 30 mins. People on the other side of the floor could smell it, and i was right there, front and center. But the most difficult part of caring for this patient was that she was refusing EVERYTHING. She refused fingersticks, insulin, medications, tests, labs, etc. And we had the doctor, med student, and myself all explain to her how anti-diarrheal medication works and it would help her diarrhea because she was complaining about it. She understood everything, but still refused to take it. Here's the killer...she wouldn't tell anyone why she was refusing anything, just that its very personal and she doesn't want to tell anyone. I tried, my instructor, the nurses, med students, doctors, everyone tried to understand why she was refusing everything...nothing worked. By the time we went back there next week i found out she had been discharged to some rehab facility. I felt bad that she felt she couldn't tell us why she didn't want treatment. Hopefully wherever she is know she is getting proper care and treatment and is doing well.

These stories are so helpful! Since being accepted to nursing school I was afraid of my first ass-wipe, and afraid of my first beligerant patient. I'm glad to have them both under my belt. It's just incredible scary when you're so unsure of what you are doing. "...let's see, I think this button will raise the bed so I can feed you your breakfast..." "AAAAAAAAAGGGGGHHHHHHHHHH!!!!!!!, what are you doing??? I'm in pain?!!! Fortunately, he really wasn't aware that I was a student because he didn't really recognize me everytime I came in the room. I think he would have thrown the "you'll never be a good nurse" comments at me!

kbenzrou · Jun 1, 2007

Well one of my worst stories was when I went the day before to pick 2 patients, get their info . I was so excited, I think it was my 3rd clinical ever on a med surg unit.

I went into the room of the second patient, all proud of myself, excited and the patient was there with his wife at his bedside and I told him that I would be taking care of him the next day with a big smile on my face...he looked me up and down and barked at me that he doesn't want some ignorant student use him as an experiment ( I am using nice words) and he didn't want me to do anything to him....I stood there thinking of a polite way to answer him ( I was dying to just say how I really felt but I want to be a nurse so bad,..) and I calmly answered him that I wasn't going to do anything to him, that I was going to be with his nurse under the supervision of my instructor. his wife felt a little bad for me I think as she tried to make conversation.

the next day at the pre-conference, I told my instructor about the incident but she still made me talk to him, give him his shots and his meds and he questioned me every single one and which doctor ordered it and why ..it was the worst day of my life ( I was so nervous giving him his insulin shot that right before I gave him his 68 units of lantus I somehow touched the seringe and lost 3 or 4 units of insulin and I had to tell my instructor, who explained that we will be right back, helped me waste it and draw new one...I was mortified, I cried so hard when I got home that day :-(

tcpmom · Jun 1, 2007

Well one of my worst stories was when I went the day before to pick 2 patients, get their info . I was so excited, I think it was my 3rd clinical ever on a med surg unit.
I went into the room of the second patient, all proud of myself, excited and the patient was there with his wife at his bedside and I told him that I would be taking care of him the next day with a big smile on my face...he looked me up and down and barked at me that he doesn't want some ignorant student use him as an experiment ( I am using nice words) and he didn't want me to do anything to him....I stood there thinking of a polite way to answer him ( I was dying to just say how I really felt but I want to be a nurse so bad,..) and I calmly answered him that I wasn't going to do anything to him, that I was going to be with his nurse under the supervision of my instructor. his wife felt a little bad for me I think as she tried to make conversation.
the next day at the pre-conference, I told my instructor about the incident but she still made me talk to him, give him his shots and his meds and he questioned me every single one and which doctor ordered it and why ..it was the worst day of my life ( I was so nervous giving him his insulin shot that right before I gave him his 68 units of lantus I somehow touched the seringe and lost 3 or 4 units of insulin and I had to tell my instructor, who explained that we will be right back, helped me waste it and draw new one...I was mortified, I cried so hard when I got home that day :-(

Wow! That sounds pretty f*%*ing awful! Please tell me you persevered and you are in a good place now.

P_RN, ADN, RN · Jun 2, 2007

Hmmmm first worst was going into my very first clinical patient's room after report only to find him deceased.

Then there was the lady who had stomach stapling who put herself NPO post op and then drank a couple of quarts of liquid and broke the stapling. Admitted with pain and went rapidly down the tube, Her docs refused to come initially because she had cried wolf many times. She died and her husband wouldn't come until the MPs at the military base arrested him and then he came with his two kids, him drunk as a lord, and stood crying in the hall until security had to come get him. BAD.

Oh then there was my first AIDS patient before they knew what it was, with no IV access and the docs changing the abx every 30 mins, and refusing him any other meds,

And then there was.......hey you guys we're NURSES......we don't have to get hardened ,but this is what we deal with, and we cry and we cry and then we come back the next day because we are what the patient needs. WE CARE.

GeminiTwinRN, BSN · Jun 2, 2007

Well, this isn't a clinical story, but it's a story from a new RN. (YAY!) anyway, I was taking care of a man who was 790 lbs, trached, and barely mobile. He had to "go", and after refusing a bedpan, which would have probably broken under the weight of him anyway, it took 8 nurses and techs to get him up to his bsc which made it impossible for any of us to leave the room due to the shear size of the bsc. While he was sitting on the bsc, his trach came out and he was satting in the 80's. There was no way we could get his trach back in while he was on the bsc, and it took all we had to get him back to bed. He was in distress, and then followed 3 calls to different docs to find one who would come up and put the guy's trach back in. It was a trach none of us RN's were familiar with, being a bovina trach.

Finally, the surgery doc was able to reinsert the trach after many attempts, and several fingers to make sure nothing was broken off in his airway. Talk about a scary 15 mins!! Yikes!!

And then it was up to about six of us to remain in the room after he was calmed from the oxygen deprivation to clean up his bum. Two RN's left to throw up and returned to finish the job. I have never before and hope to never again be in that situation. OMG, it was a scary, horrific experience.

So, yes. It can and will get worse.

:shiver:

tcpmom · Jun 2, 2007

Well, this isn't a clinical story, but it's a story from a new RN. (YAY!) anyway, I was taking care of a man who was 790 lbs, trached, and barely mobile. He had to "go", and after refusing a bedpan, which would have probably broken under the weight of him anyway, it took 8 nurses and techs to get him up to his bsc which made it impossible for any of us to leave the room due to the shear size of the bsc. While he was sitting on the bsc, his trach came out and he was satting in the 80's. There was no way we could get his trach back in while he was on the bsc, and it took all we had to get him back to bed. He was in distress, and then followed 3 calls to different docs to find one who would come up and put the guy's trach back in. It was a trach none of us RN's were familiar with, being a bovina trach.
Finally, the surgery doc was able to reinsert the trach after many attempts, and several fingers to make sure nothing was broken off in his airway. Talk about a scary 15 mins!! Yikes!!
And then it was up to about six of us to remain in the room after he was calmed from the oxygen deprivation to clean up his bum. Two RN's left to throw up and returned to finish the job. I have never before and hope to never again be in that situation. OMG, it was a scary, horrific experience.
So, yes. It can and will get worse.
:shiver:

Um....I think you won...

tcpmom · Jun 2, 2007

Hmmmm first worst was going into my very first clinical patient's room after report only to find him deceased.
And then there was.......hey you guys we're NURSES......we don't have to get hardened ,but this is what we deal with, and we cry and we cry and then we come back the next day because we are what the patient needs. WE CARE.

but do you ever find it really hard to care? or even, worse, do you ever not care? I mean, how do find the inner strength or just plain ole' stamina to clean up someone who is yelling at you? I just wish I could buy an "encouragement pill" . I'm looking for a quick fix to my feelings of inadequacy and fear!

grammyr · Jun 2, 2007

Worst story about clinicals actually happened the day before actual clinicals and no patients were involved. Last semester and it was my turn to team lead. Went to the facility the day before to pick assignments, made the calls to give the other students their patient information. So far so good. spent the night with a friend because I knew I would be up late and didn't want to drive so far home (45 miles). Got all my work done and I was really happy. Went to bed, got up the next morning nervous as a cat and when I got to my car I found it had been broken into and all my books were gone. The only thing that saved me was that I had kept all my paperwork for the day with my in the apartment. I finished the semester by borrowing books and other essentials.