Archive | October, 2008

The Kidney

30 Oct

I am back again studying the Renal System. It is just so complicated to me I have to just keep going back again and again. I get absorbed into it and it is a strange place to be. Ahhhhhhhh! there has to be a better way to get my mind around this.

Stage IV pressure ulcers

27 Oct

Bed sores or pressure ulcers are really bad. Since I do not have patients for that long of a time it is always hard to imagine how this process happens. Whenever I see a Stage IV ulcer on the sacral area I am always shocked. It is like you can actually see meat and bone. When you add continuous seepage of diarrhea to that it is just awful! The Wound V.A.C. system is really cool and seems to work well. The link has a video of how to apply the Wound Vac system/dressing to a wound.  Rectal tubes are great! Anyway they work to keep the stool off of the skin and out of the deep cavity of the that Stage IV wound and off of the wound VAC dressing.

I know how these wounds develop, it is just really sad. That is why it is just so important that these patients are turned! Prevention is the most important measure to take a stand against this. I mean it is just mind boggling to turn a patient over to inspect their skin and back and you find a huge gaping hole in their back with meat and bone exposed! Red tissue! Muscles and bones! Here is a picture of a pressure ulcer taken
an attorney website here.  They represent those patients where nursing neglect or abuse has been alleged. Pt who can not move themselves must be placed on a special bed and turned at least every two hours. Nutrition has to be optimized.  It can be hard on a busy floor to manage this, but it has to be done.

End of Life Issues

21 Oct

I am not sure what is going on lately but it seems that I have been having “more than usual” for my experiences so far of end of life issues. (If that makes any sense)~

I have LOTS of questions and few opinions already. In the not so distant past I have s few experiences of elderly patients that are curled up in the fetal position, contracted. It is not even possible to move their limbs. I wonder how they get like that? They are not eating, not communicating and appear to be in no pain or distress and yet their kidneys are failing, or some other acute or chronic illness is ravaging the body for them to be in the hospital right?

Or what about nutrional status? One nurse while giving report said about one of the above stated patients, “We are just startving the patient? How cruel!”  Well is there something wrong with me that I feel that it is cruel to stick an NGT (nasogastric tube) into a person who ultimately will need a PEG tube that the family already stated they do not want to do. What is the point of putting in an NGT into a patient that does not wake up and put them at a risk of aspirating? Do they feel hungry while they are in the natural process of dying? What is the natural process of death?

The answers sometimes come to late. I had a patient once with severe chronic congestive heart failure as well as pulmonary failure. The patient had an advance directive with DNR wishes. On the 3rd day of the patients hospital stay it was clear that the patient was near the end with no gas exchange as revealed by the arterial blood gas analysis. What was to happen? The patient needed to be intubated to sustain life, but that was clearly against the patient and family wishes. Hospice was finally arranged, although late in the day and the patient died on the stretcher in route to the hospice care center.

Another patient that I had recently encountered was actually at a nursing home that provided hospice care, the patient had clear “Do not send to the hospital orders.” On the medical record. Someone from the nursing home had the brilliant idea of calling the family when the patient started to breath “heavy and funny” “not breathing right” or something of that nature, and asked the family, “Would you like us to send your Mom to the hospital?”  My opinion is this: The family already went through this!Why are you asking the family that and confusing them?  What happens? The patient is sent to the hospital and gets, 6 consulting MD specialists, antibiotics, poked with needles, tubes everywhere. The patient is not conscious, has not been for months! Then the family looks at the nurse appalled: ” we did not really want to put Mom through this.” Of course not, and I understand that none of this would of happened if the nursing home would of never called asking in that “way”.

i mean when is enough enough? Clearly that is not up to me, but I do have my opnions and I do not think that I am cruel. Sometimes I think it is cruel what we do!

Analogy

17 Oct

It is weird saying good bye to a patient that has been on the floor for nearly three weeks, I felt sad the day that the escort came to take him to hospice. I know it was the best plan for him though after all the torture we seemed to put him through. This video found on you tube reminded me of that patient and the few others that I have seen go to hospice. The video is by Pallimed.

High Expectations

15 Oct

So the last few weeks have mostly gone by at work without any major crises in my assignments. Luckily. I haven’t cried and I feel reasuresd by some of the supportive comments, especially the last post. I think the major stressor is that the expectations are so high for nurses and it seems that more and more responsibility is added almost daily.  It is all about the “service” ~ I think that leadership is so important and I have seen a real lack of leadership and a lack of professionalism in my immediate surroundings and that is sort of depressing me, but I am getting through it and learning alot still. I am not in a rush to make any dramatic changes until I figure out where I want to be. So for now I will just take each shift as a learning experience.

Bad days

6 Oct

how many more bad days at work will I have before
I just give up and quit.

I am not sure if it is the same everywhere because I have never been anywhere else!

Tachycardias

5 Oct

It puzzles me when attending physicians are consulting cardiologists “stat” regarding sinus tachycardias before trying to figure out what is causing the tachycardia to begin with. I will admit that I blame myself too, after the fact I am always thinking…why did I not think of that earlier?! It has happened to me twice so far, both times the patients had heart rates in the 150s that was sustained, one responded to the stat beta blocker given and the other who was given stat calcium channel blocker did not respond. Either way the patients both were severely anemic with low hemoglobins (sudden drops) and one had an acute pulmonary embolism. It is like I need to beat it into my brain..”Why is the patient having Sinus tachycardia?” It is like the first thing I want to do is get the rate down and barely have a minute to think about what in the world is causing the problem.

My job is just stressing me out! It is not easy getting what I need for my patients everyshift. It should be though. It should be easier to get what the patients need, these are peoples lives. I do not want to get burned out this fast.  I still like my job, I am just not sure I am going to stay exactly where I am right now.