Labile Stress

31 Mar

This is Stress by Bleedingbird found on deviantART.

I think I felt like this artist above last week, only I was not struggling over calculus homework, although I imagine that is very stressful.

I was on the verge of a Telemetry RN breakdown, one of those tear inducing shifts, where the patients are sick, the emotions are full, and the turnover is fast.

It was just before noon when I realized that the third patient out of my five patients were to be discharged, and since I was discharging so many: I had to have an admission. That is just the way it works, if not I would only have two patients, and that just would not be fair.

I can safely discharge rather quickly, I am used to it, that is what we do: admit, transfer and discharge.

Why was I so emotional this time? I think it had to do with the nature of the patients being discharged. All three had poor social support, all three were being discharged to home. Only one had visiting nurse referrals, and all three had labile blood pressures.

That was me, in the picture above, trying to figure out: how to stagger the medications for the patient going home on: Clonidine, Labetalol, and Hydralazine all together now, all three patients! And these medications are all three times a day. Forget about all the other medications: It is a rare  elderly patient that can administer medications to themselves the way we do it in the hospital. I often wonder if they take their medications at all.  I think about this because I see the revolving door of heart failure and hypertension. The same patients come in again and again, and suddenly get better while in the hospital. It is not a secret that the medical management is a fix, so they get the medicine as prescribed, maybe some extra Lasix, get sent out with the little piece of paper that tells them when to take their medicine, and they sign the paper stating they understand, and sometimes, I know they will be back.

When there is no family around, it bothers me. I am not diminishing the capability of the healthy elderly, but these patients are sick, with chronic sickness that needs looking after.

I guess what bothered me is that, they signed the papers, but I know they did not understand, and I felt helpless. Starting teaching early is not to be underestimated.

I suppose that I can not imagine a person taking Clonidine, Labetalol, and Hydralazine and not checking their blood pressure or pulse.

A family member picked up a discharged patient and seemed shocked when I asked if there was someone to check on the patient, after the patient was home.  I wanted to cry.

Maybe I was overreacting inside, I don’t know. I think it was just that the management of these three particular patients equals a level of  complexity, that from experience, I find it difficult to imagine the patients sticking to the regime.

I find myself saying till I feel blue in the face: Do you have a scale at home? You need to weigh yourself daily and if you gain more than two pounds in one night, you should call your doctor.

So, I felt the surge of stress hormones tearing up my vasculature. And then I got lucky and had a piece of  luscious (with a capital L) cake from my favorite ICU nurse, that released some sort of endorphins and pleased my limbic system greatly. It was a huge piece, I shared it with someone else, but still ate the bigger piece.

I still love my job.


4 Responses to “Labile Stress”

  1. my2ndheartbeat March 31, 2010 at 00:41 #

    “I find myself saying till I feel blue in the face: Do you have a scale at home? You need to weigh yourself daily and if you gain more than two pounds in one night, you should call your doctor.”

    I have an elderly relative with fairly extreme high blood pressure (180/110 continuous) issues. We are constantly asking your above question. And, when the fat ankles return, usually due to non-compliance, the top 3 reponses to that question are …

    1. I didn’t have time! (how long does it take to weigh yourself?)

    2. I didn’t TAKE the time! (OMG)

    3. My weight changes 5 pounds every day. One day I weigh 170, 175 the next, then 170, then 165. (When was the last time you had your eyes checked?)

    Next comes lasix ….. did you take your lasix?

    1) I took one the other day

    2) It makes me pee too much.

    3) I cut one in half, made me sick so I stopped.

    And so it goes …….. as I’m sure you know all too well.

    • seejanenurse March 31, 2010 at 13:06 #

      Yes, that is the insight, and I understand. I imagine that it is difficult, I will never give up hope though that if patients can stick to the plan, hospitalization and the “acute-ness” of heart failure can be managed.


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