Wednesday, October 5, 2011

Trying to keep a balance

I've been working on my own since the beginning of September and while I still face MANY challenges, I find that it's becoming slightly easier to maintain a balance at work. I find writing my time line out helps a bit - what throws me is when ppl do things that they shouldn't, or I find things on assessment and I seriously have to think on my feet....

Like last night... I had a pt who had a PICC line in the left AC area who was c/o double/triple vision and said that he/she was becoming blind. The MRP knew about this and JUST at shift change had ordered a stat CT scan, a 500cc bolus of NS IV (over 1 hr), 25mg Maxeran, and 25mg of benadryl the latter first and they are to run concurrently with the bolus. The nurse giving me shift report hung the bolus for me and the benadryl - but the PICC (large) port was blocked and we had to use the small port but couldn't run the bolus that fast and so we had to run the bolus over 2hrs but also lower the bolus when hanging the other meds concurrently or the pump would beep - fastest we could run both meds was a TOTAL of 230cc/hr. Ok, no prob right?!

The benadryl went through and I hung the maxeran (which was supposed to help with the headache that was being complained of)... and I explained that we were giving medications to help with the complaints and that we were going to run some tests to see if anything was going on with the brain that would explain what was going on.

But little do I know that this explanation doesn't mean jack sh*t with this pt because while I'm assisting a fellow nurse in another room trying to take blood (I even had the tourniquet in place and the butterfly in my hand) - I get paged STAT to my pt's room for assistance... to find out that my patient had PULLED OUT THE PICC!!!


Another fellow nurse was thankfully in that room and had put pressure on the AC area, and the PICC on the other side of bed. I grabbed the PICC line but couldn't determine whether the PICC tip was intact as they surgeon MAY have cut it to make it fit in place. So I go in search of a ruler to measure the PICC line... and cross reference it to what it says it SHOULD measure. Thankfully they DO measure up the same. I get a hold of the MRP and let her know what's happened and that the bolus couldn't go in - and instead of dealing with the situation herself says that she'll have the on-call medicine physician come and assess the patient. The on-call medicine physician says that she's not going to come and assess the patient until it's her time (another hour away).

When she eventually gets around to coming and seeing my patient, she simply talks to her and changes her meds to TRY to placate her... but it worked!

Ya I was wiped to say the least

1 comment:

  1. WOW!! Thats never ever happened to me {thank god}! But it seems like you did great :)