Saturday, July 5, 2014

Dinner and quite a shift!

Dinner with pre-teen was good. When I talked to him about why he didn't want to see me - it wasn't about me at all. He didn't want to have to see hubby's family. When I asked him about what he has against my husband he said "nothing" - so I don't quite understand why he wouldn't call me and ask to go for dinner. I'm mystefied! He certainly knows how to hurt my feelings tho.

My last shift was quite an interesting one when I arrived.

I got report about my guy who got his G-tube FINALLY.... unfortunately he was bleeding quite a bit when he was returned to our unit. The receiving nurse called the MRP and she came to check him out and then together they changed the dressing over the tube.

So when I come onto shift and get report, we pulled back the covers and she shows me the abd pad over top and it's quite saturated with blood.... which was quite alarming since only 3 hours previously was it changed.

So I finished report and then phoned the MRP to inform her that just from looking at the abd pad you could tell that he was still actively bleeding.... got some stat orders and away I went.

I figured that since he is now on MY shift, that I would check out the bleeding myself so I took off the abd pad to find that there were 5-6 HEAVILY saturated 4X4 guaze underneath - oh well THAT changed things BIG TIME for me... I called the MRP back and changed things, explaining that it was actively bleeding, had saturated the 6 guazes and the abd pad and that she needed to come assess it herself. In the meantime I was told to put direct heavy pressure over the site for TWENTY MINUTES!!!!!!!!!!!!!

After 5 minutes my hand was killing me. Now for those of you who don't know - a G-tube goes into the body just below the sternum (middle of your chest - it's the bone that connects the two sides of your rib bones - it's the thing we press on when we're doing compression - tho not really the point of this story so moving right along) - and of course when I pushed down he yelped in pain. At least he was restrained cuz i'm pretty darn sure he would have decked me! I told him sorry but that he was bleeding and I was trying to help him!

While holding pressure the doc calls back and so in comes a nurse asking me to come answer the phone - told her no and that I was told to put pressure on this and that the charge nurse (who knew what was going on anyways) could answer.... so off goes the nurse to just return and question me on how the bleeding is "is it oozing or squirting".... ok.... "it's more than oozing but less than squirting" - so then the MRP gets the support doc (ICU doc who sees ppl who are doing poorly or need to be assessed ASAP) and so of course I have to stop the pressure. He pulls off the 4X4 and it was still bleeding, so he's mopping it up with another 4x4 - probably trying to determine where the bleeding was coming from and whether this guy was going to start clotting at any point. (come to find out he JUST finished his fellowship on MONDAY!!!!! hahahhaa - poor guy, putting him through this already!).

So the doc - in some "brilliant" move, simply moves the plastic phalange against the pt's skin and waits a minute.... well it doesn't keep bleeding so he says "ok, the bleeding has stopped".... YA NO

I questioned him "you sure about that one"

"well, he might not be bleeding on the outside, but maybe internally" Oh, you don't say!

"what issues are we going to have with that one?"

"well he should create a clot so long as his tube isn't manipulated in any sense and it's better for it to be internally because then his body can absorb it as this thing heals" - ok, at least that makes sense!

So we literally left it there, put a couple of drain 4x4 guazes around it and taped the g tube so that it couldn't move, and away we went.

His hemoglobin dropped from 131 to 117 in 7 hours which is pretty steep but we don't transfuse in our hospital until you're below 80 so he's far off in terms of that. He'll certainly live!

This sort of thing we don't see very often at all (uber rare) - but go figure it had to be MY patient!

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