Friday, September 30, 2016

Working hard

I started back at work. Yaaaay! Only 7 mos away! Geeze it took a long time.

My first day back I worked alongside a co worker => ended up with a migraine half way through! Thankfully my migraine med worked and I didn't have to leave work because I needed to take morphine to relieve the pain.

My next shift I was kicked to fend for myself. And WOW what a shift!

At first it flowed well. I had a flow down. Plus there were some nursing students that were paired with ME who I could delegate some tasks to. Too bad they were only there until noon. ARG all by myself. Goodness I thought I was falling out of the nest and having to learn to fly while falling 50 ft to the ground. I felt inept for sure.

Then of course the shit hit the fan after one of my patients (who got thrown on me because a nurse called in sick! - go figure) had physicians coming out of the wood work, popping up and saying that all these stat things needed to occur.

A little back story: my patient ended up at our house because my patient was found by family with what was thought coffee ground emesis and so EMS brought her to MY hospital. Oh ya, and her GCS was 7. But for who knows what they were thinking, did not think stroke considering all signs pointed to stroke.... who knows why though. Since our sister hospital is the regional stroke hospital she should have gone there and not ended up under my watchful eye.

So when I had this patient I was definately thinking stroke - pt was COMPLETELY obtunded with a GCS of 4 - she only responded to pain and certainly couldn't obey commands. She was posturing. Every sign pointed to stroke. But she hadn't been diagnosed with having had a stroke.

The head CT that they did didn't show a stroke - a bleed anyways, which would have shown up on the head CT but if it was a thrombotic stroke, it sometimes takes up to 24 hours to show up.

Back to my story...
So GI came to the unit to see the patient, did quick questioning to the daughter who was there and of me and what I have observed while caring for her. So he decided almost immediately and said "ok, I'm going to take her to scope her in ten minutes if that's alright with you" - the daughter of course said yes... then not TWO minutes later did a porter come in the room saying that she was picking her up. I was completely shocked and thought that she was going to surgery. And when I made a comment in regards to that the porter indicated that she was taking her to CT.... which perplexed me because I hadn't heard this in report and hadn't seen a physician so I had no idea what was going on.

Of course I helped transfer her onto the stretcher then asked the porter to wait at the nursing station while I figured out where exactly she was to go to first. I headed straight to the charge nurse to find out what they knew about this all. Well turns out some physician had decided to order a stat head CT - but this patient also needed to have things figured out and needed to be scoped because she had certainly bled out of her mouth and I had provided extensive mouth care and didn't see a cut to the mouth to account for how it looked. But she also really needed this head CT. So it was decided that she would go to be scoped first then to CT and back to us.

Before the patient got back the neurologist showed up and questioned me about the patient. I indicated that I was a neurology nurse for five years and thought that she had suffered a stroke. But told him that it would be good for him to lay eyes on her himself and asked that I contact him. I asked if there was a way to get a hold of him in particular and he actually gave me his pager number. Surprising considering most physicians say to just call locating and contact him that way. Of course he's gone like 5 minutes and the patient returns. So away I went and paged him and he came so quickly!

Once he laid eyes eyes on her, he completely agreed and even said that he thought that it was possibly be a brain stem infarct because of the posturing - the oddity being the fact that her legs looked like this:

The patient had the first position, which is supposedly a indication of brainstem infarct. So he wanted a stat MRI because the head CT didn't show anything.

Of course while this is all going on I'm having to discharge one patient, deal with another patient who had massive wound issues and the wound care nurse needed me to go with her to do it. Plus another pt that I had to manage - who needed bladder scans q4hrs which of course meant doing In&Outs 3 times in my shift. Not included this is the regular duties - meds, bathing, etc...

So when this all went down I was up the crick without a paddle. Thank goodness for my buddy who offered to take a few things off my shoulders so that I could take a break and decompress a bit.

Crazy thing about all this..... MRI did NOT show an infarct anywhere in her brain, or brainstem for that matter. So nothing to account for her neurological status and clinical symptoms. But where I stand - I know that I did all I coud to keep her alive and well. Who knows if it stays that way, I hope it does, I know that it would destroy her family if that changes.

1 comment:

  1. My goodness that sounds like an absolutely crazy day, but you survived it! Keep on going strong and I hope your migraines remain under control. Blessings, BedpanAlley