The big picture
Last Saturday and Sunday. This past Wednesday and yesterday. Needless to say I'm pretty worn out. I do get a nice break though, as I'm not back on until next Wednesday. I plan on spending my free time enjoying some good friend time and studying for my HESI next Monday. Yay. Anyway, I had a pretty busy last few days. Last Saturday was an interesting day. My patient had a craniotomy after a fall she had at home. Craniotomy patients (or "cranies" as they're known on the unit) cause an extreme amount of hypersensitivity...to everything! I tried my best to be so super gentle; most of the time I did ok but there were other times in which I couldn't avoid it. She didn't really say much to me until near the end of the day, but she could understand me and answered my questions appropriately...with a nod usually. Anyway, I was giving her her medications when she looked up at me and said "thank you." It was ever so quiet, but it was sincere. They say it's the "little things" that get you through. It really is true.
Sunday was a pretty tough day. My patient had lung cancer and had been in and out of the hospital for a few months with respiratory problems. He was there when I first started my rotation and was discharged a few days later. Well, this week he was back. Since he had been there so many times, a lot of the staff got to know him; it didn't help that he was really nice too. :] There was a pretty big discrepancy on his code status, which caused a lot of confusion among all of us. Then there were issues with his family, and I don't even remember entirely what the problems were. It was a good experience to see that hospital care is really a holistic approach, and if you think about it, there's not one patient but many. You're not only caring for the patient but for their family as well. When I was there yesterday he was being moved to a hospice floor. Me and my preceptor helped get his things ready and we got to talk to him before he left. He was pretty emotional as he said his goodbyes to us. He did remember me though. It's those moments that stick with you, I think. I wish him the best.
Onto Wednesday and yesterday. Since I had the same patient I thought it'd be appropriate to clump them both together. On Wednesday I met my patient for the first time. He was intubated after having a bowel resection. (Throughout the day too I was helping keep tabs on my preceptor's other patient. I got involved in drawing blood for her labs and making sure she didn't go nuts. She was 92. Had a stroke). Anyway, there had been talks about possibly extubating him that day but it just didn't happy. He was pretty sick; he was on two pressors (medications to stabilize your BP). My preceptor taught me a LOT about these medications and the fact that they are a double edged sword. Their purpose is to stabilize BP, yes, however, they shunt blood to the important areas, such as the brain and GI system. However, usually in the extremities is where blood supply is limited. As part of our assessments we have to find pulses in the extremities; well for him it was difficult because his extremities were ice cold. I had to use a doppler to find them; at one point I spent 10 minutes trying to find them on his right foot. But we do what we must. By the end of the day he was off both pressors (you have to gradually wean these medications). When I saw him yesterday he was doing MUCH better, and that morning we extubated him. Well....he also had pneumonia so for a while my preceptor and I were concerned. He did ok until about 4:00 yesterday. Earlier that morning we had given him Lasix to help pull some of the fluid out since he was pretty fluid overloaded. The problem with Lasix is is that you pee....A LOT!!!! Too much diuresing (pulling off the fluid; what Lasix is supposed to do) causes a drop in potassium. Too low or too high potassium irritates the heart. We had gotten him to sleep but I noticed he was throwing a few PVC's on the monitor and was showing sinus tach (HR in the 130's-140's). He was also a tiny man and coughing a lot but not producing anything. So my preceptor called the doctor and another dose of Lasix was given and he did much better after that. Throughout the day we had some interesting conversations. He asked me a lot of questions and his family was also super nice as well. He had an A-line in which caused a lot of questions (I ended up taking it out later....don't worry, I was supervised). The thing with A-lines is that since they're in the artery you have to hold pressure, FIRM pressure on them for at least 10 minutes. The highlight of the day came shortly after he was extubated. Our conversation is as followed:
"How do you feel now that that tube is gone?"
".....it's gone?"
"Yeah. It's out."
*thinks for a minute. Swallows. Thinks again* "Yeah...it sure is."
Again, the little things. But as you can see, I have really enjoyed the last few days as I have really gotten to see the big picture. How things are supposed to do their job but how they affect the rest of the body. I've seen two patients transition from critical to more stable and eventually to transfer on another floor. I've learned so much in the past few days. Next week is my halfway mark! Hoping to get better at time management and starting to gain that confidence!!!!
# days completed: 8
# hours remaining: 144
Sunday was a pretty tough day. My patient had lung cancer and had been in and out of the hospital for a few months with respiratory problems. He was there when I first started my rotation and was discharged a few days later. Well, this week he was back. Since he had been there so many times, a lot of the staff got to know him; it didn't help that he was really nice too. :] There was a pretty big discrepancy on his code status, which caused a lot of confusion among all of us. Then there were issues with his family, and I don't even remember entirely what the problems were. It was a good experience to see that hospital care is really a holistic approach, and if you think about it, there's not one patient but many. You're not only caring for the patient but for their family as well. When I was there yesterday he was being moved to a hospice floor. Me and my preceptor helped get his things ready and we got to talk to him before he left. He was pretty emotional as he said his goodbyes to us. He did remember me though. It's those moments that stick with you, I think. I wish him the best.
Onto Wednesday and yesterday. Since I had the same patient I thought it'd be appropriate to clump them both together. On Wednesday I met my patient for the first time. He was intubated after having a bowel resection. (Throughout the day too I was helping keep tabs on my preceptor's other patient. I got involved in drawing blood for her labs and making sure she didn't go nuts. She was 92. Had a stroke). Anyway, there had been talks about possibly extubating him that day but it just didn't happy. He was pretty sick; he was on two pressors (medications to stabilize your BP). My preceptor taught me a LOT about these medications and the fact that they are a double edged sword. Their purpose is to stabilize BP, yes, however, they shunt blood to the important areas, such as the brain and GI system. However, usually in the extremities is where blood supply is limited. As part of our assessments we have to find pulses in the extremities; well for him it was difficult because his extremities were ice cold. I had to use a doppler to find them; at one point I spent 10 minutes trying to find them on his right foot. But we do what we must. By the end of the day he was off both pressors (you have to gradually wean these medications). When I saw him yesterday he was doing MUCH better, and that morning we extubated him. Well....he also had pneumonia so for a while my preceptor and I were concerned. He did ok until about 4:00 yesterday. Earlier that morning we had given him Lasix to help pull some of the fluid out since he was pretty fluid overloaded. The problem with Lasix is is that you pee....A LOT!!!! Too much diuresing (pulling off the fluid; what Lasix is supposed to do) causes a drop in potassium. Too low or too high potassium irritates the heart. We had gotten him to sleep but I noticed he was throwing a few PVC's on the monitor and was showing sinus tach (HR in the 130's-140's). He was also a tiny man and coughing a lot but not producing anything. So my preceptor called the doctor and another dose of Lasix was given and he did much better after that. Throughout the day we had some interesting conversations. He asked me a lot of questions and his family was also super nice as well. He had an A-line in which caused a lot of questions (I ended up taking it out later....don't worry, I was supervised). The thing with A-lines is that since they're in the artery you have to hold pressure, FIRM pressure on them for at least 10 minutes. The highlight of the day came shortly after he was extubated. Our conversation is as followed:
"How do you feel now that that tube is gone?"
".....it's gone?"
"Yeah. It's out."
*thinks for a minute. Swallows. Thinks again* "Yeah...it sure is."
Again, the little things. But as you can see, I have really enjoyed the last few days as I have really gotten to see the big picture. How things are supposed to do their job but how they affect the rest of the body. I've seen two patients transition from critical to more stable and eventually to transfer on another floor. I've learned so much in the past few days. Next week is my halfway mark! Hoping to get better at time management and starting to gain that confidence!!!!
# days completed: 8
# hours remaining: 144
Comments
Post a Comment
Questions, comments and concerns are always welcome, so long as they are pertinent to the content of the post, aren't rude or offensive. Thank you for reading and being respectful in sharing your thoughts! :)