Thursday, February 25, 2010

Nursing Stuff

Today Bookworm woke up about 5:30. With a stomach bug...

About her 4th trip to the bathroom, she pointed out to me that "IT'S HURTING WORSE EVERY TIME!!!" I kind of got the idea that she felt like I could fix it. Especially when she was lying on the bathroom floor, curled in the fetal position, shaking, pale, and moaning...

Do you remember that when you were a kid? I can remember thinking that surely my mom should be able to do SOMETHING for this malady...Other than walk around spraying Lysol continuously....I gotta confess: That was exactly what I was doing, because I was showering in the hall bath when she first woke up, so her first visit was to my bathroom. Then, she came to tell me she was sick in HER bathroom, then had another episode. So, I was disinfecting my bathroom, and I ordered her to stay put unless it was to go her bed, directly to her bed, do not cross go, do not touch anything, and do not share your cooties with anyone else!

Aren't you glad your mom isn't a nurse?

Speaking of nursing, Studmuffin and I tag teamed staying home with the sickling today. He took the morning shift, then I came home about one o'clock for him to get some stuff done at work. Since I work in a procedural area, we tend to stack our mornings heavy, so if I'm going to miss part of the day, afternoons are lightest. At least, that's what we shoot for. Otherwise, we may be there late recovering patients from sedation...

Anyway, I had a frequent flyer patient today. I'll call her Miss X. Miss X comes to us AT LEAST once a month. She originally came for us to repair her dialysis fistula...There are people who have dialysis grafts that work for years and years. Then, you have the Miss X's of the world who have endless problems with them. Then, she got a kidney transplant, and we saw her to do a follow up biopsy of her transplanted kidney. Then it got an abscess. Then she had some liver failure...I keep telling her we don't give advantage miles, but she continues to come.

She is a sweet lady. She is single, but has a boyfriend who takes care of her. I've never seen any other family with her...

Today she needed some fluid drained from around her lungs, and she had a "collection of fluid surrounding her spleen" that we needed to use our CT to guide the doctor in placing the tube for drainage...

I had just finished my previous procedure (did I mention we were down 2 nurses today?) and returned him to the holding area, when my coworker handed me Miss X. She gave me a brief report, and we were off. She looked bad. Really bad....I got that weird, "this is not going to go well" feeling in my stomach that I've learned to never ignore.

I took her in, placed her on our table, hooked her up to the monitor...

Whoa! Her oxygen was only 84%. No problem, I'll bump her up...

And, alrighty, I will bump her up some more...

Okay. Her heart rate is increasing. She is now sitting at about 140. She started out around 115...

Let's try a mask. The doctor is on the phone, discussing his next case with the attending for that patient...I interrupted and voiced my concerns for her. I want him to drain her lung before we attempt the spleen, which is exact opposite of our plan. He wants to tap that fluid around her spleen, then have the PA take care of that lung. If there is fluid around her lung, that is inhibiting her breathing. I can hear her rattling from across the room....

I have the radiology tech help me put her back on the stretcher, as Miss X is now telling me the only way she can breathe is sitting up in a tripod position (leaning forward, weight on elbows) and feet dangling. She has so much fluid overload that even her feet up on the bed are placing an excess burden of fluid around her lungs...We sit her accordingly...

I have now moved her to what we call a nonrebreather. This is the maximum amount of oxygen I can give a patient, barring a c-pap, or bipap, or worse, a ventilator all of which involve machines to help push her lungs open. Her heart rate remains elevated. I see that she has received some lasix in her IV this morning, and I can tell by her catheter that she is pouring urine out. Good sign for this fluid I can hear her trying to breathe around, but not working quickly enough...

We had to cancel our procedure. I gotta say, I breathed a hallelujah. I have a relationship with Miss X. She and I had prayed when she first started spiraling down. She told me, "Thank you for praying, Andi. I know God is in control of all things."

Wow.

My eyes are tearing, just as they were as I frantically called her doctor, EKG, respiratory, bed assignments to request an ICU bed for her, and nagged my doctor to do something...

The peace her statement invokes. I know God is in control. I know He orchestrated who would be with her, and who would be in that room with me. I know He was in the room....Thank God I have such a great team, who is willing to jump in and help when they see a need. Everyone was there and ready to take action.

I eventually got orders to transfer her to the unit. I haggled with the doctor, because there were no immediate ICU beds (the ICUs have to keep one bed open for codes), and I needed orders NOW...

There is nothing worse than feeling like you are doing NOTHING when you see your patient declining, and you need to feel like you are doing SOMETHING...

Dr. T said, "Get her to the unit, that is your order."

So, I told her I was ordering an EKG...

Dr. F, her pulmonologist said, "get her to the unit, that is your order."

I nagged and eventually got an order for a stat chest xray and blood gases...

Dr. S told me "She needs the ICU. Then her doctors will write orders."

One doctor gave an order for more lasix to pull off some of the massive amount of fluids that were filling in her lungs...

I did get her to the unit.

Alive.

I gotta say, I was worried that was NOT going to be the situation for a while. I was begging for lopressor, a medication that decreases heart rate and blood pressure. At one point her pressure was 250/120...

I asked for adenosine...

Adenosine is this really cool drug that has a nano-second half life. You have to give it super fast, or it won't work...It stops the heart for just a second, and then the heart restarts. Since the half-life is so fast, it's literally just a little pause...And then, the hope is, the patient's new rhythm will be normal...

I didn't really expect them to give me the adenosine because it would not have treated her particular cause for the rapid heart rate...

You know I have dime store diagnosis, right? I think she was going septic. She had a nonexistent white blood count. She had a fever of 102. With the anti-rejection drugs she takes for her kidneys, I think her body was unable to fight off whatever was attacking her...

Here's the cycle I was desperate to stop: Temperature climbs, heart rate sky rockets, and eventually, the blood pressure tanks. To, like nonexistent tanks...

But, thankfully, God gave her a bed in the ICU before the cycle continued...

I don't know what happened to her after I turned her over to the ICU nurse. I had to come home for my sick kid. But, I work tomorrow, and I will definitely be checking on Miss X.

Do you want to know the really weird/sick thing about this whole ordeal?

I left work thinking, "I love being a nurse. WHY do I love this job? There is something seriously wrong with me to willingly do this..."

Now, I think most of you find that entire story confusing and boring. But, it's what I do. It's what I love. So, at times you will have to read about it... It purges me and helps me think about what I could have done better. Maybe I should have called a "rapid response." That would have sped things up. I should have called this, because this team is designed to help the decision process and move things along quickly...Anyway, I'm stopping now.

On a lighter note:

Studmuffin: Popcorn, why did you make a 73 on this paper? You said you're the smartest kid in class?

Popcorn: Dad, I'm not perfect!

Studmuffin: I would say not. This is 27 points away from perfect...Which would be a lot closer if you had actually finished your paper!

Popcorn: Well, I can't do everything right!

Glad to hear she's not overly burdened with that situation!

2 comments:

Paulette said...

Thank God for nurses like you. Bless you, your persistent bossiness, and passion for your profession. Keep up the great work! You are certainly an inspiration.

P.S.

Please post and let us know how Mrs. X is doing tomorrow.

Getting My Words Out said...

Did I miss the update on Mrs. X??