Tuesday, July 13, 2010

Med-Surg Day #2

Last Thursday was spent back on the med-surg floor. Thank you for all who said a little prayer for confidence! I definitely felt it as I walked through the doors that morning. I was assigned to a fantastic nurse, Joey. I've been really fortunate with the RNs that I have been assigned too because they have all wanted to teach instead of placing bed linens in my hands and telling me to go for it. While I don't mind doing bedside care at all, I love to learn and watch, catching any new procedure that i can.

My patient was a delight. A 71 year old man who had recently had a intracranial hemorrhage. He is on his way out of the facility which is exciting. When he was admitted in May, he was in acute respiratory failure and immediately placed on a trach. Just recently, the trach was removed, allowing him to breath on his own again with no supplemental O2. There are some lasting effects of the hemorrhage though. He suffers from left side neglect, favoring his right side for all activities. He had tremors as well which he takes medication for but they still interfere with his ability to care for himself entirely. When I went in to introduce myself he was fast asleep. I really don't like waking patients up. I know I had to since he needed his vitals and the breakfast tray had arrived. He was pretty slow to wake up but once he did, I introduced myself and had him try to repeat my name. It took him quite awhile since his cognition is still pretty delayed. He did however grab onto my hand and squeeze it as hard as he could. I let him know he was extra special today because he had his regular nurse AND a nursing student, so he would be spoiled for the day!

Before I had the chance to assist him with feeding, the occupational therapist came in for his morning work out. It was really helpful to see her working with him. I was able to grasp what he was capable of and where he struggled. I even made note of certain things so I could make sure to work with him on them throughout the day. It's pretty interesting how life works. We come into this world and are placed in diapers, strollers, need to be fed, and our start out learning on simple, child games. I than see people towards the end of their life who are again in diapers, use wheel chairs, need help with feeding, and are back using child toys to restore their motor skills and cognitive thought. After OT was done, it was time for my patient to eat breakfast. I wanted to make sure he did as much on his own as possible....i was simple there to make sure he didn't aspirate and help when needed. I opened everything and asked what he wanted first. IN a soft whisper he said, "coffee". My kind of guy! With the rest of his meal, I encourage him to "stab" things with his fork and than bring it up to his mouth. He did so well! I felt like a coach cheering him on with every bite he grabbed on his own. He even opened his own straw and I went crazy with excitement! I felt like a proud parent watching him attempt and accomplish new tasks. You see, for each one, it led him a step closer to not only being discharged, but also regaining independence, self esteem, and a part of his past life back.

After breakfast, speech therapy came in. It was a new therapist and since he did now know her, he shut down. I tried encouraging as well but he wouldn't have it. My instructor came in soon after to pass meds with me. Although he is not fed through his G-tube, it is still intact for medication purposes until he is cleared to swallow his meds. I said a quick prayer for confidence as my instructor intimidates me like I never have been before. As I went through the list of his meds with her and rattled off the classification, side effects, and reason for taking it, I gained a little more confidence. I began taking each tablet from the medicine cabinet and I was pretty pumped to be doing all the dosage calculations in my head. I was shaking though and I tried to make light of it with my instructor but she shut me down. Awesome. Kick me back to the curb lady. After crushing the tablets and getting everything set up to administer, the nervousness set in. Back in LVN school i could pass meds through a G-tube with my eyes closed. Well, that's gone. As I went to flush the tubing, I realized that the extra lumens were different than I had seen. I thought I had closed off the right side but was soon proven wrong as water shot out the side! Holy cow my heart stopped. My instructor was ticked! I felt like an idiot to say the least. NEVER in my life have I done that! I moved on ad continued to administer the meds by gravity through the tube and flush again. I could see how annoyed my teacher was. The thing is, we are all students. We all make mistakes. If she hadn't of intimidated me and made me feel so uncomfortable, I probably wouldn't have slipped up at that time but it was bound to happen. I KNOW she made mistakes when she was in school, but man, she made me feel awful. Confidence = shot out the window!

Aside from the mess, it was a great day. I truly enjoyed each minute with my patient. After lunch, I stopped in to check on him. I gave him his meds ( with no spills!) and than stayed to talk. I would ask him a question and wait for his reply. It was interesting because his eyes would move side to side, than his mouth would move as if he was speaking but nothing came out. You could see him searching deep into his thoughts to figure out how to say what he wanted to. Everything is delayed and he knew what he wanted to say but couldn't figure out how. When he would finally answer I would squeeze his hand so he knew I was proud and than continue on with another one. I felt a sense of pride for him that day that I haven't felt before. In just the short time I was with him, I saw improvements. The OT was walking through the halls later on and stopped to talk to me, asking how the day was going. I filled her in on his accomplishments and how great he was doing. She grabbed my should to thank me and said he hadn't been talking at all these past few days. I hope when I head back this week to stop in and say hi to him. He may not remember me, but I will always remember him.

I drove home that night with a heavy heart. I remember this feeling from before at the end of a clinical day. Emotionally, it is draining. I used to head straight to the gym right after clinical to burn off anything I was feeling before heading home to family. I'm going to have to start that again. That day I just blasted the FISH so loud it pretty much drowned out my thoughts.

My words of advice for today are: Love, love, Love those close to you. You just never know when everything will change. What you have one day, you might not the next. So tell them you love them every chance you get. Hug them. Cherish them calling you by name. And make the most of each day. Whether it is folding laundry or going for a walk, it can be taken away so quickly. Here was a man who had everything and in the blink of an eye, a vessel in his brain burst and now he is fighting to be somewhat of the person he was before. So go hug your family. Tell them you love them. And seriously, live each day to the fullest. Starting now :-)

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