Today I worked at a stepdown unit, where the ratio is four patients to one nurse. Being it was my first day back, they assigned me to four patients. My first patient is 70 year old sweet senior citizen that cannot move because of surgery to her lower extermities, she also had recent bowel resection because her intestines stopped working for some apparent reason. They removed the dead intestine and make an ileostomy to allow the intestines rest so that there is no pressure on the incisions that were made inside her. Her ileostomy bag leaks and is causing maceration to her skin, and require frequent dressing changes and incisional care. Having the bag leak gives a horrific ordor that can wake up the dead.
My second patient was a 55 year old lady, but she looked allot older than she really was. She had a pacemaker that got infected in her shoulder and required several surgeries because she had an infection that was resistant to antibiotics. She also has allot of malnutrition problems and incabable to eat on her own because she is failure to thrive. Her labs showed (albumin and prealbumin levels) significantly low, we also did a 3 day calorie count and it was concluded that a tube in her stomach would be benificial. A PEG tube was than placed into her stomach to incorporate entereal feeding directly into her stomach. She is currently on total parental nutrition (nutritin by intravenous fluid), and IV fluids. She is max assist and is at times confused and wants to get out of bed when she is uncapaable of bearing weight on her feet. I was in there every hour checking on her, and making sure that she doesnt pull anything, my main concern was her central line that was located on her neck, if pulled out she can bleed to death.
Third patient just came from ICU at change of shift, perfect timing. This patient had a heart bypass, where they take a piece of an artery from your leg or breast area and replace it on one of the arteries on the heart so that the bottom or another area of your heart can recieve blood. Patient also had catheter in his bladder for irrigation because he also had surgery to remove his prostate earlier this month secondary to cancer. The goal is to keep his bladder constantly irragated with saline to remove blod clots and prevent them from developing. He also had two chest tubes into his heart and two chest tubes in his lungs so his heart and lungs can drain the fluid from the inflammation process after surgery, this will promote healing, and prevent symptomatic symptoms. He is also moderate to max assist, and needs assistance anytime out of bed because of fall risk precautions. Imagine having all them tubes the size of a water hose, and catheter, and IV fluid lines. It was a head ache anytime when he was out of bed, but it is good for him and anytime he wanted to get out we promoted him.
My last patient, I had a patient going for a heart bypass today so I had to prepare him for surgery making sure that all diagnostic exams are current, consents are sign, patient and family understands the risk and benefits, labs are within normal limits, and patient safety. Not this patient was suppose to be my easiest patient but than was my most busiest. Patient also has historyof a kidney transplant, and requires stragtic monitoring of his labs of his immunosupprassants, such prograft. But his chemistry levels when he arrived was off. He arrived with a potassium level of 6.8 (normal is 3.5-5.0), whenever potassium is too high, or too low the heart muscle can slow down or even stop. For example, Thats why its important for runners to eat bananas, which are high in potassium, because running depletes your electrolytes and can cause you to have a cramp on your leg. We had to do so many measures to lower his potassium. making him go number two, given him insulin to push in the potassium back into the cell, than follow it with dextrose because his sugar can potentially drop also when we do this. We also gave him lasix a duiretic to make him void out his excess electrolytes. Finally at 5 am when they came to pick him up from surgery, his potassium was 4.8, and he was ready for surgery. What a night!
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