It was a slow one...

So last night was pretty uneventful as far as the evening shift goes.
So I come back to the floor from eating dinner, and the na who is assigned the other half of the floor tells me that she emptied the bsc for one of my patients. She said that she did a hemoccult because the stool was visually quite bloody before she realized that the pt was in for a lower GIB. She laughs at herself.. but I ask her.. well was it positive?? :)

One of my pts was transferred to hospice care before coming out from the unit as a transfer. This pt was quite young by our standards (age < 50). End stage cardiac failure. EF less than 10%. Respirations cyclic with 20-30 sec periods of apnea. All we can do is make the pt comfortable. It is sad though that the family wasn't quite ready to accept the prognosis, and it seemed that they were quite unsure about the care hospice provides. I did a good bit of educating with the family on heart failure. Not a lot on hospice because I don't know much about their program other than the comfort care and support that they provide to the pt, families and loved ones coping with a terminal prognosis. I wish it were easier to tell a family that their loved one was certainly going to die. I know that the doctors have discussed it with them at length, and they know what is going to happen, but it seems that they are starved for information about what is happening. The disease process, how much time does the pt have? things like that. How can I give definitive answers? I know that is what they are looking for, but no one has that answer. The pt could live a couple of days to a couple of months? I had no answers. All I could tell them about was heart failure and what it does to the body. I did the best I could to provide support, veracity, and caring to this family. It's all I could do.

Other than that.. nothing else really happened all shift. All of my patients lived for those 8 hours :) Always a good thing! Had some stable pts and a couple of really sickly ones. One pt has a creatinine of 11. No dialysis access because 2 days ago, coags were non-existent. Now, after multiple vit k injections, the inr is down to 3.5 but still too high to risk catheter placement. I am afraid though that if it isn't placed soon, the pt is going to take a turn for the worse. Mostly because the pt has stated how much better they have been feeling and has been more alert than about a week or so ago. They always seem to be getting better before it turns. And worse is when the family notices and gets false hope. I try to remind the family that even though the pt seems to feel better, the pt is still very ill. All I can do... after all, I don't predict the future.

Now here is crossing fingers that tonight goes much the same.... uneventful. But we tend to have a lot of admissions on Sunday, usually after church. Crossing fingers :)