patient has arrived back to his room from getting an eeg. nurse goes into room to reconnect the telemetry after being informed said pt is back. ask pt to pull shirt up over his head so that said electrodes can be reapplied to chest. pt complies. good, he follows commands. tele is intact. knowing that i need to get a urine sample...
..........
-nurse: do you have to pee?
-pt: yes.
-nurse: ok. i need you to pee in this little cup. do you think you can do that?
-pt: yes. yes, i need to pee. i need to pee.
nurse hands pt the little cup, expecting pt to comply and pee.
pt fiddles with cup, then holds it in his hand to side of bed, over the edge.
-pt: i need to put this right here.
pt fiddles with cup some more. nurse takes cup away from pt.
-nurse: if you have to pee, you can pee in the urinal. i will pour it into the cup. can you do that?
-pt: yes, need to pee. hand me my piss bucket.
nurse complies and hands the pt the urinal.
-pt: i have to pee. this is very important for something, but i am not sure what. (pt holds urinal in hand at end of extended arm for me to see.)
-nurse: yes, you need to pee in it.
-pt: no it has another function. i know it does. [sighs] i can't think of it at the moment.
nurse, expecting him to urinate at any moment in time, stares at pt who begins to grab the top that goes on the urinal and takes it off of the handle.
-pt: this is it, i have to get this just right.
pt begins to take the top of the urinal and put it on the handle, twist it around so that it comes back off of the handle. over. and over. and over. for at least 5 good minutes.
nurse attempts to grab urinal.
-pt snatches urinal and exlaims: this is important!
-nurse: let me have the urinal.
-pt: no, let me finish. i have to get it right.
pt once again begins fidgeting with the lid to the urinal, doing exactly the same things as before.
-nurse: give. me. the. urinal.
..........
at this point in time, i am ready to throw the damn thing across the room.
pt complies and hands me the urinal with the look of a 2 year old whose mom just took away his cookies.
-exasperated, nurse: i will just come back later for this.
pt pulls on his shirt.
-pt: i know there is something important to do with my shirt.
-nurse: no, we already put the monitor back on. put your shirt back down.
at this point in time, i am ready to throw the damn thing across the room.
pt complies and hands me the urinal with the look of a 2 year old whose mom just took away his cookies.
-exasperated, nurse: i will just come back later for this.
pt pulls on his shirt.
-pt: i know there is something important to do with my shirt.
-nurse: no, we already put the monitor back on. put your shirt back down.
..........
i step out of the room and ask cna if she can obtain urine specimen. please????
i sit down to chart, thinking 'this pt did not act like this before he went for his eeg.' i wonder what in the world they did to him in there... and then like some epiphany in my head, i immediately hop right out of the chair and hurry back to room.
observe cna having same difficulty with pt.
this time however, i look directly at pt and see that he does not have his oxygen on. instead, it is tossed to the side on his pillow.
i step out of the room and ask cna if she can obtain urine specimen. please????
i sit down to chart, thinking 'this pt did not act like this before he went for his eeg.' i wonder what in the world they did to him in there... and then like some epiphany in my head, i immediately hop right out of the chair and hurry back to room.
observe cna having same difficulty with pt.
this time however, i look directly at pt and see that he does not have his oxygen on. instead, it is tossed to the side on his pillow.
..........
UGH.
immediately get oxygen back on, attempt pulse ox. pt will not comply and begins to yank on finger probe, saying it has to be on another finger, not that finger, and so i firmly hold his arm to keep it still waiting for sat to show up. sat bleeps on for 2 secs.. sat is 84%. ask another cna to please go get me a peds sticky finger probe asap. crank oxygen up to 4L. wait for cna.
ask other cna to call rt for breathing tx. other cna comes back with finger probe. sats are now 94% on 4L. rt comes in, i ask her to turn oxygen to 3L.. we wait. sats stay steady at 94%, so i ask her to cut it down to 2L. again, sats stay steady. i tell her to go ahead and do the tx and then we will see where he is.
after tx, pt is alert but confused, his baseline. doesn't recall episode. sats are still steady. pt is stablized and moved closer to nurse's station.
and my eyes on that o2 tubing the rest of the shift.
UGH.
immediately get oxygen back on, attempt pulse ox. pt will not comply and begins to yank on finger probe, saying it has to be on another finger, not that finger, and so i firmly hold his arm to keep it still waiting for sat to show up. sat bleeps on for 2 secs.. sat is 84%. ask another cna to please go get me a peds sticky finger probe asap. crank oxygen up to 4L. wait for cna.
ask other cna to call rt for breathing tx. other cna comes back with finger probe. sats are now 94% on 4L. rt comes in, i ask her to turn oxygen to 3L.. we wait. sats stay steady at 94%, so i ask her to cut it down to 2L. again, sats stay steady. i tell her to go ahead and do the tx and then we will see where he is.
after tx, pt is alert but confused, his baseline. doesn't recall episode. sats are still steady. pt is stablized and moved closer to nurse's station.
and my eyes on that o2 tubing the rest of the shift.
1 comment:
Going back in time to the dark ages of 1991, I had been fighting a respiratory infection for two weeks. I'd get better and try to go back to work, then relapse. On SuperBowl Sunday (after the game, of course) I agreed to go to the hospital. The told me I had a severe case of pneumonia and put me on oxygen. I don't know what level it was set on, but a short while later I stopped breathing altogether. My doctor said my brain got the message there was plenty of oxygen in my system so it didn't tell my lungs to work. I came out of it 36 hours later, and will be on oxygen for the rest of my life. It really is a tricky substance to deal with.
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