Son of a bitch...
Note to my fellow students:
Don't drink a glass of wine while studying for a test after waking up at 6:00 am and spending an absolutely awful day at clinical. I can't keep my eyes open.
While sitting in our "pre-shift conference" my clinical instructor asks if anyone would like a "challenging" patient that day. Everyone turns their head and looks around, no one jumps at the opportunity, eyes rest on me, so fine...I'll take her. I get her information sheet and see the following: CVA (stroke) and Basilar artery aneurysm (Major artery dilated to point of rupture in the brain). They described her to me as a "ticking time bomb", she has an inoperable condition, will die soon, and is in complete denial about it.
I walk into her room...let me give you a picture of what I was dealing with-- a 350 lb woman, missing the majority of her teeth, emitting the most awful stench because of days of refusing baths, yeast growing from the folds of fat on her stomach and back, frequent vomiting and sputum ejection, you get the idea. I grab a cart to take her vital signs and while trying to attach the blood pressure cuff I realize there's no way that thing is fitting around her arm. I leave to go get the "large adult" cuff and can barely get it around her arm. This cuff fits easily around my thigh and I can hardly wrap it around. She has a history of high blood pressure and is on numerous meds to control it...I get 180/90 (yikes). So I go out to get her medications started, knowing that she's obviously in need of her pressure meds. While pulling out the 12 freakin meds she's on, I begin to look them up and notice she's on 3 blood pressure meds, anti-psychotics, anti-coagulents (stop blood clotting), anti-depressents, anti-emetics (stop vomiting), and a slew of others. Nice. Three of her scheduled medications are missing, so I call to re-order them and head in with the first batch. She claims she can only take them with pudding, so I put the cup of pills down, grab the pudding, and before I can stop her, she has dumped the entire cup of drugs into her pudding bowl and stirs them up. Fabulous.
She eats a couple bites and says "I can't eat all this pudding, I'll get sick"...to which I reply, "Well, all your medications are in there, so you have to take them at least"- (Why’d you dump them in there moron?) She shoves the bowl at me and says "Dig them out." I take the large bowl of pudding and begin to dig out these tiny pills, trying to remember how many are in there and wondering if I should trust her when she says she KNOWS she's already taken 4 of them. I get them all out, she takes them all, and of course, feels sick. I grab her an emesis basin and listen to her heaving, trying not to gag myself. All I can think is "Please God, do not let her throw up those pills and make me dig around in vomit to see which ones she kept down and which ones she needs to take again". She didn't throw them up, kept them all down, but was still missing three of them.
I leave and notice a Stat order in her chart to remove her Foley Catheter (pee tube). Fine- I go back in and notice that she's moved herself from the bed to the chair and in the process ripped off her oxygen connection and the pressure hose (keeps blood clots from forming in the legs) from her feet. Thanks a bunch. I replace the oxygen and take off the compression devices and notice serious skin breakdown and fungal growth on her toes. Mental note for later. I tell her that I'm going to take out her Foley. I do it while she's sitting in the chair and grab my clinical instructor, Meredith, to help me out. Even though I explained to her previously that she'll probably feel like she has to pee after I take the tube out, but since her bladder is sucked dry, she won't really need to go, she insists that she has to go NOW.
My assumption is at this point that she can walk pretty well, given that she got herself to the chair. She has no falls precaution notices, no notes for assistance while ambulating (walking)...nothing that indicates she can't stand up without assistance. So Meredith gets behind her, me in the front, just to stabilize her. She stands up and literally just has to pivot to the right and sit back down on the bedside commode. Well, apparently that was much too difficult because as soon as she stands, she crumples and her 350 pound frame takes me and Meredith right to the floor with her. Now falls in the hospital are a big deal- an "incident" if you will. Meredith and I try once to get her off the floor, not even a budge. So I push her call light to summon back-up and in runs about 5 people like it was a freakin code or something. And there's me, nursing student extraordinaire, on the floor trapped by a smelly, huge woman. It takes six of us to lift her onto the commode and sure enough, she doesn't fit on it; she has to have the hand rails removed. She's sitting on the commode and I'm fucking pissed...at her, at myself, at whoever is open to being pissed at.
Of course she doesn't pee, she has no fucking urine to pee out, so she needs to get back in bed. This time, we call in re-enforcements...the second all the people come in the room, the bitch gets up from the commode and walks to bed with two people holding her arms. WHAT THE HELL!!! She didn't need assistance in the least bit! Why did she fall before? The lazy bitch apparently thought that Meredith and I could just carry her to the commode and therefore she didn't have to move. I leave the room ready to throw something, and Meredith exclaims "When she stood up, I wanted to punch her in the face". We both tried to laugh it off, but I was seriously embarrassed about the whole incident because I know I looked extremely incompetent.
I sit down ready to spend an hour or two away from the stinky bitch and there lies another stat order for yet another blood pressure medication. Shit. I go in to give her the damn pill and she wanted it with applesauce this time, not pudding. FINE!
I go out to the nurse's station and begin charting my incident report on the fall, call the physician to get a "Falls precaution" order and have to tell him what happened and because in his mind nursing student = moron, it was fun.
The clock hits noon and her missing meds finally arrive; another blood pressure med, a liquid antibiotic, and a cream for "infected area" with no indication of what the "infected area" is (finding out later it’s for the yeast in her skin folds). It's also time for another blood pressure check, a blood sugar test, and time to give the missing meds. I go in (she's real happy to see me at this point)- tell her what we need to do, and get to it. I check her blood pressure and get 118/70- a normal blood pressure, but a significant drop from the last one. I have Meredith come in to verify the blood pressure (given that she's not the easiest to get)- and it's correct, so I wonder if I should give that current BP med, which was a pretty strong one. I check her blood sugar and SURE ENOUGH it's 192, so she needs insulin. At this point I'm thinking- dammit lady, can anything be simple with you. I try to give her the liquid antibiotic and she refuses to take it claiming that she already had it that day. No, bitch, you didn't because I gave you your meds this morning, and that was not one of them! She insists, and I leave to go get Meredith, because she was with me for the first round of meds, and knew she hadn't gotten it. I pretty much have to demand she takes it, with the help of Meredith, and upon taking it she decides to cough, spit half of it out (on my arm) and swing her arm knocking over the "thickened coffee" she made me to get a couple hours prior. With clenched teeth, I grab a towel, clean it up, and leave the room to get her insulin.
While I'm drawing up the insulin I have to call the fucking invisible, asshole physician to see what he says about the blood pressure medication. He very crudely tells me that I shouldn't give the med, acting as if I'm an idiot for calling (sorry, dick, I have to call you when deciding whether or not to give a med) He's pisses me off to the point where I blatantly confront him on why he ordered the Foley catheter removal for a patient who can't get to the bathroom and already has skin irritation from bedrest which will only be irritated further with urine incontinence, why his assessment didn't turn up the pressure ulcers or fungus on her feet, and why her chart has not been updated since the 17th, which would have notified us of the falls risk. He was silent for a minute and responded with "It's not your job to question my orders". Fine fuckhead, eat shit and die.
I go in to give her insulin and she yells at me for a bedpan- I stick her with the needle (and feel a very odd sense of pleasure)- and go to get her bedpan...pretty much running and praying that she doesn't pee on the bed before I get back. She rolls over, and I can't even see the end of her butt-cheek, it's that large. I shove the pan under her and run out of the room before she can yell for something else.
I sit at the desk, watching the clock tick by...wishing it was time to go. Sure enough, her call light goes off and I slam my head on the desk, ready to start crying. I go back in and she's freaking out because she can't pee. I KNOW IDIOT!!! I reminded her that she was feeling that because of the Foley, and that she didn't have any urine in there- it would be a few hours before she had something to pee out. I told her she could sit on the bedpan as long as she wanted and try to go. It was finally time to leave, and I was grateful for the opportunity to hand her off to the evening shift nurse with a cheerful “Good luck!”.
My only satisfaction of the day? Before I leave, I glance at her chart and notice that it has been updated with the removal of the blood pressure medication, a falls precaution, a re-insertion of the Foley catheter if skin irritation worsened, and an anti-fungal prescription for her feet.
Eat me dickhead.
Don't drink a glass of wine while studying for a test after waking up at 6:00 am and spending an absolutely awful day at clinical. I can't keep my eyes open.
While sitting in our "pre-shift conference" my clinical instructor asks if anyone would like a "challenging" patient that day. Everyone turns their head and looks around, no one jumps at the opportunity, eyes rest on me, so fine...I'll take her. I get her information sheet and see the following: CVA (stroke) and Basilar artery aneurysm (Major artery dilated to point of rupture in the brain). They described her to me as a "ticking time bomb", she has an inoperable condition, will die soon, and is in complete denial about it.
I walk into her room...let me give you a picture of what I was dealing with-- a 350 lb woman, missing the majority of her teeth, emitting the most awful stench because of days of refusing baths, yeast growing from the folds of fat on her stomach and back, frequent vomiting and sputum ejection, you get the idea. I grab a cart to take her vital signs and while trying to attach the blood pressure cuff I realize there's no way that thing is fitting around her arm. I leave to go get the "large adult" cuff and can barely get it around her arm. This cuff fits easily around my thigh and I can hardly wrap it around. She has a history of high blood pressure and is on numerous meds to control it...I get 180/90 (yikes). So I go out to get her medications started, knowing that she's obviously in need of her pressure meds. While pulling out the 12 freakin meds she's on, I begin to look them up and notice she's on 3 blood pressure meds, anti-psychotics, anti-coagulents (stop blood clotting), anti-depressents, anti-emetics (stop vomiting), and a slew of others. Nice. Three of her scheduled medications are missing, so I call to re-order them and head in with the first batch. She claims she can only take them with pudding, so I put the cup of pills down, grab the pudding, and before I can stop her, she has dumped the entire cup of drugs into her pudding bowl and stirs them up. Fabulous.
She eats a couple bites and says "I can't eat all this pudding, I'll get sick"...to which I reply, "Well, all your medications are in there, so you have to take them at least"- (Why’d you dump them in there moron?) She shoves the bowl at me and says "Dig them out." I take the large bowl of pudding and begin to dig out these tiny pills, trying to remember how many are in there and wondering if I should trust her when she says she KNOWS she's already taken 4 of them. I get them all out, she takes them all, and of course, feels sick. I grab her an emesis basin and listen to her heaving, trying not to gag myself. All I can think is "Please God, do not let her throw up those pills and make me dig around in vomit to see which ones she kept down and which ones she needs to take again". She didn't throw them up, kept them all down, but was still missing three of them.
I leave and notice a Stat order in her chart to remove her Foley Catheter (pee tube). Fine- I go back in and notice that she's moved herself from the bed to the chair and in the process ripped off her oxygen connection and the pressure hose (keeps blood clots from forming in the legs) from her feet. Thanks a bunch. I replace the oxygen and take off the compression devices and notice serious skin breakdown and fungal growth on her toes. Mental note for later. I tell her that I'm going to take out her Foley. I do it while she's sitting in the chair and grab my clinical instructor, Meredith, to help me out. Even though I explained to her previously that she'll probably feel like she has to pee after I take the tube out, but since her bladder is sucked dry, she won't really need to go, she insists that she has to go NOW.
My assumption is at this point that she can walk pretty well, given that she got herself to the chair. She has no falls precaution notices, no notes for assistance while ambulating (walking)...nothing that indicates she can't stand up without assistance. So Meredith gets behind her, me in the front, just to stabilize her. She stands up and literally just has to pivot to the right and sit back down on the bedside commode. Well, apparently that was much too difficult because as soon as she stands, she crumples and her 350 pound frame takes me and Meredith right to the floor with her. Now falls in the hospital are a big deal- an "incident" if you will. Meredith and I try once to get her off the floor, not even a budge. So I push her call light to summon back-up and in runs about 5 people like it was a freakin code or something. And there's me, nursing student extraordinaire, on the floor trapped by a smelly, huge woman. It takes six of us to lift her onto the commode and sure enough, she doesn't fit on it; she has to have the hand rails removed. She's sitting on the commode and I'm fucking pissed...at her, at myself, at whoever is open to being pissed at.
Of course she doesn't pee, she has no fucking urine to pee out, so she needs to get back in bed. This time, we call in re-enforcements...the second all the people come in the room, the bitch gets up from the commode and walks to bed with two people holding her arms. WHAT THE HELL!!! She didn't need assistance in the least bit! Why did she fall before? The lazy bitch apparently thought that Meredith and I could just carry her to the commode and therefore she didn't have to move. I leave the room ready to throw something, and Meredith exclaims "When she stood up, I wanted to punch her in the face". We both tried to laugh it off, but I was seriously embarrassed about the whole incident because I know I looked extremely incompetent.
I sit down ready to spend an hour or two away from the stinky bitch and there lies another stat order for yet another blood pressure medication. Shit. I go in to give her the damn pill and she wanted it with applesauce this time, not pudding. FINE!
I go out to the nurse's station and begin charting my incident report on the fall, call the physician to get a "Falls precaution" order and have to tell him what happened and because in his mind nursing student = moron, it was fun.
The clock hits noon and her missing meds finally arrive; another blood pressure med, a liquid antibiotic, and a cream for "infected area" with no indication of what the "infected area" is (finding out later it’s for the yeast in her skin folds). It's also time for another blood pressure check, a blood sugar test, and time to give the missing meds. I go in (she's real happy to see me at this point)- tell her what we need to do, and get to it. I check her blood pressure and get 118/70- a normal blood pressure, but a significant drop from the last one. I have Meredith come in to verify the blood pressure (given that she's not the easiest to get)- and it's correct, so I wonder if I should give that current BP med, which was a pretty strong one. I check her blood sugar and SURE ENOUGH it's 192, so she needs insulin. At this point I'm thinking- dammit lady, can anything be simple with you. I try to give her the liquid antibiotic and she refuses to take it claiming that she already had it that day. No, bitch, you didn't because I gave you your meds this morning, and that was not one of them! She insists, and I leave to go get Meredith, because she was with me for the first round of meds, and knew she hadn't gotten it. I pretty much have to demand she takes it, with the help of Meredith, and upon taking it she decides to cough, spit half of it out (on my arm) and swing her arm knocking over the "thickened coffee" she made me to get a couple hours prior. With clenched teeth, I grab a towel, clean it up, and leave the room to get her insulin.
While I'm drawing up the insulin I have to call the fucking invisible, asshole physician to see what he says about the blood pressure medication. He very crudely tells me that I shouldn't give the med, acting as if I'm an idiot for calling (sorry, dick, I have to call you when deciding whether or not to give a med) He's pisses me off to the point where I blatantly confront him on why he ordered the Foley catheter removal for a patient who can't get to the bathroom and already has skin irritation from bedrest which will only be irritated further with urine incontinence, why his assessment didn't turn up the pressure ulcers or fungus on her feet, and why her chart has not been updated since the 17th, which would have notified us of the falls risk. He was silent for a minute and responded with "It's not your job to question my orders". Fine fuckhead, eat shit and die.
I go in to give her insulin and she yells at me for a bedpan- I stick her with the needle (and feel a very odd sense of pleasure)- and go to get her bedpan...pretty much running and praying that she doesn't pee on the bed before I get back. She rolls over, and I can't even see the end of her butt-cheek, it's that large. I shove the pan under her and run out of the room before she can yell for something else.
I sit at the desk, watching the clock tick by...wishing it was time to go. Sure enough, her call light goes off and I slam my head on the desk, ready to start crying. I go back in and she's freaking out because she can't pee. I KNOW IDIOT!!! I reminded her that she was feeling that because of the Foley, and that she didn't have any urine in there- it would be a few hours before she had something to pee out. I told her she could sit on the bedpan as long as she wanted and try to go. It was finally time to leave, and I was grateful for the opportunity to hand her off to the evening shift nurse with a cheerful “Good luck!”.
My only satisfaction of the day? Before I leave, I glance at her chart and notice that it has been updated with the removal of the blood pressure medication, a falls precaution, a re-insertion of the Foley catheter if skin irritation worsened, and an anti-fungal prescription for her feet.
Eat me dickhead.