devulgari (devulgari) wrote,
devulgari
devulgari

Cranky cranky cranky equals me

Working both day and night shifts is kind of bizarre. I went to sleep last night at around 11pm, thinking I'd wake up at 7 and be able to squeeze in a pseudo day off before returning to work at 7pm tonight, but all night long I had nightmares about two of my patients. Basically they either died or got very sick because I couldn't perform the correct interventions for their problems. This is insanity, but only sort of. Consider my confused patient who had back surgery who is refusing to ambulate. He's not quite confused enough that I can just slide him into a chair to at least sit up without it being assault, since he still has the presence of mind to staunchly and eloquently refuse anything I try to do with or for him. However he's confused enough to continue to refuse to do anything even though it could, literally, kill him. (Not moving after surgery can lead to an ilius, where his bowels would just completely stop peristalsis in one or more places, or pneumonia, or open sores on his skin, etc.)

I managed to roll him back and forth in the bed and to my relief he still has sounds in his bowels, clear lungs, and mostly good skin. He had some creases in his skin from where he'd been lying on a wrinkle in a sheet but it faded after he'd been up on his other side for a while. I washed his back and did the whole lotion and powder routine, while he lambasted me continuously. However, unlike using a slide board to get him upright in a lounger chair, washing someone's back, changing their dressing, and making their skin all supple and sweet smelling is not likely to land me in court.

The thing is, the doctor doesn't know any of this. His primary care physician hasn't seen him at all, which is normal, since it's the surgeon and the neurosurgeon who have all the say in what happens within the hospital. His PCP could come in if he wanted and consult, but it's not his area of expertise. The surgeon was in to see him early in the morning before he was really ready and raring to go, and the neurosurgeon who is consulting was in 2 days ago. The Physician's Assistant for the neuro team was on the unit yesterday and I was like ok, my patient a.) Won't move b.) Won't turn c.) Half the time doesn't remember he's had surgery and wonders why his back hurts and d.) Hasn't pooped in five days. The PA is sympathetic to my plight but the thing is that all this was NEWS to him. Big news. He had never done a mini mental status exam on this patient-- since the patient converses easily and appropriately, since he is probably very intelligent and can therefore cover up his dementia, he didn't realize the depth of his confusion.

So, basically, the PA didn't order a stronger painkiller (not that there really is one that wouldn't also make this man completely whacked out beyond all possiblity of doing him any good) and he didn't get too excited about the bowel thing. Because that's a nurse's province. I get to decide what kind of laxitive he has, what kind of intervention. I decide when and where and how, to a large extent. In the doctors' orders it just says "laxative of choice." There are a dizzying array, some better than others, some that are oral and some that are not, and I can just imagine the scene if I attempt a suppository with this man, who would a.) scream and yell as we turned him on his side b.) scream and yell as I gave him the suppository and c.) scream and yell when it was time for me to put him on a bed pan.

Possibly, tonight, there will be no bed pan. Just a bed full of poop that he will then (you guessed it) scream and yell as I try to clean him up and change his sheets.

So, most of the nightmares were about him.

So I slept until noon.

Now I have to leave for work in about 5 hours. Do I just go back to bed? Do I go grocery shopping? Do I go to the gym?

I like working nights, but mixing them together with days in the same span of 2 days is nuts.
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