Last night's shift was so, so bad it was too hard to cry and easier to laugh. In short, I had five patients, two on contact precautions, one who was combative, spoke only Russian and took swipes at me whenever I neared his bed, one who suffers from psychosis and her pastime is picking holes in her skin and heiney, one who had an NG tube which didn't stop him from scarfing down a cookie he had smuggled into his room, and two rapid responses.
My shift began with 328 screaming monotonously for someone to help her because she was wet...that would have caught my attention but she has a suprapubic catheter so I was sure her psychosis was playing pee pee tricks on her mind. 324 only spoke Russian and was on a 1:1 because he snatched body parts that came within five inches of his bed. He spewed meds crushed in applesauce as some sort of retaliation for offering him care. And he was a turn 2Q so we had the joy of being assaulted six times in one shift. I won't mention that he was also incontinent. 326 was a recent DNR but that doesn't mean "do not treat" so when her heart ran aflutter with a-flutter and a-fib, I had to call in the cavalry. She ended up on a monitor and bedrest but didn't go to telemetry because of her DNR status. That and the doc wasn't feeling particularly "order-writing" that evening. When I asked him for an order for Restoril for 328 and/or me because 328 wouldn't stop her relentless calling in a mono-syllabic chant, he told me sure, but I had to call the attending to make sure it was okay first. Way to take control. Thanks for the help, Dr. Doesn't-Do-A-Lot.
My Creature Double Feature came to a head when 327, who had been calling me all night, and not via the call bell (why when yelling my name got my attention so much faster). She was AAOX3 and wanted to get on the bedside commode, one day post op for an open choley. Sure, I said, and I got her on the porta potty. I grabbed the IV pole to swing it closer and that quick she pitched to the side and her eyes glazed, unresponsive. And, true to Hollywood form, dark brown liquid gushed from her nose, just poured out like the perfect horror show. It flowed out her nose and mouth. I yelled, and I do mean yelled so that the other side of the hospital could hear me, that I needed help in 327. Another rapid response which ended in her being intubated and me nearly coding myself. However, we all survived. Okay, not all. J's patient expired. Dr. Didn't-Help-A-Lot didn't come up for several hours, making body bagging a little more challening.
After my two rapid-run-down-the-halls, I visited 326 for a check-up. She needed the bedpan so I complied and when I took her off, POOF, her ostomy appliance came apart, spewing smelly sludge all over her, me, and the sheets I had just changed for the fifth time (I'll spare you the tinkle and spurting blood from IV site details). So here we were, in a contact room with an ostomy that had herniated to the size of a small child's head and no replacement appliances. So what is a critical thinking nurse to do? Slap that Tupperware part back together, use some 3M shield and 2" tape and put in a consult for the ostomy nurse to bring DD sized ostomy softee molding stuff for this woman's protruding pouch of poop.
At first, after the first rapid response, I was almost ready to tear up. However, the second cured that and all was funny post intubation. The broad street bully in 24 was funny, the coffee snitch was funny, the ostomy like an fx gold star was funny. Even 328's picking poopie out of her pooper scooper was funny. Going back tonight for the same group; not so funny. Ah well, I can do anything for 12 hours.
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