August 14, 2013. It should have been a really normal duty day like most days.
However, I had a morning shift, my fifth one in a row. That means, I am already suffering the ''lack of sleep syndrome''.
And second, It was a hectic morning shift.
For the sake of references and just pure expression, allow me to narrow down everything that happened today. It's nothing serious, mind you. But you will get an idea of how things work around here if you work as a nurse.
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I woke up around 5 am today. Prepared myself and waited for the bus that came around 5:35, since I was still too sleepy to walk for 20 minutes to the hospital.
I changed in to my scrubs in the locker room and went up.
I received 7 Intensive care patients today. ''Überwachungspatient''. The first one is Mrs. R., she's an old lady who fell down and had a terrible brain bleeding. She had to be operated in the middle of the night two weeks ago, to save her life. She's now stable, but she still has a central venous catheter for her medications and infusion. And also, she has Escherichia Coli in Urin and it's a 3-Multi-resistant strain. That means, out of the four groups of Antibiotics, she is resistant to three of them. So, we are implementing Barriere Isolation. She has the infection in her Urin.
Second patient is Mr. L. He had an intracranial bleeding after he fell down the stairs. He was already operated upon, but he retained some damages. He is awake, but he has a tracheal canula and I have to suction him almost every 30 mintues because produces a lot of tracheal and para tracheal secretion.
He was also due for a PEG (Percutaneous Endoscopic Gastrostomy) yesterday for his gastric tube placement but since he received an anti coagulant by mistake yesterday, he had it today instead.
PAtient 3 is mrs. K, she was found unconscious in her apartement on Aug. 1, in a pool of vomitus. She was operated (hemicraniectomy right sided) on Aug 1, and she had an angiography on Aug 2 to see what caused the bleeding or the unconsciousness. She also has arteriovenous malformations. She is soporous and semi-comatose. She has a tracheal canula and has occational bouts of wheezing in which I have to give her Sultanol for a long-inhalation therapy. She also has an NGT. Btw, I am amazed by all the equipments here in germany. I will try to post some pictures next time of the NGT pumps, etc. because I never saw one before in the philippines. And Mrs. K also has an infection she has Piperacillin-tazobactam Antibiotics.
Fourth Patient is Mr. S, he also had an unfortunate accident where he slipped, but he cannot remember exactly what it was. He has a chronic subdural hematomas left and right sides frontal. He was trepanated yesterday on the bedside and ca. 53 ml dark blood came out. He was trepanated again today. He also has a history of heart disease and he is known to go down with his Heart rate to up to 35 beats per minute.
PAtient 5 is Mr. B, he was walking with his walker early this morning in the Home for the Aged when he fell down and hit his head. He was born on 1927. So he is a bit old. He should have been operated, but the daughter and the family do not want this anymore. So he was in the Intensive Station, then I took him from there, and now he is comatose, he has anisocoria, right pupil is 4mm wide and does notshow any reaction to light, and the left one is smaller, around 2,5 mm also with very little reaction. He does not have any NGT because the family still wants to decide if he should be given something to prolong his life, or not.
Patient 6 is Mrs. E, she was driving her car yesterday when suddenly, she lost consciousness. She was brought to the hospital and they saw a dark 'fleck' spot in her brain. Then since yesterday afternoon, she is getting worse and worse. Now she is almost comatose. She has meningitis and also gramm-negative bacilli in her spinal fluid. She has an extra centricular drainage and it's 10 cm above her nose bridge, cloudy CSP is coming out of it, most probably because of her infections. There are still a lot of unclear suspicions about her infections. She is isolated.
and lastly PAtient V, she is a woman around 40's, she tried to kill herself last month by driving in the other direction in the Autobahn. She had an accident of course, got multiple facial and cranial fractures, dislocation of acetabulum, subdural heamatomas, Sub-arachnodial bleedings, air got inside her cerebral area, etc.
She had a hemi-craniectomy right side, her right sided fronto temporal bone was taken out and 2 days ago she received a plastic one. she has a tracheal canula, she is comatose, her pupils are 4mm both sides and both do not show any reaction to light,she has her NGT in her mouth because of all her fractures.
Now you know my patients, I will quickly narrate my shift:
I got my endorsements, I checked the medications for the day.
Prepared the Antiobiotics for 6 am and 7 am.
I went to my ''Überwachung'' patients, did my usual vigilance checks,
repositioned the patients,
suctioned Mr. L (tracheal),
suctioned Mr. K (tracheal and oral)
checked blood sugars of Mrs K and Mrs E
received phone call to send Mr S to EKG
I ordered the transportation through our PC,
searched for a transport chair and prepared mr S for transportation.
WEnt to the 'Große Wache'
washed Mrs. R (using barriere isolation measures) and gave her her breakfast
ran out because of an emergency alarm,
another patient in the other 'große Wache' fell out his bett and was hanging by his arm on the bed side
I helped my colleague who was responsible for him
I helped distribute the patients breakfast (47 patients) and gave them coffee or tea to drink
came to my 'wache' and washed mr. L and prepared his bed so that he can be sent right away for his PEG if I receive a call
He was called, I ordered transport, organized his papers and medication, and sent him down,
Mr S is back to the station, I went down and brought the EKG results to the station 3 floors lower than ours and I had to return again for the examination 'konsil'
then I went to the isolated room of MRs. E, assessed her, instered a new NGT , washed her with cold octenisept, hung 1 L Infusion and PAracetamol for her fever,
went out, spoke with the doctor about the Urinary catheter of MRs. K which had fresh blood on it,
I suggested deblocking the catheter and reinserting it and blocking it again and then flushing it with NaCl afterwards. she agreed and I tdid that
Urin was afterwards clear
I went to the main room to have breakfast with my colleagues.
I was interrupted several times by phonecalls form worried family members of my patients,
asking me how their father or sister or mother is today
it was then alright.
we had to buy our own breakfast today because it's not allowed to take part of the meals from the hospital
then after eating I went out and helped gather the breakfast tray from thw whole station
then on one room, one patient with subarachnoidal bleeding had lots of blood on her sheets and bed because she pulled out her central venous catheter.
I helped my colleague who was responsible for her
put pressure on the vein and change the whole bed. we had to drive her out of the room,. get a new bed and transfer her on the new one.
then I went to my wache, gave the morning meds,
suctioned some more.
then I started washing mrs. K, but since she's having NGT cost, she is also having diarrhea and that was quite unpleasant because I kept on cleaning and washing her again and again.
then I hung her NGT cost using the pump and the tubes.
In that time, I replaced 4 sets of perfusor injections because they were empty.
Then I prepared some sultanol inhalation for mrs K
then I went to Mrs R and changed into my disposable gown and tried to move her from the bed to the chair with the help of the physical therapist.
then I remembered the new doctors order for her which was the taking out of her central venous line.
I had to do that sterile, then cut the tip and place it in a sterile container, and send it to the laboratory.
then I received a call from our secretary . she asked me a favor to go the the hosp. laboratory and get the 2 erythroctes bag for a Mr. U who is in the other station. I told her okay, then luckily found a practicant and asked her instead to do this.
Then i received a call to get Mr. B from the intensive station. I did this, well, you know his story from above,
then I came back to the station, placed him beside mr. S, and did my check, placed him on the monitor observation , gave him O2, and prepared his documents. gave the documents to the doctor and reported of his present state. he is also tachycardic.
then I went to the big Überwachung and gave insulin to Mrs. K, and received call for a CT scan for mrs R.,
prepared her by moving her from the chair back to the bed alone., ordered transport, and went out
got call 30 mins later from CT asking me why I did not inform them that she has an infection.
tried to explain that it was just barriere isolation, with gloves and gown if necessary.
then got another call from intensive station, I should fetch mrs. V,
i went down with O2 machine, and got her, you know her story from above as well (she tried to do suicide)
same procedure done with mr. B.,
went to the main room, saw that it was already 2 pm, hurried to empty the catheters and drainages for balancing,
doctor came in and wanted to get me to help with a cranial trepanation with Mr. S,
told her to wait a bit and tried to place Mrs.R back in the monitors coz she was back,
then saw the student/practicant that she was done with her return demonstration with teacher and asked her kindly if she can assist the doctor with the trep coz I had to do all documentation
then did my last rounds with patients,
repositioned them and assessed their vigilance and temperature.
then hung the noontime antibiotics
then removed infiltrated iv needle of mr. s
then went to main room, sat down, and began writing documentation for all patients.
I gave the endorsements to the pm shifts
then wrote down all monitoring values from 6 amd to 3 pm
by the time I was done, it was 10 minutes to 4pm
A new spanish colleague then asked me
''lara, why dont you just leave the undone things for the pm shift?''
then I answered her,
'' I know if I leave things undone, there will be negative thinsg said afterwards, and it is my job and responsibility to do them all. Just because most of our other colleagues are doing that, leaving things undone, doesnt mean I have to do that too. You and I, we come from foreign lands, somehow, we have to show them what we're worth. We have to show them that we can stand up and live up to beyond their common expectations. Prove to them that just because we're foreigners in this land does not mean that we cannot work well. instead, show them, that mostly, we can do even better than average. Exactness and CAre. That's our motto. Always do the right thing for the patients.''
she smiled and i think she felt encouraged. she told me I was right,
then just before I went down to change in my locker,
the chamber maid ran to us and said something about someone throwing up in the elevator. I put down my bag, looked for a kidney basin and ran to the elevator, I arrived at the small ones and shouted ''where'' while holding up the basin. the people there looked surprised at me
embarassed, I went to the bigger elevators and saw my colleague with a a patient who was vomiting, gave him K.B. and assisted her to the station.
elevator accidentally closed and we were dismayed because the vomitus was still on the floor.
the we pushed the button again till it was there, and placed a metal wagon in between the doors so that the cleaning women can clean it.
then finally, I went home.
so there. long, but somehow detailed version of my morning shift today.
there may be some points left out, but you get the picture.
it's a typical day in the hospital.
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