The Dog Ate My Care Plan…

Just a mom/wife/nursing student extraordinaire trying to make it in the big bad city…

Posts Tagged ‘blood’

When In Doubt, Wear Gloves

Posted by isntshelovlei on June 19, 2010

Just when should you wear gloves? Usually the rule of thumb is to always wear gloves when there is a risk of coming into contact with blood, body fluids, or mucous membranes, and if either you or the patient has areas of broken skin.

So I had a patient this weekend—I nicknamed him Mr. Independent. He had a BKA (amongst a host of other things), and didn’t want anyone helping him do anything because he was damn well capable of doing it himself (a nice change from what one of my instructors describes as the patients with the “alligator arms”). So his primary nurse asked him to at least call one of us when he planned to transfer. He of course informed us (once more) that he had already been trained to transfer and had been doing so successfully (by himself) for over six months now. But he agreed to call. So when he did, I came in and of course I didn’t think that going from point A to point B would involve coming into contact with any body fluids. But one too swift move from Mr. Independent and all I saw was red. Blood running down his arm..in the spokes of his wheelchair…on the floor. He had pulled out his frickin’ IV. I silently panicked because I immediately thought “I’m not wearing gloves!!” but I kept it pretty calm, cool, and collected on the outside. I think I automatically switched into Mom-mode. I remember once my daughter decided to jump off the top bunk bed and my son screaming “MOOOOOOMMMM! She’s BLEEEE-DING!!!!” So I’ve seen my fair share of bumps, bruises, and blood. I calmly told Mr. Independent, “I need you to STAY right there and I will be right back.” I knew gloves were right outside the room, so I popped out, grabbed a pair, just so happened to spot his nurse in the hall, waved her in, and popped back in (now gloved) to put pressure on his IV site all in about 15 seconds. Move over Carl Lewis…

So while I don’t plan to wear gloves 24/7 when I’m in the hospital, I now definitely keep a pair in my pocket—along with all of those other what-every-nurse-should-carry-in-their-pockets items…like alcohol pads!

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Silence Is Not Always Golden

Posted by isntshelovlei on May 3, 2010

Our last OB clinical was yesterday—there really was a light at the end of that long, dark tunnel. I really didn’t think I could take another day on the postpartum floor so I was glad when my instructor said I could go to the NICU. But it’s never a good sign when you get there and the charge nurse presents you to the nurse she’s assigning you to and tells her, “I’m sorry, I have to give you a student today.” WTF?!? And like I wasn’t even standing right there! The nurse kept a straight face but you could tell she was less than pleased. So there I was, only there for about 60 seconds, and I was already turned off to the whole situation and ready to leave. You have TWO whole patients who sleep 98% of the day anyway, what is the big damn deal? Lord forbid I keep you from your sticky buns and trash mags…  

But I took a deep breath and kept it moving. It was the last day, and I was determined not to feed the trolls. I did the eternal scrub up to my elbows just to be able to enter the unit but was not allowed to touch anything—not  a chart, not an isolette, and certainly not a baby—for five-and-a-half painful hours. I should have brought a crossword puzzle or something. I’m really starting to rethink my desire to be a NICU nurse. Not because of the less than stellar experience I had (because the nurses in the NICU where I volunteer are great), but because I’m starting to think it’s just not enough excitement (patient care/interaction) for me. I know that some people like relaxed jobs where they sit around and don’t do much, but if that’s all I wanted to do I could have went to school for envelope stuffing or something. The most interesting thing that happened all day was two incidents where fentanyl (big time pain med—100 times more potent than morphine) syringes came up to the unit completely empty. But they weren’t just empty syringes. They were actually drawn up to the dose that was supposed to be in them but there was nothing in those chumpies but air. Gone unnoticed, that would have been one hell of an air bubble… Freak pharmacy thing or…you fill in the blank…

Though it’s no secret that maternity wasn’t my favorite rotation, our last moments in OB will forever leave a footprint on my heart. As we walked through L&D we could hear a woman in the actual pushing stage of labor. And she was a-hollering—totally to be expected when you’re pushing something the size of a watermelon out of a hole the size of a lemon. She had the nulliparous students in the hallway cringing at how much pain she apparently was in. So she’s in there screaming and you can hear the nurses encouraging her to push. There was a climax of activity/noise and then all of a sudden it was quiet. Since we were not actually in the room and able to see what was going on, at first when you hear the woman stop screaming you figure okay—the baby is out. But then you slowly start to realize that it’s too quiet. The critical thinking wheels start to turn and you ask yourself why isn’t the baby crying? Next thing I know they were calling for a neonatal crash cart… 

…dystocia…nuchal cord x 2…baby completely blue…umbilical cord separated from the placenta…blood everywhere…

When you work in health care you will sometimes see how even in a beautiful situation such as a new life being brought into the world, things do not always go as planned. Always count your blessings.

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