Pt biba following RTC. 3xPCW around R 4-5 IC spaces. ?# R NOF as S+R of limb and dec ROM. GCS 12. MEWS of 5 due to rr 22, pr 114 and systolic bp 98. 15l o2 via non-rebreathe, maintaining sats 89%. ECG done and shown to dr. IV morphine administered as per prescription chart. CXR, Abdo XR and Hip XR ordered. Pt a/w tx ESAU.
This patient was an absolute wreck, I was helping work on him. Later that shift I found this nursing note written by a charge nurse also working on that patient. I can understand everything written there but I feel nursing notes should be a little clearer. The translation is as follows -
Patient brought in by ambulance. Three penetrating chest wounds around the right fourth and fifth intercoastal spaces. Query fractured right neck of femor as there is shortening and rotation of the limb and decreased range of motion. Glasgow coma scale of 12. Modified Early Warning System score of 5 due to resp rate of 22, pulse rate of 114 and systolic blood pressure of 98mmol. Patient on 15 litres of Oxygen via non-rebreathe mask and maintaining oxygen saturation of 89%. Electrocardiograph done and shown to doctor. Intravenous morphine administered as per prescription chart. Chest X-Ray, Abdominal X-Ray and Hip X-Ray requested. Patient awaiting transfer to emergency surgical assessment unit.
Monday, 4 May 2009
Saturday, 25 April 2009
A&E: Day Four
My fourth shift started with my primary mentor in majors, we had a couple of chest pains(?MI) and a headache with left sided vision impairment and limb weakness. All very pleasant patients. And then I got asked to take a set of obs on a patient in resus because they were rammed in there and didnt have the time to juggle everything. Seven hours later I left resus.....
It was incredible, juggling obs, drawing meds and just generally identifying jobs that needed doing and doing them before the qualified staff realised they needed to be done. At the end of my shift I got a chance to chat with two of my patients in resus(they were on half hourly obs and nothing else in there needed doing). One lady in her late eighties came in with chest pain(i'm told she was a little bit in love with me). I find that a lot of elderly patients get spoken down to. as though they have no right to know exactly what is happening to them as long as their progeny have been filled in. I do not agree with this, as long as the patient is competant and willing to know, they have every right to know whats going on with them. This also seems to help me form nurse-patient bonds. This patient was very stable when I went off duty.
Another patient was a lady probably in her late fourties, overdose of paracetamol. her fifteenth suicide attempt in the last twelve months. This told me several things. The patient felt rewarded by the attention her suicide attempts acheieved, the patient shouldnt have been in a position to make a second suicide attempt, let alone a fifteenth. She should have been sectioned under the mental health act. As a result I felt obliged to give her my most professional behavior, I did everything by the textbook, with no more than the professionally required level of warmth. Its a shame, the patient was such an intelligent person and she was wasting her life by trying to end it.
On the other hand we all over our stories and people dont end up like that unless a series of events has guided her path there. To be honest I had no idea what to do non-medically that would be in her best interests. I am sure she will survive to discharge and in all probability make another attempt, who knows one day she may accidentally succeed.
There was another patient who died under circumstances that really effected me but it is probabilty disrespectful to recount the events of his failed resuscitation on a public blog. Needless to say there are some parts of the job I will never enjoy.
However I have had another great day, largely thanks to the staff I have been working with. I am more than ready for my two days off now and a bit of sleep.
It was incredible, juggling obs, drawing meds and just generally identifying jobs that needed doing and doing them before the qualified staff realised they needed to be done. At the end of my shift I got a chance to chat with two of my patients in resus(they were on half hourly obs and nothing else in there needed doing). One lady in her late eighties came in with chest pain(i'm told she was a little bit in love with me). I find that a lot of elderly patients get spoken down to. as though they have no right to know exactly what is happening to them as long as their progeny have been filled in. I do not agree with this, as long as the patient is competant and willing to know, they have every right to know whats going on with them. This also seems to help me form nurse-patient bonds. This patient was very stable when I went off duty.
Another patient was a lady probably in her late fourties, overdose of paracetamol. her fifteenth suicide attempt in the last twelve months. This told me several things. The patient felt rewarded by the attention her suicide attempts acheieved, the patient shouldnt have been in a position to make a second suicide attempt, let alone a fifteenth. She should have been sectioned under the mental health act. As a result I felt obliged to give her my most professional behavior, I did everything by the textbook, with no more than the professionally required level of warmth. Its a shame, the patient was such an intelligent person and she was wasting her life by trying to end it.
On the other hand we all over our stories and people dont end up like that unless a series of events has guided her path there. To be honest I had no idea what to do non-medically that would be in her best interests. I am sure she will survive to discharge and in all probability make another attempt, who knows one day she may accidentally succeed.
There was another patient who died under circumstances that really effected me but it is probabilty disrespectful to recount the events of his failed resuscitation on a public blog. Needless to say there are some parts of the job I will never enjoy.
However I have had another great day, largely thanks to the staff I have been working with. I am more than ready for my two days off now and a bit of sleep.
Friday, 24 April 2009
A&E: Day Three
Today has been the best(and most exhausting) day in my two years of training. I was working on resus. I lost count of how many chest pain patients we saw. We also had a few stroke patients. Normally my hospital thrombolyses(injects an agent to break down clots) about eight people a month. Today we did this to six patients. They have to meet a very specific criteria to be eligable. It was all very exciting. While we didnt have any actual arrests in resus all of our patients were very ill. We also had two patients with very impressive breaks (one elbow, one wrist) who were sedated and had their breaks manipulated (pulled into a more stable position and cast) both of these patients were admitted as they would require surgery.
Something that strikes me as very different here is that the doctors actually get stuck in with general nursing duties, a doctor helped me transfer a patient to the ward. She also later on helped me roll a patient so I could get a bed pan under her. This would never happen on the wards. The nurses in A&E are all so laid back and relaxed, someone could walk through the doors in flames and they would probably yawn before putting the flames out. There is no such thing as a rush in A&E. I like this approach, calm and sure.
Something that strikes me as very different here is that the doctors actually get stuck in with general nursing duties, a doctor helped me transfer a patient to the ward. She also later on helped me roll a patient so I could get a bed pan under her. This would never happen on the wards. The nurses in A&E are all so laid back and relaxed, someone could walk through the doors in flames and they would probably yawn before putting the flames out. There is no such thing as a rush in A&E. I like this approach, calm and sure.
A&E: Day Two
Back on majors again today, and loving it. A couple of old ladies collapse query cause. This means taking a full set of basic tests - ECG, Pulse, Blood Pressure, O2 Saturation, Resp Rate, Temperature. And blood tests including - Full Blood Count(FBC), Microcultures and Sensitivities(MC&S), Blood Glucose Levels, etc. Because its easy enough treating the injuries sustained in the fall but the cause could be very sinister. In this case on patient was admitted with fast atrial fibrilation(Fast AF) and the other wise discharged as the fall was caused by a raging urinary tract infection(UTI, very well known for knocking little old ladies off their feet and making them a little crazy at the same time).
We also had a couple dementia patients who didnt stay with us long, they were admitted for a social sort out. Not really our job but the ward nurses are very used to this sort of thing.
All in all another awesome shift, Roll on Tomorrow!
We also had a couple dementia patients who didnt stay with us long, they were admitted for a social sort out. Not really our job but the ward nurses are very used to this sort of thing.
All in all another awesome shift, Roll on Tomorrow!
A&E: Day One
Sorry for my lack of posts recently I've been putting a bit of time into preparation for my new placement. I am now spending eight weeks on Accident and Emergency. This is very much where I want to be career wise.
For my first day I was working majors. This is where patients go if they have a serious injury or illness and will probably require inpatient admission. My first patient was a known alcoholic in his mid-fourties who was found in the middle of a road unconcious with some very nasty grazes down his arm. Grazes dont sound that bad however he was losing about a pint of serous fluid(clear body fluid) every few minutes. He had taken most of the layers of skin off his. Obviously the key here was to dress the wound and get as much saline into him as humanly possible, we also gave him various vitamins to ease the effects of the alcohol withdrawl. All in all a really good first patient.
We also had a couple of road-traffic collisions(RTC's) one of whom was triple-immobilised by the ambulance crew(neck colar, head blocks and straps all over hte body). We had to get an x-ray of his c-spine before we could remove any of this. This shouldnt be too hard but we are fairly sure he dislocated his shoulder as well so it was damn near impossible to get a clear picture of the last cervical(that spelling doesnt look right but my brain is melting so it will do) vertibrae.
All in all an exciting first day.
For my first day I was working majors. This is where patients go if they have a serious injury or illness and will probably require inpatient admission. My first patient was a known alcoholic in his mid-fourties who was found in the middle of a road unconcious with some very nasty grazes down his arm. Grazes dont sound that bad however he was losing about a pint of serous fluid(clear body fluid) every few minutes. He had taken most of the layers of skin off his. Obviously the key here was to dress the wound and get as much saline into him as humanly possible, we also gave him various vitamins to ease the effects of the alcohol withdrawl. All in all a really good first patient.
We also had a couple of road-traffic collisions(RTC's) one of whom was triple-immobilised by the ambulance crew(neck colar, head blocks and straps all over hte body). We had to get an x-ray of his c-spine before we could remove any of this. This shouldnt be too hard but we are fairly sure he dislocated his shoulder as well so it was damn near impossible to get a clear picture of the last cervical(that spelling doesnt look right but my brain is melting so it will do) vertibrae.
All in all an exciting first day.
Wednesday, 8 April 2009
Chaplains
The National Secular Society are suggesting that the chruch should fund Chaplains in UK hospitals. This would save the NHS £40,000,000 per year.
I am far from a religious person. I believe there is something bigger and more powerful in this universe than I can understand. I have no idea if its some kind of intelligent entity designing the universe to some kind of plan. I seriously doubt it but thats just me. But I have seen the effect these chaplains can have on my patients lives. They are a crucial part of a lot of patients care. It is important to appreciate that most hospital inpatients in a general hospital will be elderly. They are from a generation which has led them to go to church every week. It is important for them to feel their God(s) havent abandoned them when they are ill or dying. A few months ago I had a patient who was incredibly ill, she was dying and frankly we couldnt explain why she was still alive. She was in an incredible amount of pain and understandibly terrified, until she saw our chaplain. After a bit of a chat and a couple of prayers this patient faced her imminent death without any noticable fear. It was incredible. This is the basis of my opinion that faith is a beautiful thing, it can lead you to do things that you are not capable of and it can bring you peace. I dont necessarily mean faith in God(s), faith in yourself, faith in science, etc. The problem is religion is political. You are told to believe like this, or worship like that otherwise you are going to be punished.
As I said I am far from a religious person but as a student nurse I cant help but recognise the significance of Holistic Care(caring for the whole. physical, emotional, spiritual, etc). I am deeply worried that if the job of financing these chaplains goes to the church they will be subject to the churchs politics the same as any other priest, vicar, etc. And this may well effect the emotional wellbeing of my patients.
I am far from a religious person. I believe there is something bigger and more powerful in this universe than I can understand. I have no idea if its some kind of intelligent entity designing the universe to some kind of plan. I seriously doubt it but thats just me. But I have seen the effect these chaplains can have on my patients lives. They are a crucial part of a lot of patients care. It is important to appreciate that most hospital inpatients in a general hospital will be elderly. They are from a generation which has led them to go to church every week. It is important for them to feel their God(s) havent abandoned them when they are ill or dying. A few months ago I had a patient who was incredibly ill, she was dying and frankly we couldnt explain why she was still alive. She was in an incredible amount of pain and understandibly terrified, until she saw our chaplain. After a bit of a chat and a couple of prayers this patient faced her imminent death without any noticable fear. It was incredible. This is the basis of my opinion that faith is a beautiful thing, it can lead you to do things that you are not capable of and it can bring you peace. I dont necessarily mean faith in God(s), faith in yourself, faith in science, etc. The problem is religion is political. You are told to believe like this, or worship like that otherwise you are going to be punished.
As I said I am far from a religious person but as a student nurse I cant help but recognise the significance of Holistic Care(caring for the whole. physical, emotional, spiritual, etc). I am deeply worried that if the job of financing these chaplains goes to the church they will be subject to the churchs politics the same as any other priest, vicar, etc. And this may well effect the emotional wellbeing of my patients.
Friday, 3 April 2009
Productive Ward
Many trusts seem to be adopting a fairly interesting new system known as Productive Ward. This is where for one shift on a regular basis a nurse is taken off of his/her clinical duties and sits down and trys to think of ways to make the ward more productive. Something as simple as moving the commodes nearer the door in the sluice room so that it takes a fraction of a second less time to get the commode to the patient(which apparently adds up).
A ward in bath has made the news because rather than having the one set of keys for the drugs trolley floating around different members of staff depending on who used them last they keys are now locked up in a safe and every member of staff is given a key for the safe. The benefit here is that they can now avoid a very regular occurrence on all wards - a member of staff has gone home with the keys in their pocket and has now got to be dragged back in because none of the patients can get their medications. I would strongly argue that the downside of this system is that when they keys are floating they are always in the possession of a member of staff, someone relevant always knows where they are. If they are in a safe they are unobserved for long periods of time, added to which there are now keys for the safe all over the place. This seems far less secure and potentially very dangerous.
All in all the productive ward scheme seems to be keeping peoples attention on the importance of ward efficiency however I am not certain that the changes made are really making a difference. Another drawback is the nurse working a productive ward shift has to do it on the ward. If you are a nurse on your ward you are going to get roped into checking IV's, answering buzzers, and generally chipping in during those day to day crisis moments on the ward(which frankly I would prefer). This wouldnt be too bad if most wards didnt insist that a nurse in a productive ward shift has to wear plain clothes(no uniform).
However it does make you think how much time and energy is wasted at work through tiny inefficiencies. It does all accumulate.
On a side note I recommend you guys take a look at This Site. Its full of little educational flash games. My favourite is the blood typing game.
A ward in bath has made the news because rather than having the one set of keys for the drugs trolley floating around different members of staff depending on who used them last they keys are now locked up in a safe and every member of staff is given a key for the safe. The benefit here is that they can now avoid a very regular occurrence on all wards - a member of staff has gone home with the keys in their pocket and has now got to be dragged back in because none of the patients can get their medications. I would strongly argue that the downside of this system is that when they keys are floating they are always in the possession of a member of staff, someone relevant always knows where they are. If they are in a safe they are unobserved for long periods of time, added to which there are now keys for the safe all over the place. This seems far less secure and potentially very dangerous.
All in all the productive ward scheme seems to be keeping peoples attention on the importance of ward efficiency however I am not certain that the changes made are really making a difference. Another drawback is the nurse working a productive ward shift has to do it on the ward. If you are a nurse on your ward you are going to get roped into checking IV's, answering buzzers, and generally chipping in during those day to day crisis moments on the ward(which frankly I would prefer). This wouldnt be too bad if most wards didnt insist that a nurse in a productive ward shift has to wear plain clothes(no uniform).
However it does make you think how much time and energy is wasted at work through tiny inefficiencies. It does all accumulate.
On a side note I recommend you guys take a look at This Site. Its full of little educational flash games. My favourite is the blood typing game.
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