My Day Was Crazy

I feel like no one really cares about my clinical days BUT I'M GONNA TALK ABOUT THEM ANYWAYS.

So this week I was on the dialysis unit on Monday, which was cool. Kind of boring, but I mean, we just had to watch them set up things and ask questions so I wasn't expecting much. I dunno if anyone knows what dialysis is, but it's a machine that acts like a person's kidneys. The kidneys do a lot of things, but their main functions are regulating blood pressure (along with the heart) and getting rid of waste. So when someone's kidneys fail, they just keep all the waste inside of them and it can be really bad.

/minianatomylesson.

So a dialysis machine takes blood out of the body, filters it, and then puts it back in. It's actually kinda fascinating if you're into that kind of stuff. Which I am because nursing student. So I got to see how that whole process goes which was cool.

Then on Tuesdays I was in the cancer clinic. At the hospital here, we can't do radiation because we don't have the technology, doctors or trained technicians, but we have chemo. So I spent most of my day in the chemo area watching that whole process which was really interesting. It was such a positive atmosphere which was really nice to see since a lot of the people we see can be terminal. I got to do assessments and pull out IVs and yeah. It was a good day.

Which brings us to today. Since we only have one more week left and have to work out way up to two patients by the end, we moved up to two patients today. Since I was in an off-unit day on Tuesday, I kind of got last pick of patients, and got assigned a guy who has been on the medical floor for a while and a new admission to the floor.

The one who had been there for a while originally came in because he had a stroke, but he has a history of a few different diseases (high blood pressure, heart failure, diabetes) as well as depression and anxiety. He was dealing with some things that go along with those diagnoses, but he had been quite well considering for the past few weeks. So I was like okay cool, he's stable.

Except he wasn't. He was super tired in the morning, didn't eat breakfast and didn't really eat lunch. He's generally up early, but he didn't get out of bed until almost noon, and he wasn't really answering well when we were talking to him. Things started looking up when he got up for lunch, he went to physio/to do this exercises, but once that was done the physiotherapists brought him back and were like "we think something's wrong with him".

So the nurses jump into action and take his blood pressure, which is kind of high like usual, but then take it again 2 minutes later and it dropped like crazy, which isn't supposed to happen. One side of his body was week, he wasn't responding well, and wouldn't keep his eyes open. So at this point they think he's having another stroke which is scary.

Eventually they ruled that out, but he got taken over by one of the actual nurses on the floor because all while that was going on, I was dealing with my other patient.

He wasn't on the floor the day before when I went to do my research, but I knew he was in for lithium toxicity (poisoning), and had a history of bipolar disorder, anxiety disorder, depression, was super confused, and showed signs of muscle breakdown.

So I looked up some info on those things to kind of prepare myself. Then we get there this morning and I find out he's in 4-point restraints, which means his arms and legs were all tied down, because he was so agitated and restless and wasn't responding to anyone, and was under constant observation (someone was sitting in his room at all times).

So I go in and he's calling out a lot, won't stop moving, and is trying to pull all of his restraints off. He had an IV and the restrain on his one wrist was pushing on it a lot and almost dislodging it. We asked him his name, if he knew where he was, all the general questions you ask to assess someone's mental status. He wasn't responding at all. So we decide to give him some Valium that he was ordered to try and calm him down.

Which means I have to give my first intramuscular injection on someone who won't stop moving and tensing up. When you do those injections, you have to go right into the muscle, use a slightly different technique, and they're pretty hard to push in if the muscle isn't completely relaxed. But I did it and it was stressful but it went in.

And the Valium did nothing for him. I had to talk to poison control on the phone (they were following up with the lithium toxicity) and they said he shouldn't be on that medication anyways, so we had to get the doctor to change the orders.

So the doctor and pharmacist finally gets everything changed and order him Ativan, which is the same type of drug as Valium, just slightly different. So we give that to him, another intramuscular injection, and I still had it. He was moving around even more and made crying noises afterwards and I felt so bad.

So then another doctor comes in and is like "okay, his lithium is down, but his white cell count is up (usually means infection), we don't know why he's still so confused, we're gonna do a lumbar puncture on him".

To which I'm like WHAT OKAY WHAT because a lumbar puncture is basically putting a needle into his spine and getting fluid out to see if he has any infection in the fluid around his brain. So we get everything ready and it takes 4 of us to hold the patient down because he isn't responding to the Ativan either, even though we pushed like 8mg, which is pretty large dose.

So after we get all the fluid, the doctor goes "we're looking for meningitis or herpes encephalitis" and we're all like WHY DIDNT YOU SAY SOMETHING because both of those can be easily transferred through body fluids and none of us were wearing gowns and half weren't wearing gloves and it was just a bad time all around.

So then we get the patient all settled and the doctor goes and orders 4 different types of medications to start to treat an infection in case it was there.

So I ended up giving 4 medications through IV, making sure everything was in the right order, and his IV site ends up getting blown because of the restraint that has been pushing on it.

So I have to grab a nurse to try and put a new IV site (it took 3 people again to hold his down just to get it in) and I had to take the old IV out. Then we had to put another IV site in because he had so many meds, but none of the nurses could do it (and I'm not allowed yet) so we got one of the doctors to come in and do it. He was super chill about it which was great.

And then the patient's sister's came in, and so I had to explain everything to them. Which was kind of difficult because I felt like I barely knew what was going on but they said I was really knowledgeable and they were thankful that they could get info without having to talk to the doctor (because he only stays on the floor to see his patients and then leaves) so that was exciting.

And then we found out he was negative for meningitis, so the doctor ordered ANOTHER medication that I had to give.

And then I needed to chart everything which took forever. Bleh.

So that was my insane ass day. Now I get to sleep for a few hours and spend all day tomorrow working on this stupid assignment that's due on Friday morning. Ugh.

(Also I feel like half of this made no sense but I apologize. I just needed to tell someone about the craziness.)