The Nice, The Mean, and The Crazy!

Whew, we're back! Warning: this is a novel. Sorry!

Past few weeks have been totally crazy between midterms, clinicals, open labs, and more. But I finished my exam this morning earlier than anticipated, so I'm giving myself a break to finally update on the blog!

Biggest thing going on lately: clinicals. And I've had some interesting experiences! The first thing I want to say, is that being in nursing school and being fascinated by health problems creates an interesting dilemma. When I get my patient (henceforth, pt) and I look up what's wrong with them, it's hard not to be totally fascinated by their many diseases and multi-faceted health complications, not to mention, the prospect of going to any number of procedures with them which would be totally crazy to observe. At the same time, you feel bad about being excited about all this, because the fact of the matter is, the pts are still people, and you feel bad that there are so many things wrong with them. And then you feel bad that you're excited to learn about their many problems. It's strange. Especially on a cardiac unit, where a lot of the pts look and act totally normal, but may actually have less than 5 years to live, though they're only 24 (one of Mary Kelly's patients). I think we're all definitely gaining a new appreciation of the meaning of life and good health.

Ok story time!
Last week: my pt was a 70 yo man, who was recently diagnosed with coronary artery disease (in addition to congestive heart failure). They found out that he had 3 vessel disease and wanted to do open heart surgery (CABG) but he also had Factor V leiden disease, which is a clotting disorder. If you're heterozygous for the disease you are 4-8x more likely to throw a clot post-surgery, if you're homozygous you are 80% more likely. So they wanted to figure out what he was before going ahead with the CABG. They determined he was heterozygous for it, and so he spent pretty much all last week waiting for the surgery. I get along GREAT with old men - we always hit it off so well, so I had a lot of fun with him. He was SO nice and cooperative, and really sweet about working with a student. I got to go with him for his ECHO (like an ultrasound for hearts, looks at the heart valve functionality) and it was SO cool. You could see clear as day on the screen, his heart valves flapping open and closed. He ended up having his surgery on Monday and from what I can tell (he's no longer on our floor), things are looking good for him.

Tuesday: I had an 87 yo female, who had CAD, CHF, gastroesophogeal reflux disease (GERD), and stage 3 chronic kidney disease (CKD). Her CKD was really her biggest issue, but she was admitted to our floor (cardiac unit) because she came in with shortness of breath and chest pain. Her labs showed critical high levels of her cardiac enzymes, meaning either she had a minor heart attack or is very likely to have one. The strange thing is, both she and her family have opted to not pursue any treatments for anything. She's a do-not-resuscitate (DNR) pt, and they're looking only to get symptomatic relief, no treatment. I understand the decision, but it's still strange for me. Either way, most interesting thing about her? She was...ORNERY! She refused a bath in the morning, and was yelling at me and my clinical instructor (Louise). The first time she raised her voice with me, I was totally shocked. I was like, you are 87 and dying of several diseases, where is this coming from!? Then I thought about that statement, and figured that's probably exactly where it was coming from. Either way, I got yelled at a lot on Tuesday - every time Louise and I left the room, we just looked at each other and had to laugh. She also refused to let me remove her IV stating, "I don't want to be a guinea pig!" Haha, it was definitely an experience. After I changed her gown and sheets, and got her juice though, she was just as pleasant as could be. And she gave us great reviews...what!?

Wednesday: This wasn't my pt, but when we got to the unit yesterday, we kept hearing this yelling coming from a room. Well it turns out there was a pt there who had gotten in an altercation (broken jaw) and was taken to the ER, but he was threatening nurses and other people. They wanted to take him to an ICU, sedate him, and then get him to an OR to fix his jaw, but there was no ICU beds, so he came to our unit to wait for one. Because you can't really sedate people and monitor them closely on the floor, they couldn't do anything until he got taken to the ICU. He was in 4-pt restraints (all 4 limbs, tied to the bed) and was fighting it and yelling the entire time - SO loudly; he was not only crazy, but going through delirium tremens (really severe alcohol withdrawal). When they finally had a bed for him, one of the girls in my clinical group, Elizabeth, and I assisted Louise and other people on our floor in the transfer. I was using my full weight to hold down ONE of his legs, he was kicking so hard. Because he was flailing around so much and kept trying to take off his gown, I saw a lot of things I didn't want to - but hey, I guess that's the life of a nurse, right? They gave him Haldol (anti-psychotic) and Ativan (anti-anxiety) and it was chore trying to get it into the IV. They gave him A LOT: Louise said if they'd given me the amount of drugs they gave him, it would've killed me, without a doubt. Either way, it only helped a bit, but was enough to transfer him without TOO many problems. It was so crazy. But it was sad too.

So those are my crazy stories for the week. At least I didn't have to help with a "Code Brown" like one of the girls in my group did! Yes, that's exactly what you think it it. Clinicals are fun!

Sorry for the length!