Week Twelve: February 1-2, 2010

This week was another exciting week, on Monday I was on the floor taking care of two patients and on Tuesday I was able to go to the Ambulatory Care Unit along with the GI lab. On Monday one of my patients was a 63 year old woman who had been found on the streets severely dehydrated and confused. She was brought to the ER and she had mentioned she was currently homeless, had no family nearby, and she also claimed to have had a stroke. When I met her in the morning she seemed very quiet and somewhat overwhelmed. I don't blame her, after being admitted into the hospital it seemed as if every test imaginable was being performed; drug tests, blood tests, chest x-rays, cardiac monitoring, etc. The purpose of these tests was to obtain a baseline of her bodily systems and to monitor her current condition. She was unable to inform the health care professionals about any medical history, she just continued to say she had a stroke. There was no evidence of this other than a generalized weakness. I was unable to spend a lot of time with her because she was constantly being brought to other floors to get other tests preformed. It seemed like she appreciated my warm welcome back into her room around lunch time and she seemed very appreciative of my care for her. My other patient was an elderly male who also had history of a stroke and a million other things. He was completely nonverbal and non responsive and I hadn't had this nurse-patient relationship since Kindred. During my assessment I tried numerous ways to communicate with him and to also see if he would respond in any way, but every attempt failed. I wondered if he was taking it all in and was just unable to communicate his thoughts back to me; and I thought about how frustrating that would be to me if I were in that position. Who will ever know? I just continued on with my day caring for him as if he understood every single word that came out of my mouth. After my assessment it seemed as if the staff did not take a lot of time washing him up and making sure he was nice and clean as often as they should have. After giving him his bed bath and providing his oral care it was so rewarding seeing how nice he looked. He also seemed to be a lot more relaxed and actually was able to get in a nice nap. On Tuesday I was sent to observe the Ambulatory Care Unit and the GI lab. The Ambulatory Care Unit is providing the patient with pre and post-op medical care until that patient is able to return home. Throughout the day I believe there were about six patients but we were only able to observe a few of them. In particular I helped admit a man suffering from Alzheimer's who needed to have a basal cell carcinoma removed. His wife was with him and was so sweet, it was really interesting observing the relationship between the two of them because he was entirely dependent on her. She even made a comment regarding how difficult it was changing from being a wife into your husband's mother. He was so sweet and genuinely confused about every situation at hand. At one point he asked, "Why is everybody lookin' at me?" His wife, who was from Oklahoma, responded in her sweet voice, "Why honey, everybody's lookin' at you 'cause you're so darn handsome." I thought it was adorable especially because he continued to ask the same question maybe five or six times over and his wife not once lost her patience. I admire that woman in so many ways. Another man I was able to observe had just been brought to ACU after getting abdominal surgery was experiencing respiratory complications to due the Dilaudid he received postoperatively. Dilauded is an opioid analgesic administered to relieve pain. Opioid along with other narcotic drugs reduce the respiratory rate which is very important to monitor throughout all aspects of patient care. This man was put on four liters (which is a reasonably large dose) of oxygen and his o2 saturation level read 88%. Oxygen saturation measures how much of the hemoglobin in the red blood cells are carrying oxygen. It was interesting observing the nurses and their reactions to his low o2 sat readings. I was pulled away from this patient as I was invited to observe a colonoscopy. I was also able to observe two EGDs. An EGD (esophagogastroduodenoscopy) is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract up to the duodenum. It was really interesting being able to observe the entire procedure from admission all the way to post-operative care. The week was very busy and I enjoyed every minute of it. I have a feeling this might be my favorite rotation, but who knows it might get even better than this!