So one thing I haven’t been able to see this fall is red leaves. I’ve learned that maple leaves turn red in the fall and I am too far north for maple trees. There is considerably more green’age because of all the evergreens and lots of yellow. Maybe the weather will be nice this weekend and I can try to get outside. One more night shift..!
And yes- I posted the pic of the first snowfall. It actually didn’t stick. I ended up driving to Dryden for groceries later that day because it warmed up enough.
Earlier this week I was enjoying a Skype call with my dad when I got a late evening phone call from the hospital. They needed someone to go into work at 0100 for a patient watch. It was only 2130, so I could snooze and then log some hours. Easy peasey right.
Well not exactly. This truely acute patient required dedicated mental health interventions. I arrived and almost everything had been removed from the room. This patient has been admitted before and has used objects in the room to harm. Including the curtains, and utensils.
Luckily the patient did sleep long intervals, probably related to the medication we had to administer. While I was observing there was only one incident, and of course it was while the primary nurse was covering me about 4 hours in. I needed some fresh air and a walk to wake up. The nurse approached the patient and just inquired if they needed anything- that was all it took. Full blown violent episode. When I returned one nurse was drawing up medications and it took 3 of use to control the patient safely (Thanks NVCI training) while the nurse injected the meds. Then myself and security kept the patient in the room until the meds began to kick in. The whole incident took less than an hour before the patient settled and fell back asleep.
Unfortunately I missed a call from the hospital at about 2230 (I was snoozing) Orange could have been there by 2330 to transfer the patient to psych in Thunder Bay, but I missed the call and did not get in until the agreed time at 0100. By morning the patient had lost their bed. When I returned for my next shift the transfer was completed and a debriefing was scheduled for staff who wanted to talk about the incident. As often as these patients are admitted to this facility it still takes a toll on these Med/Surg nurses, mental health is not their forte, so it was nice to see not only support by consellors and leadership in the form of a debriefing but also the mandatory yearly Non Violent Crisis Intervention training.
For my next shift I was booked to receive a post- op patient. One that was 10 yrs old. Yep – it has been at least 5 years since I worked in St Catharines on the Surgical unit and my first pediatric patient. The kid was flown in for abdo pain and had appendicitis. The procedure was completed laproscopically so this is a good, introduction to post-op paeds care.
So what I know about nursing kids.
- Buetrol for IV fluids, at least I had some practice using this in ER.
- VS norms can vary pretty drastically for kids.
- It can be difficult for kids to express their pain.
- Med administration is based on weight, in kg.
It was 2345 when I went to the OR to pick up my patient. Yep – did I ever mention that, no porters. I had to drive the stretcher from the OR to the nursing floor and I didn’t hit any walls 🙂
My patient was very tired, it had been a very long day. My only concern overnight was blood pressure, it dropped too low for an adult. But the frequency of checking post op vitals is so frequent when I spoke to the other nurses about it, it was not a finding to worry about. Sleeping = no feeling of pain = low BP. And like I said the 8 hours I monitored this patient I had to monitor vital signs frequently. Phew!
At about 530 my patient finally expressed some pain, and I gave scheduled Advil & Tylenol. Had to bust out the calculator to check my math to ensure I was giving the correct dose. And the 3 laparotomy sites were completely intact with no drainage noted to the outside. Excellent, normal post operative pathway. Hopefully this patient will be discharged to the hostel with follow up with the surgeon in a few days.
Thursday night I returned to see that my little friend was still on the unit. It turned out that eating regular foods was troublesome during the day so one more night with me. And what a difference – this kid was totally acting like a kid. When I went in at 2330 to given some pain meds, the Ipad was on and he was clearly eating Cheesies, it was obvious. Better night there.
On the other hand, I had one new patient to my team, a 16 year old patient that came in complaining of abdo pain. This kid neglected to tell anyone he had ingested a bunch of Tylenol. So appropriate care was delayed; from the nursing station through transport to us then until he received a CT scan. Hours! I recently did a write up about Muscomyst and how it helps the liver process all of the toxic Tylenol. All this 16 year old wanted to do was leave the unit to smoke outside. There was an aid worker from the First Nations own children’s aid supervising him, but here I am back being a medical, mental health nurse. Montioring his bloodwork and speaking with poison control and giving IV meds so that the liver isn’t damaged and sitting talking with him trying to ascertain why the Tylenol was taken in the first place.
Needless to say I was ready for a weekend off after these three shifts. And the weather yesterday when I got up was lovely. Went down to the lake and spent a few hours walking and listening to Breath of Snow & Ashes Outlander book 6. Made this Chicken & Squash Casserole for dinner, enjoyed a glass of red and watched Star Trek Beyond.
Thanks for listening — feels good to write this all out.
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