Med-Surg at RRMC

This week I was a 1 east with Mrs Zimmerman. The first day I had a pt that was 96yrs old wow! Very sweet lady. She was initially admitted for change in mental status, and then treated for a uti, Which I found out from Mrs. Henley that with the elderly get a lot of confusion with uti's. This pt had alzheimers and was deaf! this brings back the zoo trip! how do we communitcate with this type of pt, well I did a lot of writing on a pad for her to read, fortunately she responded. Plus she was able to read lips some. After getting her uti treated and getting her more stable she was then released back to assistant living, with her I did po meds and an injection (pneumococcal) and also did her I&O's foley care, I had some help from one of the nurses Jan she was great with teaching! I got to do her discharge. The second day I had a little more intersting pt. I had a pt that was 49yr old she was admitted removal of her old hardware from a previous fusion of L3,L5 ,L4, S1. which she almost died from dut to an infection, so needless to say she was a high risk for infection. So they did her surgery over after removing hardware. Pt also had Hx of chronic depression, HTN, hypothyroidism, and a tolerance to pain meds. Which made her care a little more complex, she did tell me this all started with a hit and run car accident. She kept me active at least, I felt like I could'nt leave her for a second, she was trying to get up on her own, I am not confortable with someone getting up on their own on pain meds, risk for falls! so I encouraged her to please call someone or wait until I came back into room to help her, so pretty much I didnt leave her too much.I got to see the PA remove her hemovac and he did a lot of teaching about that and from there I got a chance to do a dressing change. After that she wanted to sit in her chair so Mrs Zimmerman and Tushara helped as we put on her back brace, that she hates so much. That didnt stay on long! While doing her bath I got a chance to do a good process recording on her along with some heavy duty teaching for at home. Since she is non compliant, I discussed with her about her incision and eating habits, how she should pace her self and to let her family help her, How to look for signs of infection and reminded her of her last surgery and infection! We discussed bathing and how to use her devices for at home that would help her.I also discussed with her that pain meds shouldnt be her only source of dealing with pain, since she conveyed to me in my process report of some of the things she did, like sewing and crafts, which might be hard sometimes on pain meds! but I told her about using types of distraction and relaxtion techniques do really help when you are ready to accept them and try, I even told her I use them. I do I swear! I know no one sees me as a relaxed person, oh well! The pt just looked at me, so I explained to her that I dont have her condition, but I use them for other things such as migraines for instance. I also had her verbalize back to me of this for 2 reasons one because of the meds she was on and two to reinforce she was listening and engaging in her care for plan of action. I explained to her that maybe some of the things she used to do she can still do, now maybe for differerent reasons. I knew this pt was going to be d/c so I made sure her 12:00 vitals especially temp was stable before release, due to high risk of infection. Thank you Ms Ward and Mrs Walker for beating that in our heads how important those last vitals are before discharge,because if something wrong is going to happen it will be at home. And I sure wouldnt want a doctor to look to see when was the last vital done. I reported to her nurse of her condition and that her vitals were stable and her pain level before doing her discharge. I will however work on charting I just cant get the right words to go on paper, they can come out my mouth but not to the paper.I asked my friend whom has been a nurse for 30 years, of course she laughed at me when I showed her this book called chart smart that I payed 40.00 bucks for! she told me it developes with time and experience. So hopefully with more practice repeatedly it will come for me. I feel what ever I learn hands on as far as clinical care I do well. And I feel that I do give good care to my pts at least at this point what I know how to do for them.Well this blog should make up for all my short and sweet blogs! have a good weekend