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medicalsurgical

If I could only have half of the faith… angels in disguise

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50 y/o female with multiple myeloma and leukemia presents to the ER for a fever… a medical emergency in one receiving chemotherapy due to myelosuppression.

She has been in and out of hospitals to receive chemo and then be readmitted for the side effects of cancer.

I walk into the room and she is diffusing essential oils, she is riding around the hall and her room in her wheelchair, she is cracking jokes, she is laughing, and has the biggest smile on her face, and she asks about everyone’s personal lives when they walk into the room. I have never met someone with as much hope, faith, joy, and someone who as closely resembles Jesus as this precious woman.

She told me that Jesus will put angels in your path and I was one of hers. I can say that Jesus put her as my angel during my past three, challenging shifts.

Covid has brought a much higher acuity census to the caseload and this week has been stressful, challenging, and draining.

Her joy and optimism brought the just needed light into my week. I fortunately was able to sit with her for quite some time as I administered blood transfusions.

The highlight of my entire nursing career thus far was when she asked to go to the main lobby to play the grand piano. I was able to wheel her down in her wheelchair with her IV pole, mask, and lots of hand sanitizer to go sit and play her joyful noise. I couldn’t help but become teary eyed.

Even through everything that she was facing, she continued to minister to others and bring such joy into their lives. If I have half of the faith of this Godly woman, I will be okay.

It is a reminder that even on the toughest days; take a deep breath and trust that God has your back.

Until next shift,

Shania

Sample Patients in Medical-Surgical Nursing

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**Identifying patient information has been altered to protect patient confidentiality

Patient 1: 68 y/o male with spinal stenosis and resulting functional paraplegia presents to the ER with abdominal dissension, nausea, vomiting, and diarrhea. Pt was found to have a small bowel obstruction. GI order NGT to low-intermittent wall suction (LIWS) for decompression. The patient also has a history of vascular dementia and delusional disorder. He frequently asks for food, water, and repeatedly states that nursing is starving him. Fortunately, pt eventually had several BMs and will get an abdominal X-ray to assess for small bowel obstruction resolve and hopefully NGT removal.

Patient 2: 75 y/o female is brought in with family c/o AMS. Lab work reveals a UTI and acute renal failure. Both BUN and Cr are critical and does not decrease for several days. CT abdomen reveals possible myeloma. Family does not yet know this and nursing must not reveal these results until oncology confirms.

Patient 3: 50 y/o male comes to the ER with abdominal distention, nausea, vomiting, constipation, and failed paracentesis outpatient. GI attempts EGD and colonoscopy, however pt unable to tolerate Golytely and/or enemas. Imaging reveals a colonic volvulus (twisting of the intestine)- a medical emergency. NGT placed for decompression, as patient continues to vomit. Surgery consulted brings pt for immediate colectomy with ostomy placement. Unfortunately was this patient’s h/o CKD and CHF, pt will likely be transferred to CCU post surgery. Family care during this surgery is crucial as they wait to hear how the pt recovers.

Patient 4: 30 y/o female comes to ER with c/o uncontrollable abdominal pain and ascites. Pain management is the main goal for nursing. Balancing IV pain medication for breakthrough with PO medication along with treating the side effects of nausea and pruritus is the challenge. **Patients with liver failure/cirrhosis are difficult cases as all lab work is often abnormal.. critically low H/H, elevated clotting factors, and elevated LFTs must be monitored.

Patient 5: 75 y/o male presents with abdominal pain, N/V/D. Pt is diagnosed with diverticulitis and will be treated with IVF, bowel rest (NPO), and finally diet advancement as pt tolerates.

**All of these cases are in a single shift. Some days are much easier than others and vice versa. Prioritization is key in these situations.. “Who will die first?” Remember the ABCs and include pain as top priorities. Leave charting for later, and keep all patients informed of rounding times, to limit call lights.

Med-Surg is also funny in the sense that you haven’t performed a nursing skill in a while or a certain skill increases anxiety, and the next shift you will have to perform it. This shift was that for me. I was always nervous around NGTs because they are easy to come out, some are hooked up to suction and others are not, placement must be checked frequently (ph), and patients are always anxious to pull them out. After this recent shift, I am comfortable with them!

Until next shift,

Shania

What makes a good day?

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A good day in the hospital is not like a good day on a day off. It is not a lack of patients, more free time to browse social media, or even a full 30 minute, uninterrupted lunch break (although, that would be nice).

A good day in the hospital is a day when each patient can be cared for individually, rather than quickly checking off the Cerner checklist. It’s a day with a 5 patient load and the chance to focus on the physical and emotional needs and wants of each patient.

It’s a good day when a patient wants to show me their family or a hobby they enjoy and I actual have time to sit down and listen.

It’s a good day when a patient who wants a bath is able to get one when they want it and even get a nice hairdo.

It’s a good day when a doctor appreciates the work that you do and the thought behind any questions.

It’s a good day when even when everything is going wrong, you know you couldn’t have done anything else.

It’s a good day when you have time to read progress notes.

It’s a good day when 0800 charting is done by 1100 when rounding began at 0730.

It’s a good day when there is time to walk a patient in the hallway or go outside in a wheelchair.

Its a good day when you find that one patient of the day that validates why you chose nursing.

It’s a good day when the power of prayer becomes evident.

It’s a good day when cancer has been ruled out.

It’s a good day when nurses work as a team.

What makes a good day?

There is good in every day, you decide how you see it.

Until next shift,

Shania

The patient that confirmed my specialty

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**Note: All names have been changed to protect patient confidentiality. This post contains graphic content and portrays the events of the shift without disclosing any patient specifics.

I originally started on a medical-surgical floor to utilize and master all of the nursing skills that were practiced in the skills lab. The first year on my own, I had an oncology patient that decided my specialty.

Oncology has always fascinated me, both biologically and emotionally. Each cancer patient I cared for were always so humble and gracious to receive the care that was provided for them in the hospital. I had one family that I will never forget.

This family came in and out of the unit every few weeks to either receive chemotherapy or to receive treatment from the complications that the chemo had caused.

This day was the beginning of the end for the Smiths. Sean could not stay awake and was increasingly disoriented. He would have brief episodes of lucid behavior and his wife would cling to these moments with all of her hope. She had a faith that could move mountains. She believed in miracles and frequently voiced how God would turn this around. I would sit with her and pray for strength and healing regardless of the outcome.

Sean’s H/H continuously decreased. He was passing clots through his rectum. I have never seen anything like it before and still have yet to witness such a horrifying event. Bright red blood passed like a fountain through his rectum whenever he stood up. It covered the floor and looked like a bucket of red paint was knocked off of the table. Luckily, his wife was not there to witness this. We safely got the patient back to bed and bleached the floor. You could still smell the scent of the massive GI bleed that had just occurred.

He had a critical hemoglobin, hematocrit, and platelet level. The oncologist had ordered 2 units of platelets, 1 unit of plasma, and 2 units of PRBCs. I remained in this room until late that afternoon. Due to the massive influx of IV fluids, Sean went into fluid overload. He was prescribed lasix in an attempt to counteract the extra fluids, and then we waited to see what his labs looked like the next morning.

Long story short, He died that night. I remember that I cried the next time I came back to the hospital and heard this news. I knew deep down that this was probably for the best as he was suffering, but I could not help thinking about the beautiful conversations of hope and healing I had with this family… and all the prayers that were not answered as we had hoped.

I sent a condolence card to the funeral home, but did not attend the funeral. The city was over two hours from my house, and I decided not to go. Now, two years later, I wish that I had.

I got a recognition letter from my manager the day after this shift to recognize the hard work I had put in to keep this family comfortable. Oncology continues to be a specialty that I will pursue whenever an opportunity arises.

Until next shift,

Shania

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