Saturday, April 4, 2009

My Patient Survived! Huzzah!!

I finally got a patient this week!

At the start of our day, the instructor, Nurse D., took us to the nurses station to start gathering info on our patients. She noticed my patient had the physician in with him and she told me to go stand by the door and listen. The nurse that was in with my patient noticed me and asked if I was assigned to this room. The Doc peeked his head from around the curtain and said "Ah! A student! Come in! Come in!" The Doc was my patient's surgeon and was changing the whole trach set up on my pt. The first thing I noticed was a HUGE surgical incision extending from the trach up to the left ear. Then I focused back to what the Doc was doing... As he was teaching all of us what the extra strings were for I was mentally preparing myself to see an open trach. I've never seen what it looks like without a trach in it! Ya know what? It looks like a wad of Bazooka Joe bubblegum! Very pink and fleshy, but no blood or drainage. I spent the next 20 minutes or so with my pt teaching him how to take care of his trach, and how to plug it off if so desired.

The only problem was, the doc gave him the okay to go home. When I told Nurse D, she said "no, they haven't ordered to d/c the foley yet." I knew that the urologist was on his way in to see the patient but I didn't tell her that.

I tried to get as much of my assessment done as possible, but since they were working on discharging, every time I turned around, another Doc was in checking him out... I was doing the best I could, and I finally got an opening to do the abdominal assessment! I ran in and when I exposed his abdomen, I found a very large dressing covering 70% of the abdomen. I went back to the chart... As far as I knew, the pt had CA of the tongue with metatstasis to the neck, had the mass and lymph nodes removed and a trach put in. I was TOTALLY confused by the dressing on the abd!

I soon was able to decipher the heiroglyphics of the docs handwriting and learned they also put in a PEG tube for later use during chemo. I thought "cool! I can change the dressing!" Wrong! It was still the original surgical dressing, the Doc hadn't changed it yet... So, that screwed up my whole abdominal assessment too...

Nurse D came up to me and told me that my pt was in fact going home, and his nurse was going to let me pull the foley! I was oddly excited! Yes! I get to do something!!!

Nope, wrong again. The urologist decided to send him home with the foley and have the home nurse take it out the next day.

I did however get to do some teaching, and help him get ready to go home, which was nice! But I hope that next time I get a patient who is going to stay put. Nurse D said she'll give me "a challenge" next time.

On the upside, I am getting pretty good at reading charts and the lab results... only because that's what I spent most of my day doing...

Now it's off to write the care plan... yipee.


  1. Why did he have an abdo incision? Mets to the guts?

  2. No, he had a PEG tube put in place, but they weren't using it yet. It's for use during his CA treatment.