Yesterday afternoon I went to the hospital to pick my patient as I do every Sunday. This entails looking through patients' charts on the unit to which I'm assigned in search of one that would provide a good learning experience. I wanted this one patient I'll call Mr. B, but was told he'd be going to surgery in the morning and would be off the unit for hours. As my instructor would not appreciate me sitting on my ass for those hours, I moved on and picked another patient. I spent the requisite time recording all the patient's medications, abnormal labs, history, course of illness, etc into what we call a client database. It's a way of pulling information together in order to be ready to provide nursing care. Driving home, I was disappointed that I wasn't able to take Mr. B.
This morning I arrived to find that my patient had pulled his IV out of his hand the night before, refusing to allow a new one to be started, and was generally hostile to staff. Hmmm, maybe an opening here. I asked about Mr. B and found out that he hadn't gone down to surgery yet. I approached my instructor about switching patients and she was a little apprehensive in that I hadn't prepped to take care of him. In an effort to convince her, I quickly read through his chart, copied down his meds (most of which I knew), and made a case that Mr. B was a much better learning experience. I think it was probably my ebullience that won her over.
I quickly did a general assessment (listen to heart and lungs, take vitals, assess neuro status, etc.) right before transport came to take Mr. B down to surgery, with me in tow. We arrived in pre-op and the nurse started the pre-op questionnaire. When asked about allergies, Mr. B said he was allergic to some __________ drug he was on. The nurse went to answer the phone and I thought, "But he's not on a __________ med. I wonder if he means __________?" So I asked him and he said, "Yes, that's it." Then I did a little teaching about what that medication was used for and confirmed the reaction he experienced. When the nurse came back, I was able to show her in the chart where his negative reaction had been documented earlier. Whoo-hoo, mental hi-five.
There was still some question as to whether I could observe the actual surgery. The patient couldn't take food and drink orally, so the surgeon would place a tube through his abdomen into his stomach to allow for what's called enteral tube feeding. Then liquid nutrition could be regularly pushed through the tube using a syringe. The operating room circulating nurse came by and said I could observe. I put on a cap and mask and off we went to the operating room. The scrub nurse was already laying out the various clamps, cloths, retractors, needle and thread, etc. that would be needed. The anesthesiologist and nurse anesthetist started an IV and got the meds going. Within three minutes, Mr. B was under. The circulating nurse asked me if I'd like to insert the Foley. Absolutely (not ironic in the least)!
At this point I'd like to say that I've already seen more than a few lame Rep. Mark Foley/Foley catheter jokes, and will not propagate more. OK then.
I'd put in a Foley once before, so I wasn't too nervous. Plus A) the nurse was walking me through it and B) the patient was unconscious. That done, I stepped back so she could finish prepping him. A few minutes later the surgeon arrived and in less than 30 minutes:
- Sliced down the center of Mr. B's abdomen through the skin and subcutaneous fat
- Cauterized the small blood vessels (it doesn't smell bad at all really)
- Made an incision in Mr. B's stomach and introduced the tube
- Made an exit incision in Mr. B's left abdomen and pulled the tube through
- Stitched and stapled Mr. B closed
Totally routine, but tremendously cool.
They woke up Mr. B and then off we went to Recovery. The recovery room was bustling - lots of surgeries today - and the nurses were busy hooking patients up to EKGs and oxygen saturation monitors, recording their vital signs, and administering pain medication. I pointed out to Mr. B's nurse that he had an IV medication that had been sent along with him that needed to be started. She told me to find the doctor's order in the chart (always necessary). I did and she started the IV thanking me for catching it. Mental hi-five again. Mr. B was doing great and so we disconnected him from monitoring and back we went to his room. Later in the day, I got to deliver his crushed medications and liquid nutrition through the tube.
I'm sure five years from now all this will seem mundane, but today it was awesome.