Started the day with two patients, both of whom were ready to transfer out of our unit. After getting the requisite doctor sign-outs and orders for Patient #1, I started packing up the his things when the monitor for Patient #2 alarms. I look over and see no blood pressure on the monitor, then flick my eyes over to the patient who is calmly sitting up in her chair, then to the blood on her wrist. Dang, the arterial line has come out. I ask another nurse to grab a blood pressure cuff while I get some clean gloves and gauze to hold pressure on the site of bleeding. Cuff goes on, site stops bleeding, secure it with tape, then toss the bled-on pillow.
Call report on Patient #1 (the one who didn't bleed) and move him upstairs. Back to the unit and my open spot is already assigned for a patient currently in surgery. Call housekeeping for a stat clean and start setting up for the admit. Intersperse setting up suction cannisters, tubing, monitor cables, etc. with prepping Patient #2 to transfer upstairs. Call report on her then hand off to my preceptor cause here comes the admit, a "pump case" - cardio-pulmonary bypass pump during cardiac surgery - who will be on a ventilator while recovering from anesthesia. These guys can be quite unstable and this one is initially very hypertensive. Treat that, have family back for a quick visit and status update, and then catch up on charting.
Now as Patient #3 warms up (they're chilled during surgery to reduce metabolic demand), he's vasodilating and dropping his blood pressure. Calls to doctors for fluid orders. Hang multiple bottles of albumin (yes the protein in egg whites and shampoos, though this version is human albumin) as an intravascular volume expander. Success! He's stable, which is good because now it's time to set up for another admit in the bed formally occupied by Bleeding Wrist Lady. It's not part of some cruel hazing, just happens to be the only spot open for an admit.
My preceptor helps me set up the spot while I keep one eye on still-intubated dude. Patient #4 rolls out and we're off again with stabilization, family update, and charting. While fetching a medication my preceptor says in passing, "Don't worry about the bloody sheet behind [Patient #3]'s head. It's all good. Just wanted to warn you so you don't look over and panic." I appreciate the heads up.
90 minutes later it's time to report off to the oncoming shift. Whew. Four patients in one day with two of them pump case admits is unusually heavy. Of course I had lots of help from the other nurses in my section as everyone pitches in during new admissions and nobody's going to let you (and the patient!) drown. I was most proud when a co-worker said, "I like that I didn't hear any crying over here."
5 months ago