I had a very difficult night at work...it started with floating to surgical...not so bad in itself, but first I had to bump the ICU RN that was already getting report. She wasn't too happy about that, but she got to go back to her home deptment. Then i'm going along, getting things done, and there was a whole bunch of orders on one patient that needed finishing up. OK,,, that's fine too. I had just gotten all the meds given and was hanging the TPN in one room when I'm told-here's an admit! At this point it is a little after 9pm and I hadn't had a break. That's ok...still plenty of time. But no...I am doing the admit and am told I have to go back to ACU at 11pm. This means the whole group that I spent time getting to know and the admit, all have to be given to another RN. Then I go back up to ACU and take on a whole new group. So I must give report on the ones I have, and then get my new ones, meanwhile, the off going RN is waiting to go home.
So now I'm on ACU, the patients are asking for pain meds, and I'm making rounds on the new ones...it takes time to get organized, and I've had to do this twice now. Of course...NO BREAK! OK, so I'm settling in again, and got my assessments done, and the NAC pokes her head out of a room and says Mary I need help now! UH OH! The patient in the room had vomited blood all over the floor...NOT GOOD!!!! This person had Esophageal Varices banded awhile ago, so vomiting blood is really not a good thing!!! He also had bloody stool...
Well, I called the on-call provider and luckily, she is one who is very helpful and collaborative with the staff RN's. We had a whole boatload of new orders, and I'm one on one with this guy...even though I have 3 other patients, 2 of whom are on bed alarms because they can't remember to call for help and are fall risks. I had the charge RN, the NAC, and one other RN who came back to help, but I'm running!!! The patient who vomited the blood had to have a NS bolus, Vitamin K iv, and a Protonix drip all started right away, and also several labs drawn. He had a PICC line, so I could get those labs drawn as quickly as they were put in. Then, we found his Hgb was dropping a point every hour, so started FFP's and PRBC's. We were going to transfer him to ICU...the patient refused! His blood pressure was dropping and he needed more than we could give him, but he stated he did not want to be in ICU and be intubated again...don't know that it would have gotten to that point, but who knows? Well, the lovely on call provider came in and talked to the patient about being a DNR because at that point he was a full code. He agreed to recieve blood products and other meds, but no ICU and intubation.
All night...no breaks...12 hours. There's alot of details, and I must say, without the charge helping with the blood and documentation for that, I might still be there!!!
I called off sick tonight...I couldn't do it again...I might be getting to old for all of this!!!