Week 2 of CPE II

So, of course, because I said that it was easy last week I got a difficult patient this week.  In fact, I got a high maintenance patient.

High Maintenance Patient
This patient could do quite a bit by himself, but he didn't want to.  He laid back, looked exhausted, and expected to be cleaned, fed, and whatever else I could do for him.  He also specified when he wanted certain procedures (wound changes, enema, bathing, etc) to be done, and expected everything to be done immediately when requested.  If I took a little longer to look up information or confirm that I could safely administer/combine something, he would get angry.  He'd demand to know why it was late, and then he'd refuse it altogether.  Grr!

This lack of patience extended to other things too.  While I was on break, he noticed that his IV site was red.  Rather than call for a nurse, he pulled out his IV by himself.  He eventually pulled out his own foley catheter too (the tube that lets you pee into a bag).

The thing about catheters is that there is a little balloon on the end that prevents it from falling out of your bladder.  You're supposed to deflate the balloon before you pull the tube out.  He didn't know that.  He just pulled it out with the balloon intact... ouch!

Anyways, he didn't actually mind me so much.  He just didn't like to wait.  He felt like he knew what was going on and what he was entitled to.  So he made sure that he got what he wanted, even if it wasn't always the best thing for him.

He should have been up and out of bed moving around, instead he laid in bed all day.  As a result, he had terrible constipation.  So, tip for you if you ever get hospitalized and take a lot of pain meds: if the physio and nurse tell you to get out of bed and move, you should try to do it.  Otherwise, you might get very constipated and be very uncomfortable.  Six days later, he was still constipated... poor guy.

Angry Patient

After the high maintenance patient, I got a very emotional patient.  I have nothing against emotional patients.  It's to be expected when someone goes through a trauma.  This particular patient thought I was the best thing ever.  She missed me when I was gone, looked forward to seeing me every day, and had long conversations with me about anything under the sun.  She was basically awesome to me.

However, she could flip like a switch when she didn't like someone.  She would snap at them, point an angry finger, shout insults and expletives, kick items in the room at them.  I was shocked.  Some of the nurses asked me if she might have had a head injury or whether this was normal for her.  I have no idea.

I think that, perhaps, the stress of the trauma made her kind of hyper-reactive against certain things.  Her stress level would shoot up and then she's sort of lose it.  She was unnaturally calm and cheerful after all with me.  Maybe she was just holding in all of her stresses and it would come pouring out a times at unfortunate targets.  I think that when she's done with all of her healing in the hospital, she will want to heal herself emotionally.  I think she went through a lot.  She says that she doesn't remember anything from the accident, but I think the emotional outbursts show that there's something that needs to be healed underneath.

Building Confidence
My teacher says that I should work on being more assertive.  She thinks I could have been more firm with the high maintenance patient and made him clean himself and get out of bed.  Maybe I could have reasoned with him about why some things take more time.  I think she's right to a certain degree, but I can't force someone to do something that they don't want to do.  I like to ask nicely, suggest, and encourage.  I rarely speak firmly and order people to do things.  Maybe I should try a mix and see how it goes.

Dressing Changes
In terms of skills, I got to practice changing wound dressings.  It was really cool.  I have watched a lot of nurses do this and assisted, but I had not changed the dressings entirely on my own before.  The thing that kind of bothered me was that a lot of the wounds had HUGE 5-6 inch fluid-filled blisters around them.  Apparently this can be caused by damage from the fracture/accident or from a reaction to the wound dressings (allergy).  They looked horrific to me, but I washed them carefully and put soft, new dressings on them to protect the wounds.

Losing a leg
I had the opportunity to talk with a patient before and after he had his leg amputated.  I can tell you that it is a hard thing for a young man to accept.  He told me how hard it was to wake up each day and to see his leg gone.  He would think about how his life had changed and whether he could still be a good husband and father, and he would weep.  I did my best to listen to him, and to support him through his transition.  I printed out some resources for him to look up, such as a support group for people with amputations.  I hope that he will be okay.  At very least he knows that a little student nurse cared about him and thinks he has the power to cope and heal.

So that about sums my second week in CPE II.  I would have to say that working in a trauma and orthopedic ward can be kind of traumatizing if you share a lot of empathy with the patients.  I worry about them, care about them, and I try to lessen their load.  However, they have been through a lot and their emotions are fragile.  This means that it takes a lot more effort to navigate through their emotions each day and to avoid pushing the wrong buttons.  However, it feels good to help those in need.  It's heart warming.

Have a great week!