Hurray it’s Thursday!
So let me tell you about my nightshifts; night one began very heavy as a patient deteriorated very rapidly whilst receiving handover from the dayshift nurse. Patient E was found extremely short of breath, very flushed & was becoming more agitated. This was abnormal for him. I rushed to get the observation machine and found the oxygen levels to be low, the blood pressure was high, the heart rate was racing and the temperature was through the roof. One thing in mind- SEPSIS.
‘Sepsis is a life-threatening condition that arises when the body’s response to infection causes injury to its own tissues and organs.’
After given the patient antibiotics, oxygen, fluid through the vein, collected some blood samples and monitored his urine output the patient became stable.
Around 11pm I received a diabetic patient from A&E whose blood sugar was 28mmol (this is high), after supplement doses of insulin given (to reduce blood sugar), the blood sugar was 29.8mmol (higher instead of lower). This patient requested 4 times the amount that was prescribed- this dose is the usual dosing regarding supplement doses of insulin. I then gave a further dose of the prescribed supplement insulin and rechecked again after 30 mins. The blood sugar was 33.4mmol. This patient was in DKA- ‘Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin.
Eventually the doctor was informed of this patient’s blood sugar level & a sliding scale was commenced. This is a continuous intravenous infusion administering insulin & fluid replacement according to the sugar levels to maintain a safe level of glucose in the body.
Once the doctor prescribed it, it turns out the patient was correct after all. He should have had the insulin dose he originally said.
Lesson of the night- patients with long term conditions eg. Diabetes, usually know exactly what doses they require & when they are required.
After this incident was resolved it was time to start my observation round, morning medication round & do the morning washes.
What a chaotic & fast night!
Night two I was taking care of the same patients apart from one new admission from the dayshift. The patient was admitted to our ward around 6pm and his family was by his bedside. I introduced myself and within seconds I was being thrown several different complaints at once. First complaint was he had a Fentanyl patch that needed to replaced that day. I explained to him pharmacy was closed & only for emergencies and unfortunately we do not stock this medication on the ward. Also he had been admitted for 3 days before he came to our ward and it should have been replaced & ordered by the other ward. Second complaint was the other ward took his medications to lock them away in the POD locker as per hospital policy but did not transfer him with his medications. I contacted the other ward and they had no medication belonging to him. I explained I cannot answer for other wards as he came to our ward with no medication and it was the dayshift that took handover which should have been addressed the issue on handover. I advised him to speak to the dayshift the following morning to follow up where his medications have been placed. This is why property checklists are crucial as part of an admission- patients items are often misplaced or sometimes patients don’t have property but try to blame the hospital for losing it. At least if we have a property checklist or clear documentation we can follow this up.
Another complaint was he had not opened his bowels for a week and would like some laxatives prescribed. I explained to him we had one medical doctor on-call overnight and we would only contact him for emergencies and this could wait until the dayshift. The patient could not understand that I could not give out medication without it being prescribed. This caused conflict & he demanded to speak to someone more senior. The nurse in charge that night told the patient and the family exactly what I had explain but as she was a senior staff member it seemed to make the patient and family more settled.
Why do patients wait all day (with lots of doctors present on the ward) to nightshift with all their complaints??- is this night over yet?
After completing my bedtime medication round & observation round & getting all my patients settled for bed, patient F complains of pain whilst passing urine. He is being treated for a urine infection which causes a burning sensation whilst passing urine. I encouraged him to drink plenty of fluids, gave him maximum pain relief and informed the doctor. Unfortunately there was not much else I could do as he was on the appropriate antibiotics already. This was causing him to scream out every 30 minutes keeping the other 5 patients in the bay awake. This meant constant buzzers going off and continuous tea and toast rounds.
The end of the shift is near!
Night three I come into shift to a surprise. Patient C who I have been nursing for the past two nights is influenza A positive!
This means my whole bay is in isolation and staff & patients have been exposed to the flu- note to self: flu season is not over yet.
Another night I am nursing the same patients. These patients are all stable and absolutely knackered after having no sleep the previous nights. I am able to turn off my lights early & help the others on the floor as there had been 6 admissions overnight.
Whilst I am doing my 2am observations, patient D who had made complaints the previous night about his care asked if I had a few minutes to chat as he could not sleep. Three years ago he was diagnosed with cancer which was spreading unfortunately. He had undergone radiotherapy with success & was still having chemotherapy. For almost 15 minutes this patient opened up to me about his emotions & feelings telling me he did not honestly want to keep going through this treatment as he had suffered enough with the pain and restriction of lifestyle but it was his family that had been making his decisions, he was clearly extremely overwhelmed. All he wanted was for someone to listen and to offer some support to him. Another lesson to note to self – not everyone lives in glass houses, sometimes we don’t see the whole picture from the beginning.
Finally another night over and two days off!
Happy Thursday guys!