Clincal Journal Entry #6: 2/27/2008

Before post conference this week, my instructor asked if any of us wanted any experience in particular. I feel like I've done most things we've learned in lab so far except for a dressing change. So that's what I asked for. My instructor found the perfect patient - an older woman who presented in the ER with a gluteal abscess, likely as a result from her diabetes. Patient had many comorbidities and her abscess tested positive for staph. Other than that, she was in good condition. Completely A+O, up ad. lib., and truly chatty on top of that! Her abscess had been incised and drained the previous night, so she had a little pain, but nothing a few meds couldn't solve. The nursing assistant told me she had already made Patient's bed while she bathed herself, so all I had to do was chart my morning vitals, perform an assessment, and wait until my instructor or Patient's RN could assist with the dressing change. RN wasn't eager to help, and my instructor was very busy supervising the two students scheduled to pass meds, so I just kept Patient company for most of the morning.

When my instructor came to help me, I explained how Patient's chart called for a dressing change BID or PRN, but there was no documentation as to what type. There wasn't even a report on her I+D. The night nurse's charting left many gaps in reporting Patient's care, and even as a student, it was obvious to me how many holes there were in the story. We talked to RN who had to make some phone calls to get to the bottom of the situation, and our time on the floor was almost up, so I didn't get to do my dressing change. :(

I asked my instructor what I could do to pass the last few minutes, and she gave me call light duty. I'm still indifferent to call lights, but on a geriatric floor, they usually don't mean the patient needs more water or a pillow... it usually involves feces. Yep, good ole poop. Or at least so far that has been my experience. Anyhow, our C-Diff patient's light was on, so I answered it. Sure enough, she was asking for a bedpan, so my friend and I gowned up and helped her. Once she was finished, she told me her mouth was dry, so we helped her with mouth swabs. We set her up in bed with the draw sheet, rearranged her pillows until she was much more comfortable. I have never seen such a tiny, frail woman in my life. She was just covered in decubitus ulcers - I felt so bad for her. (For those who don't know what a decubitus ulcer is, it's a pressure ulcer, sometimes called a bedsore. They present most commonly in elderly patients and are caused by lying in the same position for too long. Prolonged pressure on the skin cuts off circulation until the skin and tissues die and eventually break down. There are multiple stages of them, and they can be exacerbated by dampness, friction, etc. You can see an example of one here, but I'm going to warn you, they are absolutely disgusting. Anyhow, it's amazing how the few little things we did for her made her so much more comfortable. She was so adorable and thanked us profusely. We were, of course, just happy to help. So I guess call lights aren't all bad. :) I guess it just depends on who's behind the call light!

In post-conference, we discussed our patients, and even though my day was pretty uneventful, I really did learn how much trouble poor documentation can cause. (Not to mention endangering your patient, you can really get yourself in trouble!) As nurses, we are accountable for every single things we do or don't do, and if it's not in the chart, it did not happen. It's amazing how invaluable accurate, complete charts are to our patients. Many times the chart can even be the only thing to save a patient's life. We are trusted with so much, and we must do everything we do thoroughly and well. Always.

I'm honored to be a nurse, and yes, I still love it.

As crazy as it sounds, I thrive on this huge, overwhelming challenge. I live to learn more and more about this fascinating art in caring for the miraculous, phenomenal human body and most importantly, the many intricate, beautiful components of the human mind and spirit. Don't get me wrong, it's hard, ridiculously, frustratingly hard... but it's lovely and wonderful, too. Wouldn't trade it for the world.