I have discovered that more people click on my blog if there's a picture to go along with it. Prepare to be manipulated. This particular picture gives me anxiety. I've never had that many lines going for a patient, but I know it's possible. Anyhow.
So, it is common knowledge that nobody can read doctor's handwriting. You see their scrawl on a piece of paper and are supposed to get something intelligible out of that. It's a fact. I just wanted to point out that sometimes the things that I write down could be just as illegible if someone were to come look over my shoulder. Healthcare professionals use so many abbreviations (some of which are completely unnecessary) and make everything really confusing. When I went to college, I didn't know what an Rx was (a prescription). I've come a long way. I am going to share a couple of examples- and most of these are used in real life.
The pt is on a 1800 ADA diet with a 1600 cc restriction, but is NPO after MN so he can go for his PCI of the LAD. He has POCT tests AC and HS for his DM.
Translation: The patient is limited to 1800 calorie per day, diabetic diet with a restriction of 1600 milliliters of fluid per day. He can't have anything to eat after midnight because he is going to have a procedure done on one of his heart arteries to clear away the blockage and widen the artery. We check his blood sugar before meals and before bed so we can control his diabetes.
This patient has a hx of HTN, PAD, CRF stage IV, breast CA stage I, and COPD. They are allergic to PCNs. They are POD #2 from a I&D of the LLE wound and require VS q 4hr.
Translation: This patient has a history of high blood pressure, narrowing of the arteries in the legs, chronic kidney failure in an advanced stage, breast cancer that hasn't spread anywhere else, and a chronic lung disease. They are allergic to penicillins. They had surgery 2 days ago to drain a wound in his left leg. Caregivers will take his vital signs every four hours.
The patient had a MVA which left him with a RLE BKA 2wks ago. No CNS deficits, but pt c/o decreased LOC. We've looked at the MRI and CT and findings are WNL. We'll order an EEG, a LP, and CBR until PT and OT can evaluate.
Translation: Patient had a car accident a while ago and they had to amputate his right leg below the knee two weeks ago. There was no head or brain trauma, but the patient is complaining of a different level of consciousness. We looks at several scans of his head, but everything looks normal. We'll do a test to see what his brain electrical activity looks like and get a sample of the fluid in his brain. Keep him in bed until physical and occupational therapy can take a look at him.
Insert a foley. Patient can't take anything PO, NG tube set at LIS. Start TPN at 2100 through PICC line but keep 0.9NS at 21ml/hr to KVO. If HGB is <7.5, transfuse 1unit of PRBCs.
Translation: Put in a catheter with a bag to catch urine. Patient can't swallow anything. There's a tube down his nose that suctions out the stomach contents intermittently. He will have artificial nutrition given through an IV that goes into one of the big arteries close to the heart. We'll keep some fluids running into that IV to keep it from clotting off. If your blood tests come back low, we'll transfuse a unit of blood through the IV to get that level back up.
Order a CBC and CMP STAT, get a CPK, troponin, PT/INR, UA C&S and a set of blood cx. Do an ABG and CXR just in case. Order a KUB and schedule an EGD for the am.
Translation: Do a bunch of tests.
Well now I have a headache. The things I'll do for you guys.....
One story to share with you. I worked for a bunch of days in a row with very little turnover (that can be very good or very bad depending on your patients). I had a patient who probably led a life that would be considered very successful. They were on the younger side, had a good support system, were financially stable, tried to be healthy and were succeeding for the most part. This patient had a procedure done and was overwhelmed because they had really never been in the hospital before. Everything was new and needed to be explained. They reacted strongly to all medications because their body wasn't adjusted to them. I was in their room quite a lot for a few days to be a calming presence, to explain and teach, and to support them in a scary time.
When this patient was about to leave, they told me that they had connections to some people high up in administration and would speak positively about me. They said things like, "we'll tell them that you should get a raise" and "you were a great nurse". I was flattered and thanked them.
At the same time I was taking care of this overall healthy patient, there was another patient across the hall who was very different. This other patient didn't always smell very good. They had a lot of health issues. They had virtually no support system, didn't know how they would pay their hospital bills, and didn't have a place to go after being discharged.They definitely didn't have any special connections.
As I walked out of my patient's room, I realized that in my heart, I would treat these patients the same no matter what their circumstances were. I would walk into their room and let them know that they were safe, loved, and supported no matter what. That's because they are my patients, and I have a moral responsibility to care for them. I have always known that in principle, but comparing these two very different people allowed it to become concrete. I was still glad that my patient was satisfied with my care, but it didn't matter if they were the president of the United States or a homeless, ex-convict off the street. I wanted to walk back in there and say, "Thank you for complimenting me, but I didn't treat you specially because you have connections. I would do the same for the poor, sick, smelly patient across the hall." But I didn't. And honestly, I wouldn't mind that raise. ;)
I hope this doesn't come across as bragging about being a good nurse. I have good days and bad days. But whether the day is good or bad, I have the opportunity to care for people in a tangible, practical way. Some days I make the most of it, and other days I just do the minimum requirements. After this all happened, I was reading the Bible and came across a familiar passage from Matthew 25. I love my job because it makes passages like this come to life.
34 “Then the King will say to those on his right, ‘Come, you who are blessed by my Father; take your inheritance, the kingdom prepared for you since the creation of the world. 35 For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, 36 I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.’
37 “Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink?38 When did we see you a stranger and invite you in, or needing clothes and clothe you? 39 When did we see you sick or in prison and go to visit you?’
40 “The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’
41 “Then he will say to those on his left, ‘Depart from me, you who are cursed, into the eternal fire prepared for the devil and his angels. 42 For I was hungry and you gave me nothing to eat, I was thirsty and you gave me nothing to drink, 43 I was a stranger and you did not invite me in, I needed clothes and you did not clothe me, I was sick and in prison and you did not look after me.’
44 “They also will answer, ‘Lord, when did we see you hungry or thirsty or a stranger or needing clothes or sick or in prison, and did not help you?’
45 “He will reply, ‘Truly I tell you, whatever you did not do for one of the least of these, you did not do for me.’
I have the best job ever.
Peace out. -C-
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