The ICU was closed for the past few days, so I worked the Med/Surg floor. I took care of a couple of interesting patients (I had a total of 4 patients one day and 5 the next). One patient came with cellulitis. Someone had outlined the redness on the right lower extremity a few days before. The redness was gone except for a hard, hot, red, raised area approximately 10cm square. Over the next 12 hours this grew to be 20cm long and 10cm wide and increasingly tender. An Ultrasound was performed, and it looked like 2cm of fluid under the skin--surgery time! On Sunday (I was gone, strange scheduling) the surgeon did an I & D, packed it with dakin's soaked gauze and dressed it. When I came in Monday, no one had changed the dressing. When I looked at the wound the dressing was dry and hard. It hurt pretty bad when I took it out, but the patient did OK. The next dressing I guided the patient's relative--my hand on that hand to feel the edges of undermining, so the relative wouldn't pack it too tight. The patient thought it would hurt, but it didn't because the dressing was still wet. The family member thought she/he would puke, so this person wanted the trash can close by. The family member did just fine though--even through the sucking sound it makes when you pull out the packing.
Another patient was end stage Parkinson's disease. The family decided to have a PEG tube placed. The patient didn't handle the tube feeding well though. I needed to run it a hour, then shut it off for 20 minutes to keep the residuals under 60ml. That worked well as the patient finally got to the point of 0ml residual. I couldn't get this patient up to the RD's recommended 50ml/hour though. Maybe the GI system will start to handle it better. I've seen the stomach react by going to "sleep" for a few days before starting to handle tube feeding correctly.
Another patient had noticed some dizziness before going to bed. At midnight the patient could hardly make to the bathroom, so called a family member (who was in the medical field) to take to the hospital. My morning assessment on the neuro check showed a 4/5 weakness in the LUE, nothing else. Smile, shrugs, eye brow lift, lower extremity, you name was OK, until I stood the patient up. Wow, what a left lean. It took 2 of us to keep the patient standing. No visual changes, no room spinning, just no balance. I was too busy to look at the MRI/MRA. The CT was clean except for some age related atrophy.
Another nurse had a patient with multiple bruises, no rhabdo. These bruises came from running from two police officers and falling. What the patient was doing, wouldn't say, but there was a warrant out for an arrest. The patient didn't was to go to the pokey, so told the nurse he/she wanted to kill him/herself; OK, a psych consult, and... faking it to get out of jail. To jail this patient went.
