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  • #1

    In Nominae Patris . . . .

    Had my last night of clinic at the hospital with my current crop of nursing students. These are seniors who are about to graduate.

    Normally, I wouldn't talk much about them because of FERPA, but I am just so dag gone proud of them after the night we had in clinic.

    They've been a GREAT group. Some minor problems, but nothing that couldn't be fixed.

    Tonight one of them had a patient who was badly constipated. No BM in 2 weeks.

    We started out with the staff nurse (who is a nun, this is important) trying to manually disimpact her (meaning, using a finger to dig for gold). We got some out, but the patient couldn't tolerate it.

    So Plan B was to get her to drink GoLytely. This is a super laxative normally used for colonoscopy preps. My student hadn't had any experience with it, so I assured her I would help her.

    However, the staff nurse didn't think the patient could tolerate it so we changed to Citrate of Magnesium (a common OTC laxitive, carbonated tastes like Sprite) instead.

    The patient was confused and uncooperative. It took HOURS to get her to drink half of it.

    Sister decides to try a manual disimpaction again. It took me and two of my students to hold the patient for this, but we got things moving . . . and made a mess of the bed. Sister is looking at the mess and mutters, "Jesus," as she's working

    Later, me, four of my students and another staff nurse went to put a Foley catheter in a morbidly obese patient. It took us three tries. It was quite the difficult job. The patient is very sweet and was very patient with us as we worked, even though we made her rather uncomfortable.

    After that it was time for post conference.

    I told my students it was official: they were now nurses. They had just done two of the most unpleasant jobs the profession has to offer, and did them well, working as a team.

    I officially consecrated them as nurses In Nominae Patris et Fili et Spiritu Sancti before we left.
    They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.
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  • #2
    This is why I respect nurses, and could not be one.
    "Is it hot in here to you? It's very warm, isn't it?"--Nero, probably

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    • #3
      I had to be cathetered for a test once. I'm not morbidly obese, and I did my best to be cooperative. (Including spreading my legs as far as they can go - about 160o lateral spread. The nurse looked surprised and asked if I was okay, and I said 'sure, I'll let you know if I need a break from this position'.)

      I swear, it took ten minutes to get the damn thing in place. A highly uncomfortable process - and that was just for me. All I had to do was lie there and try to stay as relaxed as possible!
      Seshat's self-help guide:
      1. Would you rather be right, or get the result you want?
      2. If you're consistently getting results you don't want, change what you do.
      3. Deal with the situation you have now, however it occurred.
      4. Accept the consequences of your decisions.

      "All I want is a pretty girl, a decent meal, and the right to shoot lightning at fools." - Anders, Dragon Age.

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      • #4
        Quoth Seshat View Post
        I had to be cathetered for a test once. I'm not morbidly obese, and I did my best to be cooperative. (Including spreading my legs as far as they can go - about 160o lateral spread. The nurse looked surprised and asked if I was okay, and I said 'sure, I'll let you know if I need a break from this position'.)

        I swear, it took ten minutes to get the damn thing in place. A highly uncomfortable process - and that was just for me. All I had to do was lie there and try to stay as relaxed as possible!
        LOL I have discovered that medical personnel can totally underestimate the limberness of obese patients =)

        I may have femoral acetabular impingement, and osteoarthritis of the knees, but I can sit for hours in tailor seat/half lotus/crossed legs. I simply can NOT kneel [or get down upon or get up from the floor] because I have never been comfortable in classic sit up in a chair with your feet flat on the floor position, I have always been most comfortable sitting non-chair. Reinforced by modern and classical dance, I have remained very limber [though creaky] as I tend to have to spend a fair amount of time stuck in bed with my feet in full on pseudogout flare. I can still do almost a full split, if I am careful to not hyperflex my knees. My physioterrorist is amused at how flexible I actually am - but the physio addresses issues other than flexibility, we do mainly strengthening work to support my knees and hips.
        EVE Online: 99% of the time you sit around waiting for something to happen, but that 1% of action is what hooks people like crack, you don't get interviewed by the BBC for a WoW raid.

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        • #5
          Everyone's different

          My experience, though, is that people who are not physically active tend not to be very flexible, and that can make putting a catheter in somewhat difficult. In women it's all about how easy is it to visualize the urethra. In men, it's all about getting past the prostate.

          In some women it falls into the vagina after delivering children. Some tricks include putting the patient in Trendelenberg (head down, feet up), gravity pulls the urethra into place, and looking for a "winking eye" spasm of the urethra after cleaning it with betadine, leaving the catheter in the vagina if you miss on the first try (which happened that night) and using a good flashlight or gooseneck lamp to shed a little light on the matter.

          Friday night, we used a penlight because that was all we had, but it made all the difference in the world. The weird thing was, the urethra moved after the student cleaned it with the betadine, dropping back into the vagina. We had to readjust the patient to make it visible again. Fortunately, this student was experienced at putting in Foley's (she worked in the ER as a tech and did them fairly frequently) or I wouldn't have let her try again after missing the first time. It took a lot of team work to get the job done, which my students did very well, helping each other with the difficult task of keeping the perineum visible, which was why I was very proud of them
          They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

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          • #6
            Aaannnd it's things like this that make me truly thankful that there are people who love being nurses and can put up with it! Lord knows I couldn't even last an hour.

            the funny part? I was playing that Gold Miner game at the same time as I read this.
            Now, if you smell the roses but it doesn't lift your spirits, you're either allergic to rose pollen or you need medical intervention. ~ Seshat

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            • #7
              Yep, that's why I'm so glad there are nurses and I don't have to be one. Thanks, Panacea, for making more good ones!
              "I'm starting to see a pattern in the men I date" - Miss Piggy, Muppet Treasure Island

              I'm writing!! Check out the blog.

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              • #8
                Oh lord, I wouldn't even be able to deal with being cathered, let alone inserting one.

                Thank you Panacea for helping to create great nurses.
                The best professors are mad scientists! -Zoom

                Now queen of USSR-Land...

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                • #9
                  Thanks for the kind words, guys.

                  Good teaching experiences are what makes the job worthwhile.
                  They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

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                  • #10
                    I'm starting to REALLY be glad I had mine done while the epidural was in effect, I didn't even know they had put it in until I saw the bag. I've seen them done, but have never done one as I didn't need to know how, but my hat is off to the nurses who can/do.

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                    • #11
                      I hate catheters. I am about 100 lbs overweight, metal plate, artificial right hip which has tons of bone growing into my muscle (So constantly in a lot of pain, nothing to be done until the hip deteriorates to replacement ready) due to the damage in the accident the left hip has half the normal cartilage, my range of motion is about half or less what it should be (yes I had therapy for months, that got me what I have) so I can't spread em far at all. I can't lay my right leg completely flat as it hurts more. And catherters HURT going in. a lot. and I've probably got another 30-40 years at least in me if I'm normal female lucky.

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                      • #12
                        I had to get a cath for emergency surgery about 18 years ago.

                        It took four ER techs to hold me down to put it in . . . and I had a BP of 90/60 because I'd lost about half my blood supply from hemorrhaging.
                        They say that God only gives us what we can handle. Apparently, God thinks I'm a bad ass.

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