25 April 2007

Nursing notes

Since I have had a request to see some of my "nurse- notes" I decided I would revisit that. I don't know if the request was literal, too bad guppies, here it is.
I kept still have a bunch of notes on a flash drive, because I was dictating them for the last nine and 10 months and picked one at random. It was rather interesting to me, that after all these months, having only seen this patient one time. I could remember exactly who she was where she was sitting and what her house looked like, even the conversation with her daughter, and how frustrated I was with her.
So for little change of pace, I offer this as today's blog. And I hope, it is sufficiently anonymous and so I won't get killed or sued.

This patient is an 81 year old widow living at home with her daughter-who is herself recovering from a heart attack. The patient was diagnosed with pancreatic cancer and has been receiving chemotherapy, she was recently hospitalized due to an inability to swallow and persistent vomiting. It was felt that she had an obstruction due to the cancer, which had metastasized to the liver. The patient is alert an cooperative, but quite frail, and cachectic-her most recent weight was 74 pounds. She is able to eat and drink, but only small amounts. We spent time discussing dietary alternatives that would provide increased calories and protein. The patient has a moderate to severe abdominal pain, which is constant. She is currently receiving pain relief with 150 mg Fentanyl patches and morphine for breakthrough pain. Patient is using Colace and Enulose for bowel management. Her daughter is managing her medications, and other care. She has difficulty providing physical care, as she is recovering from an MI. The patient reports, nutrition-elimination is fair, she sleeps poorly due to discomfort, and has developed an open area on her left medial malleolus, it is clean and covered with Tegaderm. We discussed positioning and padding to prevent pressure sores-Especially her knees, ankles, feet, shoulders. We reviewed the plan of care and will follow up twice weekly has directed, home health aide, will provide care twice weekly, and OT will provide an evaluation. The patient has a power of attorney, with her other daughter, and a DNR order posted on the refrigerator. We discussed hospice, which the patient is currently not qualified for-due o her chemotherapy, but we may revisit this option.

This is fairly typical for the kind of notes, I had to write for every visit. If the patient had already been admitted. I didn't have to write as much, obviously. In reading through some of my other notes, I remembered the situations and often where these people lived and the conditions they endured.

On a different topic, I have been tracking my new camera, and after spending five days in California, it finally made it to Arizona- and according to the DHL tracking, it left Albuquerque for delivery this morning. So I am anxiously looking for a big yellow truck and hoping he can find Edgewood... today.
Of course, if he's heard the rumors, he may be a little scared-you know, about the squirrels* and the crocodiles (or as we say in Belize "coco-driles") Let's just hope it's brave guy with nice legs.

*if anyone watches scrubs, you will have heard about the squirrel army.

2 comments:

A.Fanny said...

I was surprised how thorough your notes were - not a short hand. In the thick of those situations you sound like a wonderful nurse (albeit one who is now glad to be FREE)! It was a treat to see y'all's expertise! I'll bet there are many who enjoyed your visits. Did you crack jokes? Did they get them?

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