NursingZen

I’m reminded time and time again that my life as a Student Nurse affords me the ultimate luxuries: the luxury of having only one or two patients to pour my energy into (i.e. Hello, let me check and empty your pee hat every single hour so I can track all your output) and the luxury of being able to ask stupid questions and make even stupider mistakes (i.e. disconnect an IV tube and fling the end of its sterile tip on to the bed like it was a telephone cord, or offer an NPO patient water and lunch, multiple times).

Because I know the day is quickly coming when I can’t fall back on student privilege, I’ve started keeping track of small successes after each clinical shift. I’m also trying to keep a list of details I missed during my shifts so that I can try to remember them next time.

Here are two small successes:

1) Advocating for a 68-year-old man with a tracheostomy tube

A tracheostomy can be a scary thing when you see—and hear–it the first time. I mean, to put it simply to my non-nurse readers, it’s a hole in a person’s neck (windpipe) with a tube coming out of it to make breathing easier. Hole, tube, neck (and blood because the hole was fresh) are what my mind latched on to when I first saw a “trach” last quarter. When the person breathes you can hear mucus rattling in his throat. When he coughs, the mucus gets squirted out of the tube that is sitting in the hole in his neck.

Last week, with fingers trembling just a little, I inspected my patient’s tracheostomy site. I could tell that the site would need thorough care and cleaning and I noticed that one edge of the neck plate (which holds the tube to the neck) was digging into his skin, causing a red sore on his neck. My nurse and I tried to clean the trach site but she then had to rush off, leaving me feeling mightily unsatisfied about the work we had done.

Throughout the day I kept bugging her about the sore on the patient’s neck, until she suggested that I call the Respiratory Therapist for advice. I called him twice. When he finally came around, he taught me how to properly clean the trach, take out the cannula, and how to reposition the neck plate. He recommended that Aquaphor cream be applied all around the site to protect the skin. When we were done, I was elated! I felt like I had made a tiny difference in this person’s care – and I didn’t even mind that he showed zero appreciation. That’s love, isn’t it?

2) The same patient: a pressure-sore discovery

It was reported to me that the patient had a Stage 1 pressure sore on his sacrum due to his immobility. Depressed, he lies in bed all day with very little movement, which is no good for his skin. (For my non-nurse readers, a pressure sore, also commonly called a bed sore, can go from being red and non-blanchable (stage 1) to total skin and tissue breakdown (stage 4) if it’s not taken care of).

As someone who has been terribly negligent about checking patients’ skin carefully, this time I was determined to do a thorough assessment. With my instructor’s guidance, lo and behold, I found a tiny spot on his butt that was no longer covered with skin. It was the beginning of a Stage 2 sore. If left untreated, and if the patient were to continue to lie on his back, that tiny sore would get worse.

I covered this Stage 2 with cream and a duoderm dressing, diligently turned him in different positions every 2 hours, and hoped for the best for him, because he’d need it: He was going to a nursing home the next day and sad to say, nursing homes = land of bed sores.

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