Weekend III - Clinical MCA I Final

Brief little ditty about last weekend: Busy day on MT for two days ~ but we had some personality difficulties that resulted in our self exile out of MT for the rest of the semester. Actually, I think our instructor had enough of some of the mean girl antics and once we transferred to Oncology, we heard that they had a reputation for that and that most people refused to float to that specific unit.

Big deal...who has time for that? I had some decent patient interventions for my post appendectomy patient. He was ready to be discharged anyway and was happy with the care he had for the two days I took care of him. The last day of clinical found me on Oncology working with 84 year old man who had acute renal failure and an altered level of consciousness. When I prepped on him, I decided that my goal for the single day I would be caring for him would include a discontinuation of his soft restraints, close observation and weaning him from the anti-psychotic medications he was getting since he was admitted to the ER, so that we could properly assess his LOC. What a difference a day makes. Taking the time as a student to really be with your patient makes all the difference in the world.

We were able to see vast improvements in his communication with his family, he was able to eat after we completed a swallow evaluation and I was actually sorry to lose the follow-up time with him. After a long weekend on two different units, I studied for the MCA I final exam, finished research on a group project and completed my write ups for my care plans for midterm evaluations.

We had two long days of lecture/theory and new assignments that need some tweaking for Healthy Aging. I've pretty much decided that anyone who decides to prescribe Ativan and Haloperidol to the elderly doesn't care too much, because all the drug research I did in the last week stated that they don't metabolize these drugs like their younger counterparts. My patient was also in renal failure, so it was even worse for him to receive these because his kidneys weren't working.

I saw the massive effects the combination of these drugs had on my Dad a couple years ago, and I saw it in one of my patients this weekend. Frankly, it makes me angry to think some physicians think this is perfectly ok (chemical restraints/physical restraints/tying people up) sometime, I'd like to stick these docs in poseys and give them a taste of their own medicine, ah but I digress.)

To be able to discontinue the restraints and these anti-psychotic drugs only reinforced my belief in this regard about the efficacy of protecting your patient, at all costs. I had a completely different patient once these awful things were D/C'd. He was slow to respond up front at first, but perfectly aware at a measurable point in time, and I was able to get him calm and comfortable. He slept for the first time in 30 hours. Believe it or not, I was able to reassess the 84 year old the following weekend (tonight) and will include the update on him in my next post tomorrow night. There is way more to report in this current week IV. Trudy & I get to work together this weekend. It should be fun!