Tuesday, April 15, 2008

Jerry Lewis in PACU

This semester we have to spend two days in PACU (formerly called the Recovery Room). The course coordinator for this semester is a PACU queen, so naturally she oversee's the experience.

Instructor Y sets us (normally three students are in PACU, but my rotation only had 2) up in a bay and we take a client. At least that is how it is supposed to work. Our first day went relatively smoothly. All thumbs here needs to work on anything skills oriented so doing new things like putting on ECG leads quickly was entertaining to observe.

The second day started off slow, so Y decides that she will give each of us a client. As I am helping the other student, my client rolls in. What seemed like a routine situation ended up being an all day affair. The client came in complaining of nausea and pain. No problem, that's why there is Phenergan and Dilaudid. Then a problem arises, the client has a Morphine allergy, but has been able to take Dilaudid. Until now. Yes, she started itching and now gets to add Dilaudid to her list of no no's. So the anesthesiologist is called and Zantac and Benadryl are ordered to help relieve the itching. The pain relief is now switched to Fentanyl via PCA and we think we are in the home stretch.

Oh wait, the foley has come undone and urine is now all over the bed. Let's clean that up, deal with her allergic reaction, pain, nausea and remember to look at her O2 Sats! At this point I felt like Jerry Lewis that whenever Y asked me a question I would want to stammer and say, " Duh, well.." At one point she asked me an easy med math question that I couldn't do in my head in the midst of all of this and so the client answered for me. I thanked her for doing my homework for me. Man I was embarrassed.

This very nice client was about to be discharged from PACU around lunchtime but had to stay around for a fluid bolus and by then I got some help from other students. I went to lunch and when I came back found out that the VAST team (they put in the IV's) was there and had to stick her twice in order to get another access for the albumin she was getting. It was then one more fluid bolus, the family coming in and she was off to her room.

I was certain my evaluation was going to include statements like " Are you sure Jerry Lewis isn't your father?" or "I've never seen anyone tangle up IV lines like that before." Instead I got all S's (Satisfactory) on my objectives and the advice to manage the client's medical problems and not concentrate so much on the emotional issues.

No comments: