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Post by chils on Nov 2, 2020 18:36:07 GMT -6
Walk into a room of a geri-psych patient. Severe dementia. He's very confused, shredded the chucks pad--it's on the floor in bits and has the blood pressure cuff in a strangle hold twisting on it. Thrashing around in the bed. I get him up and he looks OK. Walk him 170ft and he starts to become unsafe leaning forward heavily. I had a wheelchair with me as the demented are unpredictable and can become combative. I pull him down into the chair and he starts to lean forward bending double at the waist. I have to use 50lbs of force to keep him from nosediving into the floor and his feet come up off the floor as I'm pulling him back--locked in place. He becomes limp and I put my hand on his chest to keep him in the chair and wheel him to the room, call the nurse on my com-badge. She isn't available and sends a new hire. Patient is unarousable, sweaty, pale and gasping. I check his pulse and he has one. I dead-lift him back to bed (limp, unconcious sack of taters) and lay him down and his eyes pop open but he isn't speaking. Told the nurse to grab the vitals machine and call a T-rex (patient in distress but not dying). Blood pressure is 99/74, O2 is 100%, pulse 75BPM--he's OK. T-Rex team arrives and I tell them what happened. I said "I tossed him back in bed" At this point the guy is awake and says "I'll kick your ass if you throw me around!"  He probably became orthostatic--low blood pressure when walking. I'll do a full vitals set tomorrow (lying, sitting, standing) when I see him but it'll be hard because he's soooo confused. No harm done to him and I kept him from falling. |
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Post by Ken on Nov 2, 2020 18:44:49 GMT -6
Chils, we need to have a count-down for how many years, months, days, hours and minutes you have until you retire. This job is going to send you to the hospital! Nice work keeping that guy from hurting himself today. |
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Post by chils on Nov 2, 2020 18:51:53 GMT -6
Chils, we need to have a count-down for how many years, months, days, hours and minutes you have until you retire. This job is going to send you to the hospital! Nice work keeping that guy from hurting himself today. Heck no! I ain't going to no hospital! I know what goes on in there.
Ken, we are trained on moving weight. I told the nurse to be ready to pull the wheelchair back so I could swing him around but that I may need to get help if he was completely limp and wouldn't try to stand. When I leaned him forward I had my knees against his and knew he wasn't with me, said to heck with it, and levered him up by leaning him on his feet and pushing his knees straight with mine then transferred him to the bedside.
I'm glad it wasn't one of the new hires or small gals with him.
No harm done to him (or me) and I kept him from falling.
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Post by chils on Nov 3, 2020 12:30:46 GMT -6
Ran blood pressures on him today. Systolic BP dropped from 120 sitting to 90 standing and continued to drop to 82 after 4mins standing.
He was probably waaay low yesterday.
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Post by Ken on Nov 4, 2020 8:16:02 GMT -6
Ran blood pressures on him today. Systolic BP dropped from 120 sitting to 90 standing and continued to drop to 82 after 4mins standing. He was probably waaay low yesterday. Get that man a burger, stat!  |
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Post by chils on Nov 4, 2020 17:18:08 GMT -6
Ran blood pressures on him today. Systolic BP dropped from 120 sitting to 90 standing and continued to drop to 82 after 4mins standing. He was probably waaay low yesterday. Get that man a burger, stat! Lol. For some reason this guy is hungry all the time. He made two fists yesterday, hit the bed and said "I'm hungry. Why the hell won't they feed me?!" Nursing said he's been eating like a horse but he's rail thin. He almost passed out on me today just standing at the bedside. I got him some graham crackers and peanut butter after I finished with him today. He had a good looking lunch tray at bedside mostly uneaten. Said he didn't like it. |
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Post by OldMan on Nov 4, 2020 17:23:45 GMT -6
Get that man a burger, stat! Lol. For some reason this guy is hungry all the time. He made two fists yesterday, hit the bed and said "I'm hungry. Why the hell won't they feed me?!" Nursing said he's been eating like a horse but he's rail thin. He almost passed out on me today just standing at the bedside. I got him some graham crackers and peanut butter after I finished with him today. He had a good looking lunch tray at bedside mostly uneaten. Said he didn't like it. Dude has a tapeworm |
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Post by Ken on Nov 4, 2020 18:09:35 GMT -6
Yeah, you would think someone in the hospital would NOT be that hungry.  |
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Post by chils on Nov 4, 2020 18:24:13 GMT -6
Lol. For some reason this guy is hungry all the time. He made two fists yesterday, hit the bed and said "I'm hungry. Why the hell won't they feed me?!" Nursing said he's been eating like a horse but he's rail thin. He almost passed out on me today just standing at the bedside. I got him some graham crackers and peanut butter after I finished with him today. He had a good looking lunch tray at bedside mostly uneaten. Said he didn't like it. Dude has a tapeworm He came in malnourished with a fecal impaction. Poor care where he was staying. Severe dementia so he may not remember that he's eaten and his "I'm full" stomach stretch receptors may not be reading properly due to the brain damage from the dementia. |
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Post by OldMan on Nov 4, 2020 18:57:13 GMT -6
fecal impaction- great another thing to look forward to
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Post by chils on Nov 4, 2020 19:23:32 GMT -6
fecal impaction- great another thing to look forward to For the poor nurse who has to digitally check him daily it is no packnic picnic either. |
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Post by chils on Nov 5, 2020 18:27:43 GMT -6
So I had ANOTHER patient pass out on me today. He has dementia but is very nice. His wife has been allowed to stay with him so she's always present. He's had a rough time, actually almost coded and got chest compressions on Monday due to his heart rate dropping to 40BPM.
Doc put in a defibrillator and I got to see him again today in the ICU. Sat him up at bedside. At about 4mins he said "I'm gonna faint" and then slumped forward with his head down. I was holding him up and his heart rate was OK so I attempted to get a blood pressure 2X but his cuff was poorly positioned and it wouldn't read. Ended up flopping him down and the nurse called the doc.
Doc said he wanted positional blood pressures taken NOW. I had to go back in and drag this poor SOB back up and then stand him. Held him up for a full minute for the standing blood pressure--and I mean I held up a limp sack of potatoes with my knees pushing his knees straight and my arms wrapped around his waist in a bear hug so I could lever his hips forward with my hands and his knees back with my knees while pushing his chest up/back with my shoulder.
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Post by Ken on Nov 5, 2020 19:12:52 GMT -6
I don't know how you do it.  |
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Post by chils on Nov 7, 2020 7:48:42 GMT -6
I don't know how you do it. Just doing my job. The doc discharged the guy who passed out sitting at bedside with me Friday. Sent him home with his wife. She refused to allow him to go to inpatient rehab. I talked to the doc FTF about him and he said she wouldn't relent. I waited until they were ready and helped him to the wheelchair to go to his car. He did OK but that's not to say he won't pass out at home with his wife and end up on the floor.
I know it's one of those "I'll be seeing you" instances that is out of our control.
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Post by chils on Dec 1, 2020 19:01:01 GMT -6
I had a poo-poo show this afternoon. I have a stroke patient who had been having problems with high blood pressure. I work him around the medications to keep him in the range the docs want. His BP has been high all the time. Got him up and worked him. He did well but is a 2 person maximum assist to stand up and not ready to walk yet. Left him up in the chair which is great. Keeps them from getting pneumonia and skin breakdown. Went to put him to bed and his BP had tanked. He was unconscious and blood pressures said he was near death. I turned his chair facing the bed, put his legs on the bed, and me, an OT and the nurse dragged him into bed on the sheet he was sitting on. Once in bed we adjusted the bed to have his head down and I told the OT to raise his legs overhead, forcing his blood back up to his brain. This got his pressures up to a safe range. While we were doing this the nurse was hanging fluids full bore to get him hydrated and his blood pressure up. Got him in a safe range. Man I thought I was going to be doing CPR at any time. Wife was in the room but never twitched because we just took care of business without showing signs of stress. She didn't know the gravity of what was going down. The 61/34 was when I walked in the room. Took the 44/22 (thats really, REALLY bad) on the other arm to make sure the reading was right. Then we went to work. The 117/51 is with his legs over his head and bed turned 30 degrees head down.
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