Not a great day. My head really wasn’t in it this morning. I had my ass in a snit about something entirely unrelated. I woke up this morning and for whatever reason it was eating at me. This situation has since been resolved.
My patient today was difficult. Wasn’t wanting me to do anything to them. Saying things like “I’ll let you see what I want to let you see!” They said this because they had pancreatitis and had a tender abdomen. They were also NPO. Grumpy grumpy. I educated several times why they could not eat. (resting the GI tract) and they did not want to hear it and refused to get out of bed until they had something to eat. Still refused to ambulate even after the diet was advanced, they ate and was sitting in the chair. (didn’t last long). Was more cooperative and receptive to learning after a bunch of clear fluid, ice pops and jello were eaten. Was able to educate effectively after that.
I gave all my meds today. I felt like the nurse who had my patient wasn’t interested in having me around. She didn’t talk to me much and I ended up staying around other nurses who had something to teach me.
I went in to hang a bag of normal saline 0.9% and I had it all set up and ready to go there was just some air in the line. I couldn’t get it out and the patient says to me” do you know what you are doing?” He pressed the issue until I finally said “Tiffany can you get the nurse for me?” she helped me get the air out of the line and I left the room. Later this patient called that nurse and complained that I had come into the room without my instructor to hand the bag of fluid. Whatever, it’s fine that he said that because rationally he has the right to be leary of me as a student. I had to hear later from my classmate about how he loved her and such. She’s an LPN already and knows how to do this stuff. I felt really bad about that. In my heart it hurt my feelings.
I got a ‘nice try” on my care plan. I felt like crap about that too. When I tried to get some help she had to go to a meeting at the school. So now I’m hanging with crappy care plans. I have trouble with them especially with the psychosocial. Grrrrr I hate care plans!
What I did get to do is a wet to dry dressing on a thumb wound. That was pretty cool. And I d/c’d a couple of IV’s.
So I am so happy to not have any class work tonight because I’m all “nursed” out for one day.
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Pancreatitis is inflammation of the pancreas. It is a serious disorder. Pancreatitis is commonly described as autodigestion of the pancreas. It is believed that the pancreatic duct becomes temporarily obstructed, accompanied by hypersecretion of the exocrine enzymes of the pancreas. These enzymes enter the bile duct, where they are activated and, together with bile, back up (reflux) into the pancreatic duct, causing pancreatitis.
Cause: Self-digestion of the pancreas by its own proteolytic enzymes, principally trypsi,patient is acutely ill and at risk for hypovolemic shock, fluid and electrolyte disturbances, and sepsis. A more widespread and complete enzymatic digestion of the gland characterizes severe acute pancreatitis. Enzymes damage the local bloodvessels, and bleeding and thrombosis can occur. The tissue may become necrotic, with damage extending into the retroperitoneal tissues. Local complications include pancre-atic cysts or abscesses and acute fluid collections in or near the pancreas causes acute pancreatitis. Eighty percent of patients with acute pancreatitis have biliary tract disease or a history of long-term alcohol abuse. These patients usually have had undiagnosed chronic pancreatitis before their first episode of acute pancreatitis. Gallstones enter the common bile duct and lodge at the ampulla of Vater, obstructing the flow of pancreatic juice or causing are flux of bile from the common bile duct into the pancreatic duct, thus activating the powerful enzymes within the pancreas.
Other less common causes of pancreatitis include bacterial or viral infection, with pancreatitis occasionally developing as a complication of mumps virus. Spasm and edema of the ampulla of Vater, caused by duodenitis, can probably produce pancreatitis. Blunt abdominal trauma, peptic ulcer disease, ischemic vascular disease, diabetic ketoacidosis, hyperlipidemia, hypercalcemia, and the use of corticosteroids, thiazide diuretics, oral contraceptives, and other medications have also been associated with an increased incidence of pancreatitis. Acute pancreatitis may develop after surgery on or near the pancreas or after instrumentation of the pancreatic duct. Acute idiopathic pancreatitis accounts for up to 10% of the cases of acute pancreatitis.
