What a Night!!!

It is important as a nurse to stay on your toes and be ready for anything at anytime.  Things don’t always go according to plan. 
My first night of work this week, I was told that I had two patients that I needed to keep an eye on for signs and symptoms of sepsis.  Now for those who don’t know…sepsis is not a very good thing and one that you really don’t want to happen on an acute care floor where the monitoring is not as intensive as in progressive or critical care parts of the hospital. 
Well I kept a close eye on these two patients and they were fine all night long, in fact one seemed to be improving.  I left for the morning and went to get some rest before I returned that evening. 
As I received report on the first patient, I learned that she had continued to be fine all day long. Her temperature had maintained normalcy and her blood pressure was fine.  I finished receiving report and went into the patient’s room to begin my assessment.  She asked to be repositioned in bed…so I went to find some help…As the tech and I were moving her up in the bed, I noticed she felt really warm…I asked the tech to take her temperature before she got her some ice.  Her temperature was 103.1!!!  That is never a good thing…so I gave her some Tylenol to help bring the fever down.  About 30 minutes later, the tech came and found me to tell me that her blood pressure was 72/54 Not good!!!!
I paged the doctor and he came up to assess the pt.  He ordered blood cultures, a 500 ml bolus, chest and a chest X-ray.  As he was in the nursing station entering the orders, the pt complained of her throat closing off as if it was swollen.   The doctor came back in and very quickly called his upper level to get some help.  The upper level doctor came up and ordered a STAT EKG, some antibiotics and a progressive bed transfer.  I spent the majority of the night before midnight in with this patient getting her stabilized and ready for transfer. 
It was a little sad because once she was stabilized, and she realized she was being transferred, she began to cry.  “I don’t want to leave…you all take such good care of me up here…”  I told her that I wish she would stay with us…but that she should tell the nurses in progressive care that she wanted to come back up to our floor tomorrow if she was able.  She said she would.  And off she went.
This left me with four patients, with a ton of work to catch up on since I had gotten behind caring for the septic patient. 
I ran my butt off for awhile until I finally caught up, and the evening slowed down for a bit until about 0500.  As I was taking pain medication to one of my patient’s (the other patient from the night before who I was supposed to watch for sepsis) wife came running out of the room.  “There’s something not right with my husband!!!”
I went running in with all these thoughts going through my head of what it could be…especially since earlier in the evening I had witnessed him having hallucinations from a dose of dilaudid.  He was talking about seeing people flying around the room, and a helicopter flying over his head with an elephant on it…needless to say I held the dilaudid for the rest of the night…
I entered the room, and saw the patient sitting there with a weird look on his face…his eyes were open really wide, and he was mumbling a bunch of nonsense and smacking his lips together…I knew what it was in a second and went to grab the glucometer.
As I checked his glucose level, he was talking all sorts of crazy talk and being really funny.  His glucose came back at a critical low of 9.  I was very surprised he was still conscious and able to talk even if it was nonsense.  I quickly grabbed some orange juice with 2 packets of sugar missed into it.  I was able to convince him to drink the OJ, but it was not helping as much as I wanted it to…so I grabbed a tube of glucose gel.  I placed the gel in his mouth and tried to get him to swallow…he was not able to comprehend my commands…so I had him look at me and showed him how to swallow…He swallowed the majority of it down, the rest ended up all over me when he decided to begin spitting and smacking his lips.  Even after the glucose gel his glucose was only up to 48 which is still not very good. 
So I pulled out the big gun, an amp of D50!!! I knew the D50 would bring up the glucose.  As I began pushing the D50 into his IV, he started to cry.  Which was actually a good thing…it meant that his glucose was coming up…as I got about ½ of the amp administered, he suddenly came too…and knew where he was and who I was…But he couldn’t remember anything or know what had happened…I explained to him that his sugar had dropped but the D50 had helped bring it back up…but that he needed to eat some graham crackers and peanut butter so that it would stay up…
Overall it was a very busy stressful night at work…I had two incidents happen that I could not foresee so it was a good thing that I was able to think on my feet and that my training was enough to help me know what to do…Both patients turned out to be fine and I left work with both I and all my patients alive :)