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Friday, May 27, 2011

A Night in the Nursing Home wd ct 1499



Denise jumped out of her chair and raced down the hall toward the sound of someone screaming. The moon shone brightly through the window as she entered Room 332.
The elderly lady sitting up in the bed was staring at a shadow on the curtain covering the window, her hands rested on her cheeks, her mouth in an “O” shape. Her frail thin body trembled.
She turned when Denise entered and cried, “The birds—look at all the birds. They want to kill me! Please help me!” She reached her arms toward Denise. Tears ran down her cheeks.
“Maggie, it’s ok. The birds are all outside. They can’t get to you here. Shhh—it’s ok, now. Try to relax. Come on, lie back down. I won’t let anything hurt you.” Denise perched on the edge of Maggie’s bed, cradling her in her arms. She could feel the violent shaking from Maggie’s body. Denise checked Maggie’s blood pressure and pulse, and felt her forehead. No fever, at least, she thought, as she patted Maggie on the arm to reassure her.
Teri, an aide working the same shift, entered the room, anxiety etched on her face. She relaxed slightly as she realized that Denise was already in control of the situation.
“Another nightmare,” Denise explained. “She seems to be having these more frequently lately. I’m wondering if it might be due to that new medication she just started last month.”
“Which medication is that?”
“Imipramine. It’s an antidepressant that Dr. Kinsley ordered for Maggie, because she was crying and withdrawing from everything last month. One of the side effects that can happen is nightmares and hallucinations.”
“Oh, wow! What are you going to do?”
“I’m going to call Dr. Kinsley and report this to him. I’m sure he will order the med to be stopped.”
“Isn’t Dr. Kinsley that doctor that hates to be awakened in the middle of the night?”
“Yes, he is. But I think this is important. He needs to know what is going on. Can you stay with Maggie for a bit until she is ready to sleep again?”
“Yeah, sure. But, would you tell Jeannie where I am? I was helping her do bed checks. I think she’s in Julian’s room.”
“Ok, thanks. Will do.”
Denise returned to the nurse’s station and looked up the number for Dr. Kinsley’s service. She dialed the number and waited, while watching the video monitors for any hall activity. Everything was quiet inside, but she could hear the wind picking up outside. It was starting to rain.
“Shoot. I wonder if my car windows are up,” Denise rubbed her forehead as she struggled to remember if she had rolled her windows up when she arrived at work earlier. The Dr.’s answering service picked up the call and she heard the familiar sounds of his recorded message to call during office hours.
“Crap, now I’ll have to call the doctor on call at the hospital,” Denise punched in the number of the hospital. When the switchboard answered, she requested the doctor on call. She learned that Dr. Howser was on call and asked for him to return her call, then hung up the phone.
The night had started with one resident vomiting in the bathroom. Another was coughing and complained of being short of air. Denise spent much of her time assessing, medicating, and checking vital signs, then charting everything she did.
While she waited for Dr. Howser’s return call she walked down the hall to Julian’s room, where she found Jeannie making his bed. Julian was sitting in the bathroom on the toilet. The strong odor of urine permeated the air.
“Teri is sitting with Maggie for a bit. She was having of her nightmares again,” Denise whispered to Jeannie. “Do you need help here?”
“Well, yeah. I’ve been doing most of the work tonight by myself. Teri is always disappearing.”
“I’m sorry. I asked her to stay with Maggie. Here, let me help you.”
“Thanks. Would you help me get Julian back into bed?”
“Sure. Hey, Julian. How are you tonight? Are you ready to get back in bed?” Julian nodded.
“Ok, then, here we go.” Teri and Denise transferred Julian back into his bed and got him settled in for the rest of the night.
“Ok, then. I’m going back to the nurse’s station. I’m expecting a doctor’s call.”
“Alright, I’ll keep working my way up the hall. Thanks a bunch.” She smiled at Denise and picked up her soiled linens, placing them into a bag to put in the laundry chute.
The phone was ringing as Denise approached the nurse’s station. She ran the last few feet to pick up the receiver before the fourth ring.
Glen River Manor. Denise Davenport, RN, speaking. May I help you?” Denise grabbed her pen and a piece of paper to take a message if needed.
“This is Dr. Howser. I received a message to call you.”
“Yes, Dr. Howser. Maggie Simpson, one of Dr. Kinsley’s patients, is having hallucinations and nightmares. She believes there are birds in her room that are trying to kill her. She started taking imipramine twenty-five milligrams daily at bedtime on the twenty-fourth of June. She is quite anxious. Blood pressure is one thirty over seventy-two; pulse is seventy-nine and regular. She is afebrile. She has already had her imipramine tonight.” Denise paused, and waited for Dr. Howser to reply.
“Any seizure activity?”
‘”No, Doctor.”
“Bowel and bladder function normal?”
“Yes. She had a normal bowel movement this morning, and has been voiding normally all day.”
“Any talk of suicide?”
“Not that I’m aware of. She seemed cheerful at dinnertime.”
“Monitor her through the night with vital signs every four hours. Notify Dr. Kinsley in the morning. If her blood pressure drops twenty points, call me back.”
“Thank you, Doctor Howser.”
“You’re welcome. Good night.”
“Good night.”
Denise hung up the phone and went back down the hall toward Maggie’s room. She met Teri, coming out of the room.
“Shhhh. She’s asleep,” Teri whispered. “Did you find out anything?”
“Not much. Vitals every four. Report blood pressure drops. Call Dr. Kinsley in the morning. Jeannie said she was doing alright. But you might check to see if she needs help anyway.”
“You bet.”
“Holler if you need me. I’ve got to get this charted, before I forget anything.”
Jeannie poked her head out of a door down the hall, and wiggled a hooked finger to summon them to her position.
“I hate to tell you this, but Sam is on the floor. There is a puddle of urine right beside his bed. I think he stood up and just let it loose right beside the bed. He always things he’s in the bathroom, wherever he’s located.” Jeannie shook her head and smiled. “I didn’t see any injuries, but I told him to sit tight until you check him out.”
“Thanks. We’ll need a set of vitals on him. Did you see him fall?”
“No. He was sitting on the floor in that puddle just grinning at me when I walked in to check on him.”
“We’d better initiate neuro checks then. Who knows if he hit his head or not? This is turning into a fun night.”
Denise shook her had and sighed. She examined Sam for injuries and checked his neural function. Sam, a previous stroke victim, was unable to voice his needs, but by the grin on his face as Denise checked his range of motion and looked for skin tears, bruises and abrasions, she deduced that he was in no pain.
Jeannie grinned and teased Denise. “I’ll bet you’re regretting offering to work for Charlotte tonight, aren’t you?”
“Oh, it’s not so bad—yet.” Denise returned the grin. “But let’s hope it quiets down a little bit from here on out. I don’t need any more paperwork to do.”
Denise worked on paperwork and made the necessary calls to doctor, family, and on call nurse to report the fall. She also reported Maggie’s anxiety episode to the on call nurse.
A period of solitude allowed Denise to get some of her charting done. There were breathing treatments to give, and two dressing changes. These went without a hitch.
At five o’clock, Denise taped her report for the next shift, and set up the paperwork for the day shift charge nurse so she could get her labs drawn before breakfast. She restocked the glucometer kit, so there would be plenty of test strips, lancets, alcohol wipes, and cotton balls for the diabetic testing.
Aides for the day shift began arriving at five forty-five, looking around to see how many residents the night shift had dressed and were in their chairs, waiting for breakfast. Not finding many, they grumbled, “as usual, night shift has done absolutely nothing all night.”
Jeannie and Teri looked at Denise, to gauge her reaction. Denise smiled at her aides, looked at the grumblers, and quietly said, “No, nothing at all.”

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