This is a "typical" shift in triage on L&D.
Come on duty. There are 3 patients in triage. One to rule out labor, and she had a prior c/section. One with complaints of mid epigastric pain, but is only 24-25 weeks. Those first two patients had already been assessed on placed on monitors, with all lab work drawn by the previous shift nurse.
One patient that rolled in while you are getting report from the previous nurse - this lady is from the ER with very strange and vague complaints and is under 20 weeks. (Hey, they're pregnant. The ER ships em right up to us. No triage down there. None.) She has a laundry list of medical and possibly OB related complaints.
The rule out labor lady, prior c/section is having audible decels.
The epigastric pain lady is moaning loudly and dramatically when she sees you walk into the triage area.
The new ER transfer needs to pee NOW & and won't get out of bed by herself. She keeps hitting her call bell, and the secretary on the other side of the unit (the labor side, way WAY down the hall from triage) keeps calling your cell phone to let you know she needs to pee NOW!
Oh, and the great news? The most recent patient just came from the antepartum unit for a prostaglandin gel placement. She's turns out to be the actual sickest pregnant person in the bunch, but is the least demanding. She is quietly waiting in her triage bed.
What do you do first?
Oh, and you're by yourself. No secretary, no nurse's aid, no assistance available.
Just a little "taste" of triage on a very, very busy OB unit.
7 comments:
ewww 4th priority!
Thank goodness our ER triages anyone under 20 weeks. They sometimes try to sneak them up to us, but it's a pretty firm policy.
Geesh, what a day.
1) Tell new ER admit that if she was able to pee at home, and she's under 20 weeks, then she can most certainly make it out of bed to pee here.
2) Check out prostaglandin gel lady.
3) Figure out what's going on with the audible decels.
4) (Since you've been sneaking around without this lady seeing you this whole time, so her moaning is slightly less...) Go in, hold her hand and tell her how much you {don't actually} care, give her some highly overpriced hospital-issue Tums, and advise her to lay off the tomato products from now on.
5)Help 'helpless' lady to finally go pee, as she most likely stuck it out in bed to prove a point and somehow managed to hold the 50cc that is so urgently pressing on her bladder RIGHTNOW.
Audible decels would be my first priority!
Last few shifts included (just the most interesting stuff and not the parade of chronic pain, drug seeking, muscle pain, car accidents, rule out chest pain and falls):
* Young man (23) with 1st time Sz and "arm pain" -- anterior shoulder dislocation. Took an hour to reduce, because the guy was basically 250 pounds of pure, DMZ-enhanced muscle.
* Immunosupressed patient with rectal temp of 38.6 tachy to the 130s as well as a history of heart failure, renal failure, hypertension, cancer, dementia and COPD. Would prove to have both UTI and PNA as well as presumed sepsis.
* Plasma torch accident -- second and third degree burns over torso and neck.
* First time migraine refractory to saline, Regalin, benadryl, toradol, decadron and depakote. Required LP following CT for "worst headache of life."
* Transplant patient with pressures of 33/17. He's talking. Recheck. 41/22. Recheck. Same. Tube, antibiotics, fluids, multiple pressors, venous and arterial central lines. Dispo to MICU.
* Elderly patient with a ground level fall and open tib-fib fracture sent for repair from outlying hospital. No accepting doctor. Transferring facility failed to note the severe COPD and asthma exacerbation in progress before giving 3mg Dilaudid and 10mg morphine. Pt arrived retaining with a pH of 7.17 and satting 82% on a nasal cannula. She was on bipap for hours but we avoided an ED tube. Admission required consults to five different services (ortho, unreferred medicine, hospitalist, anesthesia, MICU) as each one passed the ball to the others. Total phone calls well into the double digits.
And so on. Of course, that's what I signed up for. I find it kind of fun. Other specialists tend not to like it, although that does not stop many of them from turning their noses up at we "overpaid triage nurses."
As your experience reflects, the job of a triage nurse is nothing to sneer at!
I think the nurses need to have a talk w/ management about triage not being the appropriate place to start inductions first of all. In the second place ER needs to assess pts who are not 20wks period. The manegement has to be the one to tackle that beast...in our unit we send them back to ER. I think priority one is to call charge nurse to transfer repeat c-section to the unit for admission and prep for her section.
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