One of our patients, Female in her 50s, had fallen from the bed at 0200 the night prior. They found her on the floor naked without any clothes on. She has no recollection of what happened and had 2 abrasions/lacerations on her chin. Her blood pressure dropped. Her sugar was normal and aside from all these, she was cold to touch and cyanotic. They covered her with warm blankets. All these happened the night prior as per handover report.
During one of my rounds, I assessed her and noticed her right arm was weak and she can hardly move them. Her pupils are equal round and reactive to light but were 4-5mm dilated. No facial droop but she appeared very weak. I immediately informed my preceptor that day, J.C. and she also informed the Dr. F. who came and see the patient who was ordered to have a CT Angiogram immediately and meds were held (apixaban, metoprolol and the rest) She was in no good shape to take the meds anyway. We were ruling out a hemorrhagic stroke. Lasix 20mg was ordered but we checked her blood pressure and it was 80/40 so we didn't give it to her. 500Ml of NS bolus was administered after establishing an IV line on her left thumb after nth tries. I came with her in the CT lab where an angiogram cant be done because they need a G20 or a G22 angio compatible needle. We tried but to no avail. A Brain CT without contrast was done where a new left occipital lobe was seen. No wonder she had new right side weakness. However when she came back to the room her BP was 70/30. New IV lines established after how many tries while a transfer to MS-ICU was being ordered by the physician.
It was one of the most nerve-wracking experience in my life. I feel like I could have done more. I could have advocated more for the patient. I wrote this entry because I want to be reminded that there is always something you can do as an extra-effort. I don't know if anyone experience this (Nurse-guilt). You have done everything you can for the patient but you feel like there should've been more. And I am reminded of why we need to study and advocate for continuous learning for ourselves.
I feel like I needed to let this out my chest or else I will be eaten by this overwhelming feeling. Thank you for reading even though I know this has nothing to do with you and that you too are going through something. This too shall pass. Let's all move on and move forward.
Xoxo,
Nina
