How was YOUR night?
At 1915 I walked into room 5, where we were holding a CCU patient with a K+ of 8.4 (that would not be getting a bed on my shift), and the first thing I saw were 4 empty little brown bottles with black lids.
Some of you know where this is going. (Pun intended.)
At 0030, the flow had slowed, and her K+ was 7.1.
4 more little brown bottles with black lids. (Actually, the bottle isn't brown, is it? It's the goo inside that makes it brown.)
Did I mention that she weighed 300 lbs?
*sigh*
How was YOUR night?
For those of you that are feeling left out, K+ is potassium, and anything over 5.5 is bad. 8.4 is super bad, as is 7.1. The little bottles with the black lids contain Kayexalate, which binds with excess potassium and is then excreted by the body. In the form of large quantities of liquid poo. You can figure the rest out.
24 comments:
Not even a modicum as bad as that. My sincere condolences...
Last semester was my first in nursing school, and the very first patient I ever took care of had been given those same little bottles. I questioned if I wanted to be a nurse after that day.
Though for the record, I graduate in December and poo doesn't bother me anymore.
I really think you should start another blog >The Poo Files<. Although I'm sure you can come up with another more clever name for it... You could even post pictures! :รพ
Thanks for the explanation at the bottom of your post. I was totally lost for a minute there. And can I just say that the situation sounds gross for even a normal size person, but a 300 lb person would be even worse... Go take a nap.
Oh, thanks for asking. I called in sick to work.
I'd rather be called the C-word over and over all night long than read the word "Kayexalate" under the physician's orders part of a chart.
300 pound poo patient.
SHIT!!!
Had a patient once, a little old lady, with severe abdominal pain largely due to constipation and gas. When the resident stood at the bedside and told us he was ordering a return-flow enema, she and I both turned to look at him with such overt, focused hostility that he actually turned pale and took several steps back from the bed. Heh.
I'll admit she did feel a little better after the enema. But I remember that while I was administering it, I was thinking, "My non-nursing friends would never BELIEVE what I do at work some days."
Wow...really sorry.
I have to admit that I've ordered Kayexalate more than a few times without thinking about the other end of it...
I hate poo.
So, I hope for you that she was at least continent of bowel? Was she able to get up at all to a bedside commode?
Nothing worse than diarrhea for a total-care, incontinent individual.
OHhhhhh!!! Barf! I could never do what you all do.
My short-gut son once had a K+ of 8.2. Strangely, the Kayexalate actually made his poop thicker, as it was normally the consistency of water...
--lexi
Let's add this to the list of reasons why I don't want to be a nurse.
Mmmmmmmm....
Making it hard to enjoy my bowl of chocolate pudding.
I weigh 300 pounds.
And I am working on it, in honor of you.
Guess I'm lucky to have trouble keeping my K+ up to 3.2 most of the time. It's easier to down 4 Micro K's than do Kayexalate routine. Ugh!
Hi!
A question and a comment. The comment first -- what I consider the ultimate poop story was posted more than three years ago, by Head Nurse, at http://head-nurse.blogspot.com/2004_10_01_archive.html. Look for the sub-heading "Head Nurse, now with more poop". :-)
The question would be, why not hang a liter 5% dextrose mixed with 7 or 8 units of insulin, instead of the Kayexalate?
Thanks,
Felix.
Kinda sad that after only an 8 week internship in renal those K+ values don't phase me anymore. Luckily we usually sent them to hemo rather than busted out the kayexalate.
Well, at least you did not have to give it by retention enema! I have seen some MD's order it given that way!
This one time (at band camp) I had an old guy who was expelling his k+koktail and the way he had his legs crossed (sedated et intubated), made a perfect seal on the bed... therefore, he had poo-soup filling up. I didn't know what to do (if I moved him it would go EVERYWHERE), so I grabbed a yanker and sucked it all up. It filled an entire canister.
I had a pt actually get discharged with a K of 6+ pushing 7 because his family were medical professionals and he had a doctor's appointment that day.
Did I mention he was also cardiac? Well, my guess is they parked him on the throne at home a littl later and just threw the Kayexalate at him there in the confines of their lovely suburban home.
It serves his RN relative right--that b*#$ch was nothing but trouble for our staff. She never showed up, but always complained about what we didn't do--take him to the computer, make him walk in the halls, etc.
Hello, we couldn't even get the guy in the shower without a freakin' MD order. My guess is she's forgotten that pt's can refuse a lot of stuff, and he certainly refused activity out the wazoo.
BTW I was his favorite nurse. The witch RN brought in donuts for staff--on my day off.
I hate K+ issues. Hate giving Kayexalate, and I hate giving potassium PO OR IV. It burns.
However, for a K+ that high, we'd forget the Kayexalate. An amp of calcium gluconate (unless the pt's on dig), an amp of D50, 10 U regular insulin IV, and...what's the last one...Oh yeah, bicarb. And then think about emergent dialysis.
Felix and GuitarGirl: We did the Calcium-Insulin/Glucose-Albuterol-etc, routine, too. And she was scheduled for "emergent dialysis". Which in my neck of the woods, means "tomorrow morning".
You just reminded me of my very first code. During the code it was discovered that the pt's K was above 8. The MD running the code ordered a Kayexalate ENEMA. No shit (hee hee). The nurse gave it. I still remember her over the bed with the bucket shouting to the patient, "TRY TO HOLD IT IN AS LONG AS YOU CAN, SIR!!"
I was stunned at the time. I wondered if I really wanted to be a nurse.
Now I remember it and just try not to laugh out loud, or snort!
WHY do they ALWAYS have to weigh 300 pounds!? I've never understood why the weight of the patient has to be directly proportionate to the amount (and frequency) of the poop!
Wow. Shitty night.
(I recently found this blog and am seriously enjoying reading back through it. Thanks.)
Post a Comment