the alerts and orientations

Shift #3

One important bit of information that you always give another nurse or provider at shift change is how alert and oriented the patients are. 

Do they wake up when I speak to them?

Do they respond?

Do they answer my question correctly? 

Sometimes the patient will be almost half dead and will still be able to grimace at who the president of the United States is. 

Most Covid patients are alert and oriented to person, place, and time (AOx3). Then they will lose the sense of time..AOx2. Then will become agitated, forgetful, confused. 

Today was a constant battle with patients wanting to rip every connection or extension off of themselves. I overheard one nurse say, "If you take your oxygen off, you will die!" 

The patient arrested 2 hours later and died. One patient fell because she was forgetful and confused. With all of the room doors closed, how can we monitor if they fall, rip off cords, or extensions of themselves? 

Today I had a patient with metastasized esophageal cancer and COVID. A nasogastric tube was in place. I started the dense calorie feeds through the tube, and he ripped it half way out while the feeds were still going. The patient aspirated, causing an even bigger problem. They tell us, "You shouldn't have to go in the room so much" but I tell you I did not feel right about my patient. How am I supposed to protect my patients and only go into their rooms only 4 times a shift.  It is unsafe and impractical. 

Today throughout the day, I was able to laugh some. I truly believe that my time during Covid would be worse if I did not have people praying for me. But I still feel guilty. With each laugh from a joke, scowl when the phone rings from a family member, or complaint about how hard it is -- I feel guilty. 

This is what I see every time I retrieve a piece of PPE. I read this quote and become more alert and oriented to my surroundings and the new normalcy of being a COVID19 nurse.