Tuesday, December 21, 2004

Total Nurses Post

I had a resident the other night, whose case is bothering me. He's a deceptively young looking 90 year old African American male. He is pleasant, cooperative, and completely alert and oriented. He was hospitalized several weeks ago at a local area hospital after being seen for dyspnea upon exertion. X-rays showed lower lobe infiltrates, and he was diagnosed with pneumonia.

He is currently receiving care because of a stage III wound to the coccyx. What I don't understand is how he ended up with the wound in the first place. He's mobile, using a walker only for balance. He has no sensory deficit, and can feel pain. He's capable of making position changes without assistance. So how did he end up with a serious decubitus?

I did a little more digging into his habits and behaviors by reading his chart and talking with him. He receives meals on wheels which he wont eat at times if he doesn't like the food. Since one of his diagnoses upon admission was dehydration, I'm wondering if there isn't a dietary issue here as well. Perhaps more protein needed? Also, since he has been widowed, he doesn't like to sleep in his bed. There is a practical side as well as it is easier to toilet in the night quickly if he doesn't have to get all the way out of bed. But I suspect the psych/soc issue is a pressing one also, as he still misses sleeping next to his wife. This means that he spends pretty much all day AND night firmly on his bottom.

So now the issue is, what nursing interventions can I implement to assist with wound healing, prevention of further ulcers, and keeping him healthy and happy? This is a question I'm still struggling with a bit. I passed on info to the day shift (primarily responsible for coordinating care) about dietary consults, etc. But I'd like social services to see him also to evaluate what community services he'd be eligible for in addition to meals on wheels. Also, I think he education. He needs to understand what he's doing to himself by staying in such a position all the time. I'd prefer him to wet occasionally trying to get to the bathroom than get an infection in an ulcer. But I'm not sure how to address the psych/soc issue. I can't tell a man to stop missing his wife.

Somehow this man made me remember why I love being a nurse. Not just the helping, but the figuring out HOW to help. And seeing someone when they leave knowing that they're better for the care they have received. He was the kind of resident you'd love to put in your pocket and take home. He made me remember how strongly I feel that I have got to go back to school!

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