Nursing Student Coach
Join Lauren Chapnick, RN, as she takes you through the journey of becoming a nurse! On Nursing Student Coach, Lauren, who is a new nursing professional, along with her knowledgeable guests will give you the tools to succeed in your nursing career. They will discuss ways to reduce anxiety and stress, share tips on studying and preparing for your NCLEX, and so much more - you won't be alone in this adventure! New episodes air every Thursday.
Nursing Student Coach
Tales from the ER: The Curious Case of "Betty" and Her Jar of Black Sludge
Have you ever been handed a Tupperware container of evidence by a patient? Sounds bizarre, right? Well, let me take you through an ER shift that was anything but ordinary, featuring our memorable patient, "Betty." She waltzed in with abdominal pain and a very direct approach to communicating her symptoms. Betty's self-diagnosed treatment plan, rooted in decades-old research assistant experience, leads us on an eye-opening journey about the crucial role of medical knowledge and patient education.
Join us as we unravel Betty's story, which is as colorful as it is instructive. We'll explore the detective work nurses undertake in the ER, the common misconceptions around managing gastrointestinal issues, and why reaching for Advil and milk might not be the best course of action for suspected peptic ulcer disease. You're in for an episode that's not only filled with interesting medical twists but also laced with humor and the importance of accurate patient information for better health outcomes. Buckle up for a narrative that's as engaging as it is informative, and remember, the next time you're in Betty's shoes, leave the Tupperware at home.
Is the nursing student coach giving you the strategies you need the most. Hi everybody, welcome to Nursing Student Coach. Today I want to tell you about a patient that I had recently. Let's call her Betty that's not her real name but we're going to call her Betty for the sake of her privacy. Betty was quite a character. I came in I knew her chief complaint was abdominal pain.
Speaker 1:So one of our roles as a nurse in the emergency department is we are playing detective. We have to assess our patient in such a way and ask the right questions to kind of get to the bottom of what is going on. So our assessment is very important. So I walk into this room and Betty she's in her 60s. She has this giant blanket that she's knitting and she's got her you know tote with her she brought in, instead of a purse, she has this big shopping bag, this recyclable shopping bag. So I say hi, my name is Lauren, I'm one of the nurses here. What brings you to the emergency department today? She reaches into her bag and she plops down on the table a container, a Tuberware container, sealed in a Ziploc bag of poop. It was black, sludgy poop and she plopped it right in front of me and I believe my reaction was oh, what's this? Because nobody had ever brought in a stool sample before. So she puts it up and I say, oh, all right, it looks like you're having some black stool, all right. So we know that she very likely has some sort of GI bleed going on.
Speaker 1:So I start asking my questions. I say how long has this been going on? And she says a few days. Where is your pain? It's, you know, epigastric pain, basically just stomach pain. And I ask her what makes it worse, what makes it better, what does it feel like? And she says it really hurts when she eats anything, and pretty much within 30 minutes after she's just in agony. That's a big clue because that is a very likely sign of a gastric ulcer, which led us to think probably PUD, peptic Ulcer Disease. And what this is is tiny little sores, tiny little ulcers, either in your esophagus, your stomach, or, it can happen, in your duodenum, that get very irritated when you eat and cause extreme pain and they can bleed and lead to black tarry stool, which was boom, right in front of me. Thank you so much, betty. That was just a fabulous gift, little treat at the end of my shift there, this jar of poo just being presented to me.
Speaker 1:But listen, I love talking to all the different people that come in. I love hearing their stories and one of the things I love about ER nursing is being that first point of contact when somebody comes in in crisis. And she was in pain and she was going through something and she was also quite a character. So she was a huge opportunity for patient education. And I'll tell you why. Because I asked her. I said what have you been doing to make it feel better, like, have you taken anything to treat this? And this is when she says Lauren, I am a medical professional, I know how to treat this. And so I think, oh, all right, maybe she's a nurse.
Speaker 1:Turns out she worked in a lab as a research assistant 40 years ago for a few months. So she says I know how to treat this. I'm in pain, I've been taking Advil and it has not been helping. And then she says I've also been drinking milk and that has not been helping at all. So here's the thing N said use, that's ibuprofen, aspirin any N, said they. That is one of the causes of Peptic ulcer disease. The other cause is H pylori bacteria. So she was actually making her problem worse by taking NSAIDs. Nsaids can cause gastric irritation and bleeding. It is one of the last things you want to take if you have Peptic Ulcer disease. And milk is a myth. It used to be thought that milk helps with the pain and relieves gastric ulcer disease, but it actually makes it worse. So she was not doing herself any favors.
Speaker 1:So Betty was very likely going to get admitted. She was very likely going to get an endoscopy, an exploratory endoscopy, to see if there were ulcers going on. But we were going to start the initial treatment for PUD and then she was going to be admitted upstairs. So that's sort of how the ED works. You, the patient, comes in, they're either going to get admitted, they're going to stay for observation for less than 24 hours on a separate floor, or they're going to go home, or they might get transferred out to another facility. If it's something we can't treat something very critical. So in Betty's case she was going to get admitted either for observation or inpatient. I'm not sure she was such a character, let me tell you, because we had to get some blood work on her, we had to start an IV we gave her. I'll tell you about the initial treatment for PUD. We gave her a PPI, a proton pump inhibitor my hospital uses protonics or pentoprasol IV and we also gave her some IV antibiotics. Generally you would give two antibiotics like an.
Speaker 1:Amoxicillin and chlorothromycin are two of the choices that are commonly used to start the treatment of Peptic ulcer disease. Let's talk real quick about PPI's proton pump inhibitors and their risk, their side effects. Now, most of these side effects are if you take this medication long term, it can lead to bone loss and osteoporosis and which puts you at risk for fractures. That's one of the risks. Another risk is it puts you at greater risk of infection because it decreases the response of your immune system. And PPI's can also be associated with C diff, associated diarrhea which, if you've never smelled it before, is quite pungent. So you don't want to take a PPI, a proton pump inhibitor, for too long. You want to give the lowest dose for the shortest amount of time possible.
Speaker 1:So that was the treatment for Betty. She had a PPI, she had two antibiotics and she was going to get sent upstairs for an endoscopy. Let me just tell you a little bit more about Betty and our interaction and just kind of what I learned about patient communication. So we had to start an IV on her and she said you get one chance. And let me tell you that when I was a medical professional, they used to use me for practice because I have wonderful veins, ha ha. So I Put the tourniquet on her, I look at her arm. There are no veins to be felt. Seen anything, I don't. I don't know it. Maybe she used to have good veins, but she definitely does not, if that makes any sense. So I gave it the good old college try. I tried to start her IV and I missed. So she said I had one shot. So then I said alright, well, what do you want to do? I said I can call in our team that can do an ultrasound IV. So that's what they ended up doing.
Speaker 1:She also Learned that she was going to be admitted to the hospital and had some questions. So she says Well, will they be waking me up to take my vital signs? And I said well, betty, you are bleeding. So yes, they are going to be Monitoring your vital signs at least every four hours. Once you go upstairs and she looks at me, she says do you know what it means to leave against medical advice. I said yeah, I know what that means. She said well, that is exactly what I will be doing if anybody wakes me up.
Speaker 1:I said listen, betty, you got a look at the risk versus the benefit. If you are bleeding and, god forbid, you start hemorrhaging, then we need to know if your blood pressure is dropping. They have to monitor your vital signs. That's just part of the deal. Sleeping in the hospital, you know, one of the things you can do is get some earplugs, maybe get a sleep mask, but unfortunately you won't be here for long. But unfortunately that is part of the deal of, you know, getting admitted to the hospital. Well, she didn't care for that too much, but that's the tale of Betty with her jar of poo and her peptic ulcer disease. I hope that that helps you in case and a question comes up on your next exam. But that's all I got for you today, guys, I hope you have an amazing day. Stay well, bye, bye. Thanks for tuning in To the nursing student coach podcast.