>BoldAntes que todo, la seguridad mía, la del paciente y el entornoBold
Edad:45 años
Dx: Fisura leve del femur, en parte del trocánter mayor, osteoartritis o artrosis en la cabeza del fémur en miembro inferior derecho (desgaste del hueso fémur en la parte de arriba que es que lo une el hueso fémur con la pelvis en pierna derecha) y absceso en el musculo grácil en miembro inferior derecho.
Imágenes tomadas de internet para hacer la demostración del diagnosticó del paciente y editadas por mí, para ser más específica en los lugares donde presenta las lesiones el paciente.
English version
How my day starts as a nurse companion in a health care institution (Clínica Medical Duarte).
On 07/18/2023 I was assigned to take care of a patient, in the clinic, today I am not a home care but a hospitalist, let's start with my chronology of the day.
First of all, my safety, the patient's safety and the environment.
Patient Data:
Nelson Suarez
Age: 45 years old
Dx: Mild femoral fissure, in part of the greater trochanter, osteoarthritis or osteoarthritis in the femoral head in the right lower limb (wear of the femur bone in the upper part that joins the femur bone with the pelvis in the right leg) and abscess in the gracilis muscle in the right lower limb.
>06:30 hrs salgo de la casa, porque en la clínica dejan ingresar después de las 07:00 hrs, llegó a la clínica me identifico, vengo a el paciente Nelson Suárez, entrego mi cédula y me dan un adhesivo, en el cual dice mis datos y los datos del paciente.
English version
At 6:30 a.m. I leave the house, because in the clinic they let me enter after 7:00 a.m. I arrive at the clinic, identify myself, come to the patient Nelson Suárez, hand over my ID card and they give me a sticker, on which it says my data and the patient's data.
English version
Upon arrival I get him with the surgical suit (gown, mask, leggings and cap), I identify myself and tell him that I am the nurse who will accompany him during the day, he had a surgical procedure, he was going to drain the abscess that he told you previously, this would be the 2nd time he was drained in less than 15 days, in the right upper medial limb, (upper back of the right arm was channeled intravenous fluids (Normal Saline Solution 0. 9%), with catheter # 20, with their respective identification, (start date, date of change, # of intravenous catheter and name of the professional who performed the cannulation), I also review the sites of the catheterization (start date, date of change, # of intravenous catheter and name of the professional who performed the cannulation). 9%), with catheter # 20, with its respective identification, (start date, date of change, # of intravenous catheter and name of the professional who performed the cannulation), I also check the puncture sites for signs of phlebitis or extravasion of veins, this patient last week was drained for the 1st time, on 12/07/201/23, purulent secretion (pus) was extracted, according to information provided by the patient, "they took out about 300 milliliters" nothing was left for him to continue draining, in the wound that was previously punctured, they only placed a gauze with fixomull (this is a type of gauze with adhesive), and this patient has been administering it for 6 days diluted in a 100 ml bag of SSN.
>Esta imagen de medicamento no es el tratamiento de mi paciente, porque cuando baje a acompañarlo a su procedimiento quirúrgico ya habían recogido los insumos que le habían quedado la noche anterior. (Tome la foto de otro paciente, con su consentimiento para enseñarle como entregan las preparaciones magistrales al personal de enfermería para que ellos lo administren.
English version
This picture of medication is not my patient's treatment, because when I went down to accompany him to his surgical procedure they had already picked up the supplies left over from the night before. (I took the picture to show him how they deliver the preparations to the nursing staff so that they can administer them.
Se me olvido comentarles que al llegar a la habitación le hago las preguntas reglamentarias al paciente:
-Me siente bien?
-Respira bien?
-Tiene algún dolor o dolencia?
No logro tomar los signos vitales del paciente, porque esos valores los toman las enfermeras de la institución a las 06:00 hrs antes de entregar de turno y como no estoy a esa hora no logro saber con exactitud los signos vitales, pero si el paciente refiere no tener ningún síntoma, se sobreentiende que está bien.
English version
I forgot to tell you that when I get to the room I ask the patient the usual questions:
-Do I feel well?
-Are you breathing well?
-Do you have any pain or ailment?
I am not able to take the patient's vital signs, because those values are taken by the nurses of the institution at 06:00 hrs before they go on duty and since I am not there at that time I am not able to know exactly the vital signs, but if the patient reports not having any symptoms, it is understood that he/she is fine.
07:30 hrs nos vienen a buscar para llevarnos a dónde le hacen el procedimiento, estábamos en el 5to piso y bajamos al 1ero, allí esperamos como 1 hora, porque tenía 2 personas por delante, ya que es por orden de llegada, como a las 08:30 hrs pasamos, lo ayudo a estabilizarlo en la camilla donde lo van acostar, le ayudo con sus piernas ya que con la fisura y el desgaste óseo en la cadera, se le imposibilita deambular solo, los médicos dicen que no se atreven a operarlo, porque según es riesgosa la operación, no sé porque no lo operan de verdad. El procedimiento duro como 40 min, le drenaron y le colocaron una bolsa de cystoflo (bolsa recolectora de fluidos ya sea sangre, orina, etc, con llave de 3 vías con su respectiva conexión adherida a la herida.
Esto fue todo lo que dreno el paciente desde el momento que le colocaron en dren hasta el momento que me retire, 15 ml aproximadamente de fluido.
English version
07:30 hrs they come to pick us up to take us to where they do the procedure, we were on the 5th floor and we went down to the 1st floor, there we waited about 1 hour, because there were 2 people ahead of us, since it is on a first come first served basis, at about 08: I help him to stabilize him on the stretcher where they will put him to bed, I help him with his legs because with the fissure and the bone wear in the hip, it is impossible for him to walk alone, the doctors say that they do not dare to operate him, because according to them the operation is risky, I do not know why they do not really operate him. . The procedure lasted about 40 minutes, they drained him and placed a cystoflo bag (fluid collection bag for blood, urine, etc.) with a 3 way key with its respective connection attached to the wound.
This was all that the patient drained from the time the drain was placed until the time I left, approximately 15 ml of fluid.
Llegamos a las 09:30 am a la habitación, después de esperar al camillero como 15 min para que nos trajera, yo lo quería traer, pero me dijeron que no, que tenía que subir con el camillero que nos bajó, típico el camillero estaba haciendo vida social.
Cuando llegamos a la habitación, ya estaba el desayuno del paciente, le quitó todo el traje quirúrgico, me coloco su ropa habitual, lo estabilizó y procedo a darle el desayuno (2 pancitos integrales con un pedazo de queso, una taza de caldo de papa, 1 taza de café con leche), él come solo, ya que solo lo que tienen es movilidad reducida ya que camina con andadera (aquí en Colombia lo llaman caminador).
English version
We arrived at 09:30 am to the room, after waiting for the orderly about 15 minutes to bring us, I wanted to bring him, but they told me no, I had to go up with the orderly who brought us down, typical the orderly was doing social life.
When we got to the room, the patient's breakfast was already there, he took off all his surgical suit, I put on his usual clothes, stabilized him and proceeded to give him breakfast (2 whole wheat breads with a piece of cheese, a cup of potato broth, 1 cup of coffee with milk), he eats alone, since he only has reduced mobility since he walks with a walker (here in Colombia they call it a walker).
>A las 10:00 hrs le tomaron la glucómetria al paciente y le da como resultado 201 mg/dl, aclaro este paciente también es diabético, tiene picos de hiperglicemia recurrentes, pero la enfermera dice que es por el dolor de la punción y el drenaje que le acaban de hacer.
10:20 hrs la enfermera viene y le administra el tratamiento (medicamentos) correspondiente.
10:15 hrs le traen la merienda, se la doy, precede a comer, (un durazno)
Mi finalidad aquí es darle confort, acompañamiento, estabilidad y seguridad al paciente, ahora está viendo el Tour de Francia mientras entretiene la mente para olvidarse del dolor por la punción.
11:05 hrs paciente descansando (duerme)
11:45 hrs como me dice que tiene mucho dolor, le comento a la enfermera y esta a su vez le administra dipirina para el dolor!
12:30 hrs se procede a darle almuerzo al paciente, bajo en sal, tolerando bien la dieta hipercalorica, ya que tiene baja contextura muscular.
English version
10:20 a.m. The nurse comes and administers the corresponding treatment (medication).
10:15 hrs they bring him the snack, I give it to him, precedes to eat (a peach).
My purpose here is to give comfort, support, stability and security to the patient, now he is watching the Tour de France while he entertains his mind to forget about the pain caused by the puncture.
11:05 hrs patient resting (sleeps)
11:45 hrs as he tells me that he is in a lot of pain, I tell the nurse and she administers dipyrine for the pain!
12:30 hrs we proceed to give the patient lunch, low in salt, tolerating the hypercaloric diet well, since he has a low muscular build.
14:00 hrs De regreso de mi hora de almuerzo.
14:20 hrs le doy el prebióticos al paciente, ordenado por la nutricionista. (suplemento Vitamínico) 4 Cucharadas del suplemento en 280 ml de agua, diluir bien y consumir, el paciente toma el Prowhey diariamente ya que está muy bajo de peso y esto lo ayuda a mantener y a ganar peso también.
14:30 hrs Se hidrata la piel del paciente ya que está muy reseca e igual corto y limo las uñas de manos y pies.
15:30 hrs después de hacer hidratado al paciente vengo yo a hidratarme con mi respectivo café y a deleitarme con esta vista.
English version
13:00 hrs I go to lunch
14:00 hrs I return from lunch
14:20 hrs I give the patient the prebiotic, ordered by the nutritionist (Vitamin supplement) 4 tablespoons of the supplement in 280 ml of water, dilute well and consume, the patient takes the Prowhey daily since he is very underweight and this helps him to maintain and gain weight as well.
14:30 hrs I moisturize the patient's skin since it is very dry and I cut and file the fingernails and toenails.
15:30 hrs after hydrating the patient I come to hydrate myself with my respective coffee and enjoy this view.
15:40 Viene la nutricionista pasando consulta y hablo con ella, referente a la alimentación y el suplemento dietario que el consume.
16:00 procedo a dar la merienda (mediatarde) al paciente.
Esta fruta se llama Uchua, es muy común verla y consumirla aquí en Colombia en Venezuela nunca la vi.
17:00 hrs vienen administrarle medicamentos al paciente nuevamente, yo vigilo y estoy pendiente, hacen cambio de jelco de miembro superior derecho a miembro superior izquierdo, ya que el paciente refiere tener molestia.
Me quedo un rato más acompañando al paciente y las 18:00 hrs me retiro, el paciente me da las gracias por haberlo acompañado durante el día, es gratificante ver esa sonrisa que queda reflejadas en sus rostros y cuando te dicen GRACIAS, eso quiere decir que están conforme con mi trabajo y que lo estoy haciendo bien, todos los días trato de ir puliéndome, aprendiendo y perfeccionando mi trato hacia los pacientes, de verdad nunca me vi en el papel de enfermera y pues tampoco es algo que me desagrade pero es bien ayudar a los mal vulnerables de una u otra manera, tal vez en la otra vida fue descendiente de Florence Nightingale y ahora es que estoy descubriendo este talento oculto. 🤣
>Florence Nightingale (Florencia 1820-1910) fue una enfermera, escritora y estadística británica, considerada precursora de la enfermería profesional contemporánea y creadora del primer modelo conceptual de enfermería.
Informacion sustraida de: https://es.wikipedia.org/wiki/Florence_Nightingale
English version
15:40 The nutritionist comes in for a consultation and I talk to her about the diet and the dietary supplement that he consumes.
16:00 I proceed to give the snack (mid afternoon) to the patient.nto Vitamínico) 4 spoonfuls of the supplement in 280 ml of water, dilute well and consume, the patient takes the Prowhey daily since he is very low of weight and this helps him to maintain and to gain weight also.
This fruit is called Uchua, it is very common to see it and consume it here in Colombia, in Venezuela I have never seen it.
17:00 hrs come to administer medications to the patient again, I am watching and I am pending, they change the jelco from the right upper limb to the left upper limb, since the patient refers to have discomfort.
I stay a while longer accompanying the patient and at 18:00 hrs I leave, the patient thanks me for accompanying him during the day: 00 hrs I retire, the patient thanks me for having accompanied him during the day, it is gratifying to see that smile that is reflected in their faces and when they say THANK YOU, that means that they are happy with my work and that I am doing well, every day I try to go polishing myself, I never really saw myself in the role of a nurse and it is not something I dislike but it is good to help the vulnerable in one way or another, maybe in the other life I was a descendant of Florence Nightingale and now I am discovering this hidden talent, hahahahahah....🤣
Florence Nightingale (Florence 1820-1910) was a British nurse, writer and statistician, considered a forerunner of contemporary professional nursing and creator of the first conceptual model of nursing.
Information taken from: https://es.wikipedia.org/wiki/Florence_Nightingale
Bueno salgo de la clínica y llego a la casa a descansar para el día siguiente escribir otra aventura con mis pacientes.
English version
Once during the internship to graduate from the Aux nursing school I heard that those who studied nursing were frustrated doctors, that is, people who for one reason or another could not study medicine and well I do not feel frustrated because if I had wanted to I would have studied in Venezuela, nothing limited me, only that a career in medicine was not in the plans.
Well, I leave the clinic and go home to rest for the next day to write another adventure with my patients.
Las imagenes son tomadas con mi celular personal Vivo 33Y, las personas que aparecen en la publicacion,dieron su consentimiento para la creacion del post.
Texto traduccido por Deepl Traductor.
Portada hecha en Canva
English version
The images are taken with my personal cell phone Vivo 33Y, the people who appear in the publication, gave their consent for the creation of the post.
Text translated by Deepl Translator.
Cover made in Canva