My shift started off with some drama. When I went to get my surgical gown at the beginning of my shift there were none to be found. I went at let the charge nurse know and she said she had talked to the supply manager and he should be on his way up. The supply manager showed up with a few gowns and a cart of some other supplies. The charge nurse was very irritated with the amount of gowns and supplies he brought with him. Over the weekend no one brought my unit additional supplies and were were out of EVERYTHING. We didn't have sanitation wipes that we use to clean patients, any flushes, needles, bags, gowns, our supply room was empty. So the charge nurse and the supply manager were arguing about what supplies we should receive. I was proud of how she handled it. I also felt bad for the supply manager because he is also very limited on what he can give us and its not his fault the hospital is low of everything. This goes back to just the lack of basic supplies because of the system being so overwhelmed.
I also started my shift with a massive headache. Between a lack of sleep, stress and dehydration I think my body was kinda telling me to do something about it. I was able to take some Tylenol and drink about 100 oz of water in the first hour or so and my head started to feel much better. I forget to drink during my shift because I am so busy and I am always wearing a mask. My shift itself was probably the smoothest I have had so far. I had two vented patients that were each on a handful of drips, but I had a med/surg nurse to help me with tasks throughout the night. This made a huge difference for me. She was able to give all the basic nightly meds while I could just worry about the ventilator and medications that I was running through the pump. 1 of my patients was on the prone rotation. This also makes my work load a little easier because we have an entire prone team that is in charge of moving the patient.
Pressure sores are obviously a big concern with these immobile sedated patients. Turning and cleaning patients is always one of the most labor intensive tasks I do each shift. I would describe most Covid patients appearance like the Michelin man, because of the extreme amount of edema and fluid in there extremities. Most of them are just oozing fluid from their skin. This makes skin tears and wounds so common. I have even seen massive pressure sores on faces of patients that are lying prone. It is so sad.
I hung a Unit of blood on one of my patients last night. His H&H were low. I asked the doc about it and I guess even though it was the first time i had to do it for one of my patients this has also been a pretty common theme. Most patients go into kidney failure and stop producing an adequate amount of red blood cells, along with the fluid shifting already taking place in their bodies this causes low blood counts. I thought that was interesting.
A couple of the residents went on a hospital search for flushes. They didn't find any but they did find a stock pile of 10 cc syringes (which we were also out of) so they took a 1000 cc bag of NS and made a bunch of flushes that we could use throughout the night. This was a huge help.