Critical Thinking... I suppose

A couple weeks into acute care, I had a patient who I had no idea what to do with. Among a long list of diagnoses and a complex significant health history, I was a bit overwhelmed with the case.
She had been admitted to the hospital for a GI bleed, but it was not her first. In three months, she had suffered 7 GI bleeds and had to have an EGD procedure each time, where they go in and laser the lesions in her intestines to stop the bleeding. The doctors call her case that of a "watermelon stomach." The first thing I thought was, 'well why does this keep happening?' How can we make it stop? My patient had anemia and a very low hematocrit in junction with Congestive Heart Failure and a history of AFib, a pacemaker, and an artificial mitral valve. Clearly, she had significant cardiovascular health problems and because of that, she was taking Warfarin. She needed to take an anti-coagulant regularly to prevent blood clotting and increased cardiac output.
Because of the blood thinner, the lesions in her intestines were more apt to bleeding when they might have otherwise been able to heal and be fine. I listened to the doctor speak with my patient about her choices and how she wanted to spend the rest of her life, as she was an 86 year old. Simply, she could cease taking the anti-coagulant which might solve her recurrent GI bleeds, but she'd be at an increased risk for clotting or possibly having a stroke. On the other hand, she could continue with the Warfarin but have a possibility of bleeding out from the GI bleeds.
After the doctor would leave her room, the patient would look to me and ask me what I thought she should do. I never gave her a straight answer, because I myself had no idea which route to take. I believe I have a strong sense in critical thinking and I have been successful when determining the priorities of my patients and other general situations, but how does critical thinking allow us to choose our way to die? I mean, inevitably, this woman is going to die and it's rather a choice she has been given on how she would like to pass away. How do we as nurses use critical thinking to make a decision like that? The textbook just doesn't hold answers for things like this.

Trapped in the Elevator

Those of you in my clinical group have already heard about this, but I figured I would share it with the rest of you.

So... it's the first day of clinicals and I'm nervous, anxious, excited and have hundreds of thoughts running through my mind. It's nearly 1:00pm and I haven't even taken a bathroom break, needless to say a lunch. I realized that I'm a half an hour away from our post clinical conference and I still haven't gotten my flu shot. I tell my nurse where I am going and head to the elevators on my floor. After I get into the elevator, I push level 1 and stand there for a while wondering why it's taking so long.

A few minutes later, I have pushed every single button in the elevator except the fire/emergency button. I have pushed the "open door immediately" button and have still gotten no result. Finally, the elevator drops suddenly and the door opens in a basement looking area. I get out and walk around, and have no idea where I'm at. I try to get back into the elevator but it won't even open up. I finally make my way outside and re-enter the hospital and head back up to my assigned department.

Moral of the story.... don't use the In-Service Elevators.

Acute Care

Acute Care; what a change of pace from long term care. In the hospital, I have different emotions coming over me, similar to that of our first day in long term care. I am overwhelmed, nervous, excited, stressed, and anxious. It's a bit nerveracking being here but I know I will get used to it and feel more confident as the experience increases. I worked with a patient who had a foot of her colon removed due to diverticulitis and another patient with kidney failure who was trying to make a decision whether to go on dialysis or not. It was amazing how everything we have talked about in lecture and skills lab thusfar came together in a day. It made me realize how important our lectures and classes are, that the topics discussed are actually relevant to what we need to know in real life! Even stuff I don't feel confident in, I still understood the general concept of it. We were looking at the charts and the patient's electrolyte levels and I could differentiate which ones were high and which ones were low. I could do a physical assessment on a patient with less anxiety and pressure that I had in long term care for our checkout. I'm nervous, but excited for what's ahead.