Overnight critical nursing diary

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At Millennium we are able to provide 24 hours onsite care to our critical patients. If this means staying up all night then that is what we will do. This is an account of one of my overnight stays to nurse three patients. An 8 year old Labrador called Jamie who had surgery earlier in the day to remove a foreign body; Dillon a 9 month old cat that had been shot with an air gun and had also had surgery that day to remove the pellet and an elderly cat named Percy who was admitted in the evening with breathing problems. Both Jamie and Dillon were recovering well from their surgery, but Percy was of primary concern for the night.

Percy had been admitted a few hours earlier because his owner had noticed he was having breathing problems.   On examination by the vet, it was clear that he was struggling to breathe.   His breathing was very fast and laboured and we needed to help him as soon as possible.   It was also noticed on examinion that Percy had a heart murmur.

Percy was admitted to the hospital and put into our oxygen kennel. This kennel is specially designed so that the patient can sit on a comfortable bed whilst oxygen is delivered directly into the kennel. It means the patient receives the oxygen treatment without having to be restrained, which can distress them when they are struggling to breathe. 
We X-rayed Percy and the vet was suspicious of a mass visible in his chest that may have been a tumour.  He also had some fluid in his chest. 
After discussion with Percy’s owner it was decided that he would stay with us overnight.  Then if stable the next day, we would take a sample from his chest to identify the suspicious mass. He was given a diuretic medication to help reduce the fluid in his chest. In some instances we would try to drain this fluid off, but in this case the Vet felt that this medication would be appropriate at this point. The vet also gave him a steroid and antibiotic injection. 

Patients that have difficulty breathing must be monitored regularly, they can deteriorate rapidly and any change in their condition can be fatal. This was why the decision was made for me to stay with him throughout the night to monitor his condition.

10.00PM   We gave Percy some pain relief.  He was struggling to sit comfortably and the effort of breathing was becoming quite painful. Because he couldn't get comfortable, rest and sleep were difficult for him. We gave him a pain relief that is also a mild sedative so he could get some rest. The veterinary surgeon then left the practice, leaving me to care for Percy. If an emerency arose, I would contact the vet for assistance. 
I checked on the other 2 patients. Dillon was very comfortable and settled. However, Jamie was very unsettled and panting a lot. I took her for a short walk in our dog yard and gave her some anti sickness medication as she vomited when she was out of her kennel. She had had major surgery that day and was understandably feeling uncomfortable. I gave her some additional pain relief and put her into her bed to settle down. I needed to check her regularly to make sure she didn't develop any complications after her surgery.

10.40PM   Percy had settled well with the pain relief and was more comfortable. The medications we had given him had started to take effect and his breathing had slowed down to a more normal level. He had become quite sleepy with the medication and his breathing rate had settled. When I was happy he was stable, I turned the lights off and let him sleep until midnight as it was important he rested and remained calm. Any stress could aggravate his breathing problems.

12.00AM   Percy remained settled and sleeping. He sat up when I came to examine him and then went back to sleep again! His breathing remained stable and I continued to monitor and record his vital signs.   I left him to sleep for another hour as I was happy he was stable. 
I also checked on Dillon who was very comfortable and purring! Jamie remained fairly unsettled, she had had all the medication she required so all I could do was monitor her for further problems. She was showing no signs of surgery complications so the likelihood was that she was stressed about being away from home which is why she wouldn’t sleep and was panting. I turned off all the lights to encourage her to settle down and continued regular checks.

1.00AM   Percy’s breathing was still stable, his vital signs fine and he remained sleeping.

2.00AM   Again vital signs fine. His condition had remained unchanged for the past few hours.   I left it 2 hours before assessing him fully again, which allowed him a longer period of sleep without being disturbed.
Jamie was much more settled, she was still panting but she was now lying down. She was due for some more pain relief which I gave her via injection.

4.00AM   The sedative affects of Percy’s pain relief had started to wear off. He was more active now and vocalising slightly. His bed needed cleaning so I allowed him out of the kennel whilst I did this. Although it was a small amount of activity, it was enough to increase his breathing rate so I moved quickly and returned him to his kennel.  Other than this he seemed quite comfortable and had eaten a small amount of food. 
Jamie was much more settled and no longer panting. When I went in to assess her, she looked up at me briefly, then settled back down.

6.00AM   Percy’s vital signs were good and his breathing stable, he also remained calm.   Jamie remained settled. Dillon was comfortable and still purring!   After checking all 3 patients were ok, I walked Jamie and cleaned all the patients’ kennels out ready to start the day!

7.00AM   The daytime ward nurse came in to take over from my night shift.  I completed a ward round with her so she knew all about the patients, the treatment and care they were having (as recorded on their hospitilisation charts) and was aware of how they had been overnight. She went on to continue with my patient’s nursing care throughout the day.

As nurses, our aim is to provide high quality nursing care to all our patients. When they are feeling poorly and stressed, it is essential that we make them as comfortable as possible and provide them with whatever care they need, day or night.   Our nursing care plans helps us to individualise this care with the patient’s owner.   Just knowing what our patient’s eat and realising their normal routine at home can affect their recovery and so becomes part of our care plan.   

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