You got the door? Ready for a report on room 346? Yes I am.
Okay, so we have an Yvette Ogum. She is a 34-year-old female brought into ambulance last night at 1800 for a heroin overdose. She was given two doses of naloxone, 2 milligrams each dose. She vomited twice following the naloxone.
Following stabilization in the ER, she was brought to our floor for monitoring. The patient is allergic to aspirin and has a history of back surgery in 2012. She has depression and drug abuse. The patient has been admitted twice before for heroin overdose and has been sent to rehab three times in the last three years. I'm guessing she became addicted to the pain medication after her back surgery and switched over to heroin because it was cheaper and easier to get.
She did tell me that she's currently going through a divorce with her husband and that she has a bad relationship with her two kids. No surprise there. The patient is a hard stick. and has a 22 gauge in her right forearm. Labs pending for ETOH, urine toxicology, CBC, CMP, magnesium, and phosphorus.
In terms of assessment, she is alert and oriented times three, lung sounds clear, pulse is strong. admin tender. She has track marks all over her extremities, no sign of cellulitis or abscesses yet, but keep watch of her left forearm.
We have her on 400 milligrams ibuprofen every six hours for her back pain. Next dose is at 8 a.m. She's been ringing her call-bell every hour. She is super anxious. She's really high maintenance, so best just to avoid her.
She's a drug seeker. She'll eat up all your time. Good luck with her.
I'm feeling very concerned about the direction we're going here. We are trying to give them a heads up on the situation, but labeling the patient can be unproductive. My experience has been that most often these patients are under medicated.
What was her most recent Cal score? Her most recent Cal score was 14. And how did she sleep last night? With the amount of time she was using her call bell, I'm pretty sure she didn't get any sleep last night.
I gotta get out of here. Good luck with her. Hello, I'm Sharon.
I'm going to be your nurse for today. What would you like to be called? Look. I've been in severe pain all night. All they gave me was Motrin.
Motrin's fine for bee stings, but it's not going to do anything to help the pain that's going to drive me through that wall. I'm sorry you feel bad. I'm here to help you. Can you please rate your pain on a scale of 1 to 10? It feels like a Mack truck ran over my back, backed up, and ran back over it again.
A 25! Can I have some morphine? Okay, I'll see what I can do.
But first I have to do an assessment. I'm going to ask you some questions. Are you feeling any other symptoms?
You mean besides being annoyed by these twits? I've been ignored when I call for help and being treated like a leper. I'm sorry you feel this way, like you've been ignored.
It seems like you had a rough night and are very uncomfortable. I'm going to call the doctor to see if I can get some more pain medicine for your withdrawal symptoms. But first, I'm going to complete an assessment on you.
Okay, whatever. Do you have any tremors? Okay, I'm going to check your heart rate. I'm gonna look into your eyes.
Thank you. How many times have you vomited? Three times since I got here. Is it still clear liquid coming up?
Yeah, yeah. Have you had any diarrhea? Yeah, and soon all my insides will either be sh** out or puked up.
Can I have some Oxy? Okay, I'm going to call the doctor for you to get some more pain medicine, okay? I have seen that you're sweated through your gown.
I'm going to get you a new gown, some cool compress, and I have some nausea medication for you. Does that sound like a plan? Whatever, I'll believe it when I see it. Okay, I'll be right back with that, okay? Hello, this is Dr. Lopez.
How may I help you? Dr. Lopez, this is Sharon Fairweather calling from Montgomery Hospital about your patient, Ms. Yvette Ogam, in room 346. Oh yes, I remember her. What is happening with her now?
She was admitted for a heroin overdose yesterday. Her COWS score is a 35. She has a history of depression and back pain following surgery five years ago. She appears to be in a lot of pain and is... anxious and vomiting. What's the vital signs?
Blood pressure 150 over 85, heart rate 122, respirations 22, temperature 98.6, pulse ox 100% on room air. She's due for her ibuprofen but that does not seem to cover her back pain. I am worried that she's withdrawing from heroin. I would like to have an order for anti-anxiety medication.
And something besides the ibuprofen for her pain. Any allergies? Only to aspirin.
Okay, give her... Your cow score is now a 10. How are you feeling about your pain now? I can manage.
You know, you're the only one that's treated me like a human being since I got here. You know? Paraline withdrawal is no walk in the park. I've seen you've been through detox several times. We're going to help you get help when you leave here.
I can't keep doing this to my kids. They need me. I am here for you, to support you.
We're going to get you help and we're going to look at all the solutions that are possible. You are not alone. We're all working together for you to feel better.