11/19/17

I had the opportunity to shadow a registered nurse for two nights this month. The nurse I

followed around was working his shift in the Emergency Department and Johnston Memorial

Hospital in Abington, VA. Tim Countiss, the nurse, has been a registered nurse for eight years.

The first night I observed his shift, which was November 10th from 8pm to midnight, many

things occurred. An older woman came in first from a nearby nursing home. She had fallen out

of her bed and had hip and pelvis pain on her left side, anatomically, as well has a skin tear on

her left forearm. We cleaned the wound with saline after taking her vitals. She also had dementia

so her mental status was altered which made the history of the injury was hard to gather because

the nursing home stated that they did not find her on the floor in blood until they did the room

checks. She could have sat there on the floor for at least an hour. Her x rays showed that she had

no trauma to her acetabulum, femoral head, shaft of femur, pelvis, ischial tuberosity, or ilium.

She had severe bruising and tenderness but the doctor said that the reasoning and severe pain

could just be her age and brittleness. Next, they stitched her wound up and gave her some pain

medication and ended up sending her back to the nursing home. There was a sick baby that was

22 months and he had a fever of 102 degrees fahrenheit. They hooked him up to fluids and found

that he had flu symptoms and sent him home as well to sleep. Next, at about 10:30pm, the

ambulance brought a woman in suffering from alcohol withdrawal. She is apparently a regular

with the emergency department. The issue was that her issue with being without alcohol, made

her violent to the point where she would grab arms, scratch, yell, spit, and rip out her IV. Once

she was stable and not vomiting, we sent her back in the ambulance. Because she is there often,

they do not ask much on history of the patient because they saw her two days before. They know

her issue and we were all aware of her state of health. Most of what Tim does is check vitals

every so often, giving medications that the doctors have prescribed, constantly scribing
11/19/17

everything that is done, doing blood work, putting in an IV, and always checking in on patients.

My first night with Tim was interesting because of the way they do their evaluations. EMS does

most of their evaluation and we are then caught up when the patient arrives. In an athletic

training setting, we do the full evaluation before EMS arrives usually.

On my second night there, which was November 11th from 7pm to 11:30pm. When I arrived,

there was a man with chest pain that would disappear when he sat down. The nurses worked

together to run all tests to get a good idea of his health. Then they contacted the on call cardio

doctor to come in. At the time that the doctor arrived, we transported the patient up to the third

floor. Two older women came in 30 minutes apart at round 9pm. One had pneumonia and the

other had a urinary tract infection. They both had dementia so it made it difficult to keep and IV

in them and the pulse oximetry on their fingers. One was very resistant to the care we were

trying to give her. She ripped her IV out so there was blood everywhere and her medicine was all

over the bed and the floor. Cleaning her up was difficult because of her resistance from her

altered mental status. After getting those patients admitted, we got one man from the jail with

chest pain and another admit with chest pain. The man from the jail admitted that he was faking

chest pain once he got there to get better food and get a vacation from the jail for a night. The

woman was on a lot of medicine and admitted that she drank only soda and fast food. She

confused chest pain with stomach pain and indigestion. We sent her home after her stomach

settled. At 11pm, a 13 year old girl came in with wrist pain. She had no bruising or palpable

deformity. With the x rays, we found that she had a fracture on the lateral side of her ulna. No

surgery needed so we casted her wrist and sent her home at 11:30pm when I left.

Observing Tim was very interesting. They have a different role in emergencies. They are

on the end of the Golden Hour of care after an injury happens. They only really ask about pain
11/19/17

scale and their pain, symptoms, and if their symptoms change and not much more than that. The

environment is hectic because it has to be because that place revolves around emergencies. The

doctors and nurses communicate through their computers by prescribing meds and sending it to

their nurses and then the nurses check them off. This was so fun and interesting because my

mother is also a registered nurse so I got to look into what she does a little more.