Saturday, October 25, 2014

"Creating calm in your heart, creates calm in your patients"

My favorite quote from Annette Tersigni. Yesterday I had a patient recovering from abdominal surgery. She was going home post procedure. The anesthesiologist only ordered IV fentanyl ( strong short-lived narcotic) because she felt as though IV dilaudid (strong longer-lived narcotic) may delay her going home. I disagreed with the doctor but since my patient arrived very sleepy, I thought I would be able to get away with just giving her IV fentanyl . My patient was very drowsy, she wouldn't open her eyes and barely spoke to me, but when I asked her if she had pain she would say yes and rate it 9/10. Now to the eyes she looked very comfortable, but something told me to treat her pain anyway, so I did. I ended up giving her multiple doses of fentanyl and it just wasn't working. She began to clench her fist and tears were rolling down her eyes. Although she still wouldn't open her eyes or really talk to me, I believed her pain. I knew she wasn't too drowsy to handle more narcotics. I then called the on call anesthesiologist and explained the case and requested IV dilaudid for her. As I was pushing the IV dilaudid, I touched her shoulder and explained to her that she needed to try to slow down her breathing. She was breathing almost 30x/min (normal 8-20)! I let her know that the heavy fast breathing was only making her pain worse as she was using more of her abdominal muscles. At this time, I also realized I needed to take some deep breaths. I was becoming frustrated with her because I had already given her a ton of IV fentanyl, she was still sleepy, and I started to think I would never get her pain under control. I was also frustrated that she wouldn't communicate with me the way I wanted. I wanted her to open her eyes and talk, I wanted her to wake up and sit up so that she could begin to take liquids and pain pills. I started thinking, "she's never gonna go home"

After realizing how frustrated I was, I began to think my negativity isn't good for her. I wasn't providing a healing environment because my thoughts were not good. I was not focused on the task at hand. I was so worried about "how am I gonna get her home" that I wasn't focusing on what was going on with her right now. As I encouraged her to take slow deep breaths, I did too. Soon after the IV dilaudid and a little deep breathing, she closed her eyes and fell asleep for about 10 minutes. When she woke up, she opened her eyes, asked for a drink, and even scooted herself up in bed unassisted. Her respirations were down to 11/minute and she looked so much better!

Within the next hour she was discharged! I couldn't help but have a smile on my face because I knew I did the right thing for her. I know the narcotics played a major role in her pain control, but Im sure the deep breathing and the change in my attitude helped as well.

As a recovery room nurse, I don't have the chance to practice actual yoga postures with my patients. I have been practicing breathing with them however. After all, on our flowsheet one of the nursing interventions is "encourage deep breathing". Breathing or pranayama or "Sacred breath"(yoga nursing term) is often the most beneficial component of a yoga practice, well of any type of healing. I can't think of any situation in patient care or my personal practice where a few deep breaths ever did any harm. It brings calms in our patients allowing their medications to work better for them. It also helps them clear the anesthesia and medications given, as exhaling is a way of the body releasing whatever is no longer serving us :)

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