change in pt condition - what to do?

  1. 0
    I'm recently hired on a medsurg floor, from hospital statistic, near 45% of of hospital's RRT calls comes from our floor.. I'm terrified just thinking about when I am off orientation. I can feel my brain freeze just thinking about – eg. What if my patient suddenly become more lethargic? What should I do next? What if his RR suddenly increased? (check temp., listen to lung sound, elevate HOB if pt have trouble breathing…etc but what to do next?) I realize I am no longer a nursing student and can’t just go “get the nurse”.. I am the nurse now! AH!

    The last thing I want is "freeze" when I see my patient has a change in condition, or hesitate what to do.. it really helps me when I hear other people's story or experience, what situations they encounter and how they respond/take action to solve it...

    So I was wondering if you could share some of your experience on what are some of the change in patient condition that you have encountered on the floor and what did you do? eg. what did you do when pt had BP dropping, increase in respiratory rate, decrease HR, ALOC change.. besides to just call the doctor; and what are the things we can do/trouble shoot before calling the doctor?

    eg.
    per CNA pt had drop in BP --> double check BP, temp., lower HOB, trendalenburt position, check for any bleeding if post op/wound.. anything else?

    *I am aware every patient/situation is different; therefore the way to respond varies. But still appreciate to hear other people's experience =)
    Last edit by miniangel729 on Oct 10, '12
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  3. 9 Comments so far...

  4. 4
    A month ago you felt you were being micromanaged and smothered. The first year is the hardest. ((HUGS))

    The biggest thing I can tell you is to call for help. Get a trusted co-worker. Get your charge nurse. Two heads are always better than one. Even after many many years of being a nurse I will go to a trusted co-worker and ask then to listen, look, hear and give an opinion on a patient.....even if I already know the answer it helps to get a second opinion.

    The next important advice is do not panic.....in the hospital you are NEVER alone. Remember your ABC's and call for help.

    RELAX......it is overwhelming but it will all be ok.

    Organization is key....I share these brain sheets all the time.

    brain sheets.......here are a few.

    mtpmedsurg.doc 1 patient float.doc‎
    5 pt. shift.doc‎
    finalgraduateshiftreport.doc‎
    horshiftsheet.doc‎
    report sheet.doc‎
    day sheet 2 doc.doc

    critical thinking flow sheet for nursing students
    student clinical report sheet for one patient

    I made some for nursing students and some other an members (daytonite, RIP) have made these for others.....adapt them way you want. I hope they help
    Last edit by Esme12 on Oct 10, '12
  5. 1
    Esme12 those worksheet are amazing!!! I printed them out and thanks for posting them.
    Esme12 likes this.
  6. 0
    You are welcome!
  7. 1
    [COLOR=#660000]thanks esme12 for your encouragement and brainsheet! I am modifying my current brains and yours examples are really helpful. I know this coming year won't be easy, sometimes I wish I can skip the first year learning curve and download even just one year of experience from the experienced nurses.. ha.. I will keep reminding myself that I'm not alone and I will make it.. thanks again[/COLOR]
    Wise Woman RN likes this.
  8. 1
    I am always worried about the same thing! I've been off orientation for about a couple months now, and the patients are so unstable on my floor I'm having situations like this come up nearly every time at work! Definitely get another nurse in the room (or several nurses) to help. Have them stay with the patient while you call the doctor. I feel like I always have pts de-satting nearly every night I'm there! I've just been getting co-workers into help, either increasing their O2 or putting pt on a non-rebreather mask, getting vitals, elevating HOB, and calling the doctor, respiratory therapist, and a couple times a critical assessment team. I've realized once you call for help about a patient's condition quickly deteriorating, you will have more people in the room than you even need most of the time!
    nooneelse likes this.
  9. 0
    If a patient had a sudden change, I would quickly assess them/get set of vitals (call your tech to bring the stuff to you and help with that) and stay with the pt, call RRT, then get someone to notify the physician.

    If there's a code, assess (quick to make sure it is a code situation), pull the code button, and start CPR. The code noise will alert others who will bring the other stuff to you.

    That's what I would do. I just got my license though and have not gotten my first nursing job yet.
  10. 0
    When you come off orientation, you're not expected to know everything. Your charge nurse and resource nurses will expect you to ask questions. If your patient is crashing, they will want to know about it.

    At the beginning of your shift, take 5 minutes to think about worst case scenarios. What is the worst thing that could happen to your patient? What would the beginning signs of that look like? What would you do? If you are still on orientation, you need to ask your preceptor about worst case scenarios *now*. Review them with her for each patient. When something unusual or terrible happens on my unit, I still ask - how did you know it was happening? What were the early signs?

    So when your patient takes a turn for the worse, don't panic, get a set of vitals while you're thinking about what could be happening. Think of urine output as a vital sign, too. Do you have protocols for standing orders? Know them cold when you come off orientation. Review what's going on with another nurse.

    Good luck!
  11. 1
    I am a new grad in the ER, I have been there for 6 months and still feel like I know nothing! I had 3 months orientation, so I have been "on my own" for 3 months. I had a patient come in a few months ago (right after I had gotten off orientation) complaining of nausea and vomiting for a few days, she appeared to be stable to me, BP was 120s/70s. She was up and down to the bathroom on her own for about the first hour she was there. When I went in to draw blood from her, I noticed she was very sweaty. i rechecked her BP and it was 70s/40s, rechecked it again and it was 60s/39. Her O2 sat immediately went from 97% to 86%. Of course I started panicking a little, trying not to freak the patient out I asked her how she was feeling and she said very weak. Keep in mind this was the first time a situation like this had happened to me, I had never had a patient crash before. I grabbed a tech that was walking by, she immediately put her in Trendelenburg and I got the doctor, who ordered a 2nd line and tons of fluids. She never coded, but I realized at that time that a patient can crash on you at any minute and you have to be ready. The doctor told me next time that happens, immediately grab a doctor and alert the charge nurse. Thinking back, there were several things I could have done differently, but I learned from that situation. If blood pressure drops and O2 sats drop, immediately put them in Trendelenburg, put some oxygen on them, and alert the doctor (push the alert button and call others, do not leave the patient!). I still fear situations like this, but at least I know what to do next time! It takes practice to learn, you can't learn things like that from books!
    nooneelse likes this.
  12. 0
    I think there are a few things that help you feel more comfortable in these situations. First, make sure you are doing good thorough assessments at the beginning of your shift. That way, when you are reassessing after a status change, you may pick up on more information. Yes get VS, but recheck pulses and perfusion. And not just that they have pulses, but are they the same? Are they bounding or weak and thready? If they are having a change in LOC, do a thorough neuro exam, checking pupils, bilateral upper and lower strength, orientation/following commands, etc. You do want to get your charge nurse or co-workers in there, but they are not in a position to notice assessment changes, only you are. Also, turn all of the lights on in the room, I've seen too many nurses be worried about a patient, but not think about turning lights on.

    The next thing I would recommend would be to get your ACLS or PALS certification. It is a lot less scary to have a patient deteriorate if you have a clue about how to resuscitate a patient. Knowing the algorithms will not only help you be more comfortable in those situations but it can help you anticipate what you might need to do, so you can have your supplies ready. We do the Heart Code version at my hospital now, and I loved being able to take my time and go through the scenarios and see if I knew what to do. And where I work the class is free and we get paid for our time to do the training. Definitely something to look into.


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