Quote from reisling
any advice for a new rapid response nurse. I feel like I need to make a diagnosis the minute I walk in the room, The nurse training me is no help at all.
You will get much faster with your diagnosis after having seen a lot of problems. At the start, just play detective - gather all the information you can and start eliminating systems: ie, is this a respiratory problem (no), ok, is cardiac the issue (no), ok is it neurological (yep), ok what type of problem could it be?
What I like to get in report when I respond to a rapid response is: What the main problem that they called me for? How is that different than before?
So in the case of the OP - when i walk into the room and ask what is wrong, I would like "pt is having an acute change of LOC. I 've had him since midnight and he went from a&o*2 to completely unoriented. His pupils are now sluggish and he has lost bladder control."
This tells me why I am here, so i can start gathering information. Disclaimer here as everyone is different - I prefer now to ask questions rather than have someone just rush through everything they can think of to tell me because the asking questions allows me to order it better in my mind - however some people might want all the info you can give.
So I'll start by asking the simple questions that could lead to change in consciousness - 1) Did he have any narcotics or benzo's recently? (No) 2) Is his sats low? (No) 3) Is his blood sugar low (No) -- each time I am mentally crossing off what might have caused the behavior.
At the same time I am gathering information I am directing more gathering - such as an ABG by RT, a stroke exam by me, labs by our tech, ekg by another RT - basically anything that can help me pierce together what has happened.
Once I get through the obvious, we start over. 1) Any change in vitals (No) 2) Any other change in behavior prior to this? (possible - going home, no need for meds) 3) Any pertinent history as to why he would want to go home (yep - etoh). 4) Why did he come into the hospital (hernia repair).
So in the end I have crossed off respiratory (unless abg came back acidotic), cardiac (unless ekg shows change in rhythm), medication (unless recent narcotic/benzo), metabolic (glucose is normal), infection (no since cbc and temp normal) - and have settled on neuro (possible tia versus seizure).
So as best as i can say a checklist for me would be:
What is the reason you called and why do you think it was important.
What have you given recently or what vitals might account for it.
Why is he here, and what other history do you think is pertinent.
When you call - always have the chart in the room and if you do electronic charting have the computer up and running. Get a blood glucose immediately if at all appropriate.
Hope this helps
Remember also to take a deep breath. When people get nervous (as a stressful situation can do) they tend to talk really fast and jump from area to area. If your patient is breathing and has a strong pulse - you got a little bit of time for us to assess and you to go over the problem.