[MadisonsMomRN]

Originally Posted by Angie O'Plasty, RN

Sounds like he was in shock.

http://0-medlineplus.nlm.nih.gov.cat...7.htm#Symptoms

An examination indicates the presence of shock. There is usually low blood pressure, rapid pulse, and low body temperature.

Yes!!... that was probably it. He did have a low BP and his pulse was thready and tachy... thanks for jarring the old memory there!

He was pale, cool, clammy, lightheaded. He wasn't confused at all. He was sitting in medical talking completely normal. He walked back to his cell.

[MadisonsMomRN]

When he came up at first he said that he vomited three good times and it looked like blood. Then he said "if I threw up that much blood I wouldn't be standing here right now." (I honestly doubted that it was all blood at that time) He had pizza for dinner so we were thinking that was part of the redness in his emesis. Ugh... that was probably a lot of blood. He vomited again like that about an hour later and he said he tasted blood that time. Poor guy. I should have sent him out the first time he came up.

[RN1989]

I agree with your last assessment that you should have sent him ASAP on his first visit to you. A guy that has a bp less than a hundred with a hr of 100 and low temp is showing signs of trying to compensate for shock. But I am so very happy that you stood up for what is right and got this guy the help he needed when you realized that something wasn't right. Kudos to you for going against the popular grain and giving this guy a chance at life no matter what others think.

[MadisonsMomRN]

Originally Posted by RN1989

I agree with your last assessment that you should have sent him ASAP on his first visit to you. A guy that has a bp less than a hundred with a hr of 100 and low temp is showing signs of trying to compensate for shock. But I am so very happy that you stood up for what is right and got this guy the help he needed when you realized that something wasn't right. Kudos to you for going against the popular grain and giving this guy a chance at life no matter what others think.

I know that 'some' inmates are real manipulators and many are not. When I took his BP I was looking in his chart for 'his' normals. This was a little guy. No significant history in his late 20's (28 I think) When I took his temp I thought that the thermometer was messed up. It was an ear thermometer. We were out of probe covers (ugh... another story) so I just alcoholed it before and after because I needed a temp on him.

He was sitting there with his cup of water talking normally. He was verbally appropriate and polite. He said that he was starting to feel a little better and that he wanted to go back to his cell to try to lay down. Shock was the LAST thing on my mind. I know now that I shouldn't have let him go back. I reiterated to him that if he starting feeling lightheaded, if he vomited again or if developed any symptoms what so ever to tell a guard to bring him up asap.

I had never seen this guy before. I didn't know what he "normally" looked like. His color looked bad though. He was pale and sort of yellowy looking. I was looking in his chart for possible hepatitis history. I found that he did have a history of alcoholism.

Even when he came back up the guards cuffed him to the bench outside of medical and left him there alone. I asked where he was and they said on "In front of central." I am like... "Can you bring him in here?" I went out there and he was leaning over with his head resting on him hands... He looked at me and said "There is something wrong... it feels like something busted. I threw up again and tasted blood this time" He asked for some water because he had ice with him and I told him "No, I am sending you out right now."

I feel a little bad now because he was more than likely experiencing shock. I have been a nurse for about 5 years and haven't experienced seeing anyone in shock. It was right in front of my face and I didn't see it... I totally didn't expect it.

The important thing is that he did get his care and is on the road to recovery. What an ordeal!

[CookieCritter]

I'm with Angie

It does sound like shock

"Shock can occur after any kind of trauma: a severe allergic reaction, poisoning, heat stroke, burns, or any other severe stress on the body. But the phenomenon can also ensue from severe dehydration, excessive vomiting, or extreme diarrhea. What happens when the body goes into shock is that blood -- and the oxygen it carries -- can't get to vital organs, and the organs begin to fail. Treating shock early can save lives; left untreated it can be life-threatening. It's essential to recognize the signs of shock and treat it quickly."

You did mention he told you that he vomited 3x but maybe he really did vomit a lot more like that. I have never met a men who could count well when they were sick (just kidding)

Seriously though since he's a trustee he probably didn't want to sound like a whiner. Just wondering if he is the houseman by chance. (the head trustee in some detention facilities are called that)

The houseman in particular has a lot to lose if he looks weak in front of other inmates.

He probably intentionally told you less then what really happened since he's surrounded by blatant liars and exaggerators and didn't want you to lump him into that category.

http://www.ahealthyme.com/topic/shock

[CookieCritter]

Originally Posted by MadisonsMomRN

II feel a little bad now because he was more than likely experiencing shock. I have been a nurse for about 5 years and haven't experienced seeing anyone in shock. It was right in front of my face and I didn't see it... I totally didn't expect it.

The important thing is that he did get his care and is on the road to recovery. What an ordeal!

Don't beat yourself up and play armchair quarterback on yourself.

You knew something was wrong and he did get the appropriate care thanks to you. Next time if it happens you will know it's shock. He is just fine now and you can breathe easily. You did right by him and I think you knew subconciously what it was during your assessment. I think the minor argument with the "Reno 911" sarge had a lot to do with you second guessing yourself on the shock issue.

[MadisonsMomRN]

Well, another update. He is back... he has C-diff and MRSA. Great huh? I work this Thursday so I am sure I will see him then.

I am not sure if he is a houseman. He worked in the kitchen but recently was "promoted" to commissary. He was worried about his job.

Thank you ALL for your wonderful supportive comments and wealth of information! Its all a big learning experience. This makes me more knowledgable from actual experience and more confident in my assessment and clinical skills.

[RNLUV4U]

You did a great job in the decision you made! Remember the sergant doesnt have a license to worry about and we are ultimately responsible if an inmate dies on our watch. Always trust your instincts!

[Valerie Salva]

MadisonsMomRN-

Good for you, and I'm glad your boss backed you!

[canterbury tales]

One of the most important things one learns working for the department of corrections is to protect your license. You completed your assessment and did the right thing. Proctecting our licenses is not as hard when you can recognize an offender in need of care above the level we can provide in our correctional environment. Cudos to you