"But for me, 98.4 means I have a fever...."

Momfirstalways · Mar 15, 2012

I was on vacation 2.5 hours away from home and had a blocking kidney stone. I had to leave and go home to my hospital. I will never forget in the emergency room the surgical resident said to me " YOur not that sick since you don't have a fever!" Really-- I had a stent put in the next day, I was on iv antibiotics because my urine was total pus and infected. I had to return to have the stone removed and a stent was placed until 3 weeks later. I was off of work. But I was not sick! lol. Everyone is different! People should be looked at as individuals. If a patient does not understand their vitals then the nurse should take the time to explain them.

Altra, BSN, RN · Mar 16, 2012

Most will not believe me, but I have cared for a patient with "stable" V-tach. However possible, my patient had a heart rate of 140, and clearly V-tach. She was fine, orientated X 4 and a stable B/P.

OT but ... I have too, twice. Both patients alert, denied CP, SOB or any other s/s, carrying on calm conversations.

And no, it wasn't monitor artifact ...

Vespertinas · Mar 16, 2012

I hope all the cranky RNs are paying attention to those responses saying, "I feel malaise/feverish when I hit 99" because this is real. A hard line on your numbers will get in the way of a good assessment. Ya'll seem very set in your ideas and it comes off as borderline insulting to some people who are trying to help you help them.

healthstar][/i]I hate it when I ask patients( how does your blood pressure run?) Patient: normal( whatever the normal is)Me: do you happen to remember the numbers?I hate when people say the word "normal" , what is normal?

And when a pt says their BP is "normal", it means they don't know. Their doctor never told them they have a problem with their blood pressure so as far as they're concerned, it's "normal". It means they're not the nurse, you are. I wonder how you would describe the sounds your car makes to your mechanic.

Vespertinas · Mar 16, 2012

OT but ... I have too, twice. Both patients alert, denied CP, SOB or any other s/s, carrying on calm conversations.

it was wide? bu-but... you still cardioverted, right?

Woodenpug, BSN · Mar 16, 2012

it was wide? bu-but... you still cardioverted, right?

I, obviously, don't know about Altra's patients, but mine was discharged the next day for out patient care of a minor problem. She had been admitted to "our lady of 280" hospital by a notorious EC doc. We worked eight hour shifts and it was over a quarter century ago so I don't have the full details. Point is she was fine. Cardioversion would have been a mistake. I do remember that back then we usually had standing orders to push lidocaine for a three beat run of v-tach and to start a lido drip for runs of seven or more.

DixieRedHead, ASN, RN · Mar 16, 2012

I still want to know, What do you want me to do? What action do you want me, as a nurse to take. I can assure you that no triage nurse is going to send you away. They are going to record what you say, and make a chart. But, also, as a nurse, what action do you want that nurse to take?

I do not understand.

Epic_RN · Mar 16, 2012

I still want to know, What do you want me to do? What action do you want me, as a nurse to take. I can assure you that no triage nurse is going to send you away. They are going to record what you say, and make a chart. But, also, as a nurse, what action do you want that nurse to take?
I do not understand.

I'm thinking it's not the action (or task) that is the issue, it's the reaction from the nurse to the patient that is being debated. Just my :twocents:

Epic_RN · Mar 16, 2012

I had a patient who was a fresh surgery. The night shift nurse and my preceptor both treated her like a whiner, as she continued to complain of severe pain despite the several pain medications that were ordered. It may have been unintentional, but that perception came through loud and clear to the patient. Early on in the shift I told the patient that I had given her everything that I could for pain at the moment and that it would be several hours before anything else was due. I also told her that I understood that she was in a great deal of pain and that I would do the best I could to stay on top of it, as the dr's orders allowed. Just this little bit of validation of her pain and reassurance that I understood made a huge difference in our interaction for the rest of the shift. While she was still in pain, she was not difficult to deal with after that and very appreciative when I would bring in her meds or more hot water for her tea.

This is isn't to say that there aren't those patients who look for everything little thing to stress over or exaggerate their symptoms -- I know that. OTOH, sometimes it's not what you DO but simply how you react and what you SAY that can calm a patient.... They're in the hospital, in pain and/or sick, they have no control. That must be pretty darn scary -- at least it would be for me.

CrazierThanYou · Mar 16, 2012

I was on vacation 2.5 hours away from home and had a blocking kidney stone. I had to leave and go home to my hospital. I will never forget in the emergency room the surgical resident said to me " YOur not that sick since you don't have a fever!" Really-- I had a stent put in the next day, I was on iv antibiotics because my urine was total pus and infected. I had to return to have the stone removed and a stent was placed until 3 weeks later. I was off of work. But I was not sick! lol. Everyone is different! People should be looked at as individuals. If a patient does not understand their vitals then the nurse should take the time to explain them.

Some years ago, I suddenly become very sick. High fever, intense abdominal pain, head splitting headache, vomiting, you name it. My mom drove me to the ER because I felt so bad. During triage, the nurse asked me my symptoms. I began with the headache and before I could say a word, she said "Well, my God, I have a headache. Doesn't mean a thing." in this incredibly sarcastic and snotty voice.

Turns out, I had a UTI that was turning septic.

Altra, BSN, RN · Mar 16, 2012

Some years ago, I suddenly become very sick. High fever, intense abdominal pain, head splitting headache, vomiting, you name it. My mom drove me to the ER because I felt so bad. During triage, the nurse asked me my symptoms. I began with the headache and before I could say a word, she said "Well, my God, I have a headache. Doesn't mean a thing." in this incredibly sarcastic and snotty voice.
Turns out, I had a UTI that was turning septic.

It was an obviously inappropriate comment, and I'm not excusing it.

But as a nurse, remember that the emergency department threshhold for "very sick" is ... not the same as what it is to laypeople. "Very sick" is that guy who's getting tubed as his two pupils are two quite different sizes, or the one next to him on 2 pressors.

llg, PhD, RN · Mar 16, 2012

I still want to know, What do you want me to do? What action do you want me, as a nurse to take. I can assure you that no triage nurse is going to send you away. They are going to record what you say, and make a chart. But, also, as a nurse, what action do you want that nurse to take?
I do not understand.

1. Make sure you've done a good assessment

2. Say something to reassure the patient so that he/she knows he has been heard and understood. Help the patient feel "cared for" by saying something like, "Thank you for telling me that. I'll make a note of it." or "We'll be watching that temperature." etc.

Not all nursing interventions need to involve physical treatments. Emotional reassurance is a big part of being a nurse -- and it usually takes only a few seconds to provide. Often, it's a facial expression ... or a tone of voice ... that takes no time at all, but conveys to the patient that they have been heard and that you care about them.

allnurses Guide · Mar 18, 2012

It was an obviously inappropriate comment, and I'm not excusing it.
But as a nurse, remember that the emergency department threshhold for "very sick" is ... not the same as what it is to laypeople. "Very sick" is that guy who's getting tubed as his two pupils are two quite different sizes, or the one next to him on 2 pressors.

Sepsis is "very sick", and too often fatal.