I am a relatively new nurse working on an acute psych unit. All of our patients are medically cleared before they come to us from the other floors, but the other night I ran into a situation with a new admission that has me confused and a little nervous.
I was doing the admission on a 30something male, admitted for anxiety d/o and detox (30-50 beers Qday). VSS, and his labs, surprisingly, were quite good. LFTs normal, ammonia WNL, lytes were fine. NKA. In the ED, they had started him on a banana bag, but discontinued it because the pt developed hives (this part was relayed to me by the pt...no one from the ED had bothered to tell me during phone report...yikes). I have never had a pt who had any type of reaction to a banana bag, so that had me confused. So anyhow, the hives were on his bilat forearms and on his lower abdomen too. He denied any itchiness or dyspnea, and his vitals were still good, so we finished up his admission paperwork, I rechecked the hives, and there had been no change. Still no itchiness, breathing trouble, etc. I had my clinical nurse manager come in to reassess him with me, then I finished my shift at 0330 and went home. The next day, I found out in report that he had been shipped back to the ED on 1st shift for vague complaints of chest pain. Apparently there was some ST elevation on the EKG. I'm freaking out because I did his admission, and his cardiac history was significant for a mitral valve issue for which he takes antibiotics prior to dental procedures, and nothing vascular. I am so worried that I missed something, and I can't look at his medical record unless he comes back to our unit. I can't see how a banana bag could lead to ST elevation (although I always thought it was weird that there's no K+ in banana bags!) Can anyone offer some advice or point out if I did something wrong in my admission assessment? Or are these just a string of unrelated things that probably don't have anything to do with each other? Help please!