Do I have to go back tonight?

Nurses General Nursing

Published

Should have been in bed an hour ago & I'm just getting home because of a pt who was convinced no one wanted to help her, spent all night in & out of her room, hoping the other 5 pts I had were ok (they were). Then at 0330, she feels "funny" but only complains that it feels like fluid is building up in her legs. O2 sats 92% & since we had just log rolled & boosted her in bed (using trendelenberg's - she's 300+lb), I explained her sats may have dropped briefly. BP a bit high but she denies chest pain; lungs clear. She progressively gets more anxious (which she has been all shift & the previous shift as well), & demands to see her dr. Sats dip into upper 80's briefly, but she is starting to panic & basically hyperventilate because we "aren't doing anything."

Charge RN & then supervisor are contacted to come in, but pt is adamant that we aren't doctors & we're gonna let her die (only complaint still is that her legs are swelling up, but my observation is that they are no different than the start of my shift or the previous night when I cared for her). Call doc who orders lasix & ativan (whoops - allergy to diazepam & we don't give). Pt still isn't satisfied because doc didn't personally come in & see her & how does he know how she's doing? Nevermind the fact that he would be making rounds within about 2 hours. (She could die by then!)

Long story short, I feel like I spent at least 50% of the shift in her room trying to calm her down along with everyone else working the floor. And of course after the lasix, she was on the bedpan q30m & it just about takes all four of the staff on the floor to successfully place that due to her size.

Not trying to make light of what she was feeling & there were a few tests ordered to make sure she wasn't having an underlying problem that wasn't giving us the usual symptoms. I'm just tired & dread going back. Maybe I'll get to float tonight!

On a side note, it was kind of comical when the bipolar schizophrenic pt across the hall decided all the commotion was talk about him & came out in the hallway to start cussing at people who weren't there. Then, the lady thought someone was talking about her!

Specializes in PACU, pre/postoperative, ortho.

No, I totally understand that a feeling of panic could be the only symptom to an underlying problem. That is part of the reason why we were all with her so much, why I called in my charge & then supervisor when she was becoming progressively anxious; PE & MI were uppermost in my thoughts; she was POD2 for a knee revision. I mentioned calling RR but both charge & supervisor did not feel it necessary & being very new, I pretty much look to them for direction when I have concerns with a patient. Sats did not stay in the 80's, they dropped to 88 for about a minute & then back up again to her baseline which is about 92. She had an inhaler prn which she refused. Doc was called within about 20-30 minutes from the onset, given her VS/symptoms & ordered the lasix. She was mad because we didn't get him to come in & see her right then. He came in near to shift change & I was in the room when he assessed; lungs still clear & he told her he would order some tests. I know he ordered a cardiac panel, but not sure if x-ray was ordered. I spoke to the family who also let me know that she does have anxiety issues & gets worked up easily.

So, I don't know.....yes, it was always there in my mind that something serious could be going on but the general agreement with everyone I reported to was that it was not. There is so much more that I could say about her general attitude even before this happened & how she was pretty much convinced we couldn't help her & weren't trying. Just hoping that all testing came back ok & I'll post again later! Thanks for the input!

Up Vote Up Vote ×
Specializes in ICU/CCU (PCCN); Heme/Onc/BMT.
A chest x-ray and ABG needed to be done. If they are WNL, consult with pharmacy to obtain an appropriate anti-anxiety agent.

No way would I spend half my shift on that... the doctor needs to know ... the patient requests examination now, not at his/her convenience.

This is one of a number of responses here that crossed my mind too. . . .

Hope the patient is doing better. Would be interesting to find out the cause of your patient's change in status.

Up Vote Up Vote ×

I think the op stated that other tests where done to rule out seroious issues.

Up Vote Up Vote ×

Sounds like you did good. Chronically anxious patients are so hard to deal with. They're like the boy who cried wolf. You never know if THIS TIME is anxiety for something truly bad, or if it's just their usual anxious self.

But if you're scheduled to go back to work, yup, you gotta go! :p

Up Vote Up Vote ×

Yes, you have to go back tonight - you have to confirm everyone's assessments!----- Dave

Up Vote Up Vote ×

Good luck going back to her. Sounds like you did everything appropriately. I would suggest upon returning to work, if you have her again consult with the family to see what if any medication she takes for her anxiety. I took over a postpartum patient that had been giving the day shift nurse fits all day, she had a history of anxiety, panic attacks, and manic depression that her family was unaware of. After spending an hour with her getting her oob for initial ambulation, peri-care in the bathroom, and back to bed with major tears and drama, I called for a Xanax order. She was so much easier to get oob the second time.

On another note, I had a severe asthmatic s/p SVD patient go into respiratory distress and had to call a MERT (medical emergency response team) for her because R/T was taking to long to respond. I transferred her back to L&D but she continued to desat, called another MERT, ICU doctor responded and wanted to intubate her, pt begged not to have it done. She was moved to ICU and placed on CPAP. She had been admitted to the unit during the pregnancy for acute exacerbation of asthma and inutbated at that time. I was so relieved to find out she was okay when I called to check on her the following night.

Up Vote Up Vote ×
Specializes in Intensive Care (SICU, NICU, CICU, VICU).

I know we are all super nurses, but I think the OP just wanted to vent...not to have her post dissected..btw if a patient weighing 300 lbs (and seems to have a hx of resp issues with a baseline sat of 92) is put in trendelenburg they may have some issues with dropping their sats because of the inability to fully expand their lungs coupled with hyperventilating and shallow breathing. And the OP never said anything about malingering, she/he was just describing the pt...Rapid response?? Really??

Up Vote Up Vote ×
Specializes in CDI Supervisor; Formerly NICU.

Threads like this one make me thank God (again) that I work with babies. :)

Up Vote Up Vote ×
I know we are all super nurses, but I think the OP just wanted to vent...not to have her post dissected..btw if a patient weighing 300 lbs (and seems to have a hx of resp issues with a baseline sat of 92) is put in trendelenburg they may have some issues with dropping their sats because of the inability to fully expand their lungs coupled with hyperventilating and shallow breathing. And the OP never said anything about malingering, she/he was just describing the pt...Rapid response?? Really??

I've noticed that to in my patients, if they are short, 300lbs and "stacked" (I believe that is the term they use). They complain that it feels like there's a weight on their chest and it's hard for them to breath in trendelenburg. I want to tell them it's their 10lb bowling ball boobs pushing down but modesty is key. If I find that supine with a pillow works just as well in practice. It keeps the abdominal organs / belly fat from leaning on the diaphragm and the boobs fall to the side. Some patients like to wear a bra as well, I usually have them remove that and they find they can breathe easier.

Up Vote Up Vote ×
Specializes in PACU, pre/postoperative, ortho.

Ok, cardiac enzymes & cxr negative. Much better night with a little bit of haldol & family present! Apparently, she also started having a melt down yesterday when the surgeon's NP was with her; she gave PT a hard time for "picking on her" & trying to make her do a few exercises. So, although she was still the type of pt that takes forever to get comfortable & needs a little extra care, she was much more like the first night I was with her.

Off to bed!

Up Vote Up Vote ×

Is she a CHF pt? Mine do go into high 80s sat and the doctors say it is ok between 88-93% maybe thats why the lasix order as well. .I go thru this all the time and we dont send them to ICU unless its critical. I work in a teaching hospital and the dr can usually be summoned to come up,if they dont we call administration and they MAKE them come. I hopre you have a better night tonight.

Up Vote Up Vote ×
+ Add a Comment