Feel like a horrible nurse! - page 3

Last nights shift made me feel like i never even even to nursing school! I have a pt with esrd and heading for dialysis at 0800. He has many serious problems but this is what i am focusing on. His... Read More

  1. by   OncoRN84
    That first year will make or break you but your judgement sounds reasonable. I really wouldn't be terribly concerned about that pressure for an hd patient awaiting dialysis that morning. Be kind to yourself! Normally, I hold meds until dialysis is over as it will drop their pressure anyway. It sounds like the attending and nephro need to talk to ensure more consistent care. It'll get better- I promise you- tincture of time....
  2. by   kjb_lpn
    Generally speaking, friend, there will be days when you feel like you don't always catch something, or that somehow you should be better. The trick is not to let them get you down, remind yourself you're Human - and that you can but try. Accept these as learning experiences and take what you can from them. You'll pick up seasoning and learn more with time.

    One Thanksgiving night, I had a pt begin to vomit; coffee ground like substance. I actually called the doctor after it happened a second time and didn't realize until later I should have realized the first time what it meant. Yes, I felt like a terrible nurse. But I also remembered that lesson.

    Good luck!
  3. by   RobbiRN
    High blood pressure is way overrated as something that needs an immediate fix. Half the country is on 4 to 5 BP meds running around with numbers like the ones you were worried about. Your own BP might have been higher while you worried about calling. This is an oversimplification, but just remember the basic formula: It takes time for really high BP and high BS to kill people. Really low BP and low BS can kill them in minutes. Those are your emergencies.

    Caring and focusing on your patients will make you a great nurse. You're on the right track.
  4. by   chris21sn
    I don't think you should feel bad at all. Firstly, his blood pressure will go down regardless because of his dialysis. I believe some nurses even hold bp meds if a bp is moderately highish - just because they wouldn't want to send a dialysis pt of 150/85to become 135/75 and have him coming back at 70/90. Plus you followed the parameters of the orders. I think you're doing fine! No worries
  5. by   Karafair
    At the hospital I work at, the perimeters that are pretty much the same for everyone, including dialysis patients is call if over 170/100. Dialysis patients almost always have higher bp right before dialysis. That being said, the nephrologist's perimeters were kind of low.
  6. by   Orion81RN
    You know what good nurses do? They reflect on what they should have done and list 1. Yada yada 2. Yada yada. 3. Yada yada. And then talk to peers about it. And that is EXACTLY what you did. Now you can put this behind you and know you are not a horrible nurse, you did what any good nurse would do. Reflect and think of what to do next time
    Chin up. ;-/
    Last edit by Orion81RN on Jul 15, '17 : Reason: Typo
  7. by   jprn2018
    The fact that you feel bad about this just goes to show that you are a very caring, dedicated nurse. It's the nurses that don't care about issues like this that are not meant to have gone to nursing school. This is just a lesson, and one that you will be sure not to repeat again.
  8. by   connectchoicecareme
    Usually when we send a dialysis patient for hemodialysis.We usually hold the blood pressure medications because the bp tend to drop after the hemodialysis.But sometimes there are expectional cases in which the doctor might order to give blood pressure medications even though the patient is going for hemodialysis.
    Or there are written instructions of what to do by the nephrologist during hemodialysis.If you as a dialysis nurse was supposed to call when diastolic is >115.Why then should you call when is >90.Some doctors will want you to look and feel stupid.When in doubt talk to your honest,reliable experience colleagues.
    Don't take it personally.Some days are bad and some days are good in nursing.Nursing is the way to go.Do your job in the hospital go home, shower,eat dinner and make love with your partner.
    As an adjunct professor, you finish work at school,you are still taking work to your home. You have to grade,post grades and answer phone calls from the students.
    As an acute care nurse when you are done for the day you are done.How cool is that?
    Don't you love it?