Heart Problems???????????? Please help

ceecel.dee, MSN, RN · Feb 2, 2004

Originally posted by ADNRN
"And what, pray tell, is ablation? Am I missing something, because I'm thinking placenta here?".....now this made me smile!
"She said her HR went from 170 to 80 in 3 sec, talk about your extreme parasympathetic responses!".....very good!
" Then she says she has a cold (which sounds bacterial in nature)".....colds are viral, but good thought process!
"and people still want her strapped to a halter EKG.".....not unusual for anyone c/o an arrhythmia that needs diagnosing.
"She finally says she wasn't using the equipment right and we all breathe a sigh of relief." .....We nurses have a funny way of wanting everything to be okay for everybody.
"I'm only a student. But I like the responses that told her to just go to the doctor. Man, that's their job. Once they say she has 9 volt battery inadvertently connected to her vagus nerve, we can do all the nursing interventions to care for her. But we don't dx, do we? I mean we don't dx other than diagnoses r/t nursing care, right? NANDA and all that?"....Most nurses enjoy the mental gymnastics called critical thinking that is a big part of our jobs. You would not believe the number of close catches nurses perform for patients due to the fact that the doctor has missed something. No, we do not write the diagnoses that we catch as medical dx, but we do write the assessments, lab work we recognize as a potential factor, and patient's s/s that allude to a medical dx. We say to the Dr., "should we check a hemaglobin", or the patient's I&O's have been upside down for 3 days and I heard crackles" or "he coughs with every meal and with all thin liquids. Would you like a swallow eval?"...you get the picture.
"By the way, I'm not singling anyone out. I went running for the med/surg book myself. But I realized as I fitfully threw books from the shelf in search of a medical dx for this 19 year old that my part hadn't come yet."....Our jobs are much bigger than waiting for the Dr. to direct our care.
"She wasn't on my floor in a bed yet. We're nurses, right?" .....Yes, we are, so we jump in to help where ever we can. We are not diagnosing, we are just voicing thoughts that pop into our heads, based on our experiences...based on what we have seen before. We just offer suggestions, and the poster accepts what seems to fit, and rejects what is off base.
"OK, my heads on the block axe away." [/b]

No chopping here. That's just how we play.

;)

nurseT · Feb 3, 2004

Anxiety can cause changes in blood pressure, heart rate, breathing, circulation, diaphoresis. She's got the crud but could be having panic attacks too.

ratchit · Feb 4, 2004

ADNRN, we definitely don't wait for the doc to diagnose. The docs have certain privileges under their licenses that we don't, but a good nurse doesn't just do "what the doctor ordered." Heck, a lot of critical care nursing in a teaching hospital is leading residents (who don't always want our input) in the right direction.

I'm happy that someone who laid eyes on prairiegirl thinks she just has a sinus infection. That would be great. To me, it doesn't explain why the NP didn't find that or why she had these symptoms on and off for months, but looking back, she mentioned that it had been happening for a while but only gave one example outside the last week or so. I nearly fainted at my wedding when I was 32- can't imagine how much more stressful it was for an 18 or 19 year old. Which all adds up to: it's hard to diagnose online.

She got good advice, all geared towards encouraging her to get accurate info about what happened, get evaluated by someone in person, and not let her symptoms be ignored if they weren't going away.

ADNRN · Feb 4, 2004

Originally posted by ratchit
ADNRN, we definitely don't wait for the doc to diagnose. The docs have certain privileges under their licenses that we don't, but a good nurse doesn't just do "what the doctor ordered." Heck, a lot of critical care nursing in a teaching hospital is leading residents (who don't always want our input) in the right direction.

I'm happy that someone who laid eyes on prairiegirl thinks she just has a sinus infection. That would be great. To me, it doesn't explain why the NP didn't find that or why she had these symptoms on and off for months, but looking back, she mentioned that it had been happening for a while but only gave one example outside the last week or so. I nearly fainted at my wedding when I was 32- can't imagine how much more stressful it was for an 18 or 19 year old. Which all adds up to: it's hard to diagnose online.

She got good advice, all geared towards encouraging her to get accurate info about what happened, get evaluated by someone in person, and not let her symptoms be ignored if they weren't going away.

OK, good reply, and I hear what you're saying, but I do think we do in fact wait for MD orders, except those things which are independent nursing interventions.

I intend to work in critical care and cardiac stepdown, I do not intend to make medical dx. That's not my profession, that's not my concern. Mine is to assess the patient's physical condition, report that condition, administer medications, and treatments, perform nursing interventions based on my assessments, educate patients and provide care to the degree the client cannot care for themselves. I don't intend to train residents, and I don't want to, unless they want to know about nursing care.

For instance, in the above, the best response might have been to say, "It sounds like someone hooked a battery up to your vagus nerve, but I'm not your cardiologist, so I strongly recommend you go see your doctor right away (I'm being facetious to make a point).