Duplicate Threads merged........
You are still within your first year after graduation/licensure......this is a tough year, give or take a few months. Coming out of school and suddenly you are responsible for everything can be overwhelming. It is impossible to begin to list things for each and every disease process and it is different for children.
In general......there are subtle changes that might "tip you off". The patient might tell you that they don't feel well. They become restless, confused say thing like...something isn't right. The family might feel that the patient is acting oddly or not themselves......that again something isn't right.
Know your patient and assess them frequently.....look at their baseline, "usual" vital signs of this, and past, admissions. Check your vital signs, B/P (both arms) HR Resp rate Sat% Glucose Temp, are the higher or lower that they "should be".....what is their output? One of the indicators of well being is end organ perfusion....a urine output of at a minimum 30cc/hr....it should be at least 1ml/kg/hour in the "normal" patient.
Look at the cap refill, the patients color, nails beds, lung sounds.....are they different from earlier or are the different from what you were told by the earlier shift? Go over the list of symptoms, in your head or a quick google search on your phone, to know/learn what to look for.....I always look stuff up that I don't know....when I started out I spent many lunch hours at the hospital library learning my "craft".....for school gives the bare minimum. A ton of extra time was required after school/work to get to that Ah Ha moment when some of it finally made sense.
There might be A little voice in your head, a nagging feeling, that tells you something isn't right. A general trending that the patient is no longer at their baseline. It does take time, experience and organization of that information. You need brain sheets.......here are a few.
1 patient float.doc
5 pt. shift.doc
day sheet 2 doc.doc
ICU report sheet.doc
Why do you ask? Are you switching units? or just feel like you are still struggling to keep up.....I hope this helps