I had a great night Saturday night. I started out with 3 patients and ended up with 4. Anyhoo, I had a man that had some increased nausea and vomiting very small amounts of bile. His abdomen was distended, soft, but more acsites than Friday night when I cared for him. He didn't have any increase in pain. He had a ruex and y...done (not sure on the spelling
), anyhoo...his electrolytes were stabling out...his K went from 6.6 to 5.0 which was better...his sodium was stable....everything else fine, except his liver enzymes were going up and his BUN was 55. Anyway, I called the hepatobiliary MD that night and told her what was going on but told her that the amount of emesis that he was vomiting (maybe 10 to 15 cc's each time which wasn't too frequent) wasn't enough for an NG tube. I told her about the increased ascites and the new electrolyte levels...stable h/h...she wanted us to watch him throughout the night. He was fine...or so he said. I asked him around 2am if he was okay or felt nauseated. He told me he didn't and his daughter who is an RN at another hospital said that the vomitting had subsided.
At about 5am, one of my other patients went into repspiratory distress. I flew into that room (and yes, nurses have wings). I stayed with her until I got her stable. It was about 6am when I returned to my other man who had n/v. The MD was outside the room and he asked about the man's n/v. The pt told the MD that he was still nauseated. When I asked him, he denied it. I witnessed an increase of bile emesis while I was in the room. I went ahead and gave him 4mg zofran IV knowing it wouldn't have any effect, but the MD wanted him to have it anyway. But, I felt like I had abandoned this patient. I knew maybe he needed an NG tube at that point. I felt like I dumped in on the day nurse who said he needed an NG tube. The MD just said that his BUN level would have warranted the n/v and was reluctant to put the tube in.
I felt so bad when I left. I felt like I wasn't aggressive enough with this. What do you think?