What do you do when...

  1. Ok...Another new RN question from me.
    What do you do when you have a patient that you know something bad is going on with, but you can't put your finger on it?

    This happened to me the other night. I got everyone I could drag into the room to see what their opinion was and no one else could find anything new wrong that would be causing the new anxiety and other symptoms. I called the doc twice early in the night (well...before 1am anyway) and ended up calling him twice just before 5 am when FINALLY pt was in repiratory distress and was transferred to ICU. I feel like maybe if he had gotten there earlier in the night maybe the outcome would have been better, but there was nothing to base moving him earlier on other than my observation that his behavior was "different" and his BP seemed more difficult to hear (severe PVD pt, never had been easy to get a BP on) and I guess those observations don't fit the criteria to transfer to the unit.
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  2. 9 Comments

  3. by   lsyorke
    [QUOTE=memphispanda]Ok...Another new RN question from me.
    What do you do when you have a patient that you know something bad is going on with, but you can't put your finger on it?

    Always trust that gut instinct!!!! It will happen over and over again!
  4. by   CCU NRS
    Sometimes there really is nothing you can do. Imminent doom syndrome happens. I have seen it, anxiety that is not relieved and leads to or is caused by an event that eventually happens.

    With resp. distress if you know your doc or more importantly your doc knows you, you can get an order for interventions based on parameters.

    Ask if you can go to a NRB mask if sats are below 90% or a general keep sats >90% and if it happens (decreased sats)would you like a set of ABGs. Something for anxiety to help the Pt relax, even if its just Benedryl for restlessness it can help calm a person that is having anxiety. you can ask for B/P parameters and if he would like to be notified if these happen.
    I have noticed that docs are usually smart enough to know when someone is asking the right questions and listen a little closer, and perhaps intervene sooner when they percieve the situation has a potential to deteriorate and they know that the person telling them has a Good Eye so to speak.
  5. by   dianah
    It's called intuition mixed with common sense. Some have it, some have to develop it. Some never get it. Good for you, listening to your gut!
  6. by   lady_jezebel
    This new RN can't wait until she's there one day! Truly, nothing is more valuable than EXPERIENCE in the profession of nursing.
  7. by   IloveSnoopy
    I know exactly what you are talking about. I went thru the same thing all weekend with a patient. Clinically, she was stable, yet I just had this feeling that something wasn't right. Well...my suspicions were correct...because apparently she crashed the end of day shift on Sunday...and was gone by the time I got there on nights. I actually had called the doc and just "updated" him on her,etc....I think he thought I was crazy...he just told me to continue to monitor her...which i was already doing. Like someone else said...it's not really something that can be learned....it's just a sixth sense so to speak. I also agree.....Good for You....for listening to your sixth sense. Bravo :hatparty:
    Luv,
    Snoop
  8. by   CoffeeRTC
    I know exactly what you are talking about..Its just a feeling you get and cant really pinpoint what is wrong... Working in LTC you get a lot of these. Normally I will call the family to see if they noticed anything different and keep a close eye on the pts.. sometimes ask the MD for a few labs or even check the blood sugar.. Be surprised what you find.. UTI, urosepsis, exac of CHF. Always go with you gut, do a full assessment and document.
  9. by   laurasc
    When I was a student nurse someone once said to me that when you feel for a pulse you actually feel two. One, you feel the beats which you count and two you feel the patient. It always seemed very cryptic and nonsensical to me until the day I realized that I was indeed "feeling" the patient. It's what I call the "nurse's eyes"...a combination of training, experience and intuition, the very essence of nursing IMO.

    As for the outcome being different....yes, it could have been different. If you hadn't of been that vigilant, you could have missed it altogether and your patient could have died.

    You used your "Nurse's eyes" that night. You did good. Very well done.
  10. by   unknown99
    Yes, always trust your nurses intuition. It is a gift!!! If I have a patient who I know something is wrong, but can't put my finger on it, I keep after the doctor until something is actually done!!!
  11. by   Tweety
    Kudos for having the instinct to know there might be a problem and you were on the ball observing him. The outcome would have been the same had you transfered him to the unit earlier, so don't feel bad that the patient later crashed, the patient was going to crash even if he/she were in the unit. Suppose you didn't have such keen assessment skills and thought he/she was just fine and went about your business, the outcome would have been much worse.

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