What went wrong?

  1. As an agency nurse I work for a small community hospital at times
    (Home health is my reg job). This is my fave facility. I had a bad experience. Here goes.

    1) I hear a pump beeping in a patients room.
    2) I enter the room to see if I can be of assistance.
    3) The patient looks BAD
    4) I try to get a response from the patient. (zero response).
    5) I find the patients nurse quickly and ask if said patient is a dnr and tell her the shape she is in. That it sounds like she has aspirated something.
    6) The nurse states "She wasnt like that a few minutes ago".
    7) I go into the room with o2 sat to check and the nurse comes in right behind me to take vitals. The patients 02 sats are 60. I tell the nurse. Who basically lets me know she does not want me there.
    8) I go out of the room. The code is called by yet another nurse. I get the cart in the room the code is started.

    Well to make a long story short the patient expired.

    I find out. The patient had a ng tube to suction and pulled it out and that she refused to have it reinserted. By the time I saw her she was in no shape to refuse the ng tube. If this were my pt I think I would of reinserted it at that point. ( My god, the amount of fluids was unbelievable). Then sent her to the unit and intubated.

    I dont know. It just seemed like a really messed up situation. I do believe the patient would still be here if the ng were reinserted to suction.
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  2. 19 Comments

  3. by   NRSKarenRN
    The patient had a ng tube to suction and pulled it out and that she refused to have it reinserted
    If the patient is competent to make a decision and refuses a procedure (explanaxtion of consequences/outcomes done), then inserting an NG tube against patients will is considered assault and battery---a crime.

    As adults, we have the right to refuse medical care.

    Maybe this patient had been sick awhile and decided that she just couldn't stand the tube being reinserted ? Tht you don't know.

    What most concerns me is your statement:
    The patients 02 sats are 60. I tell the nurse. Who basically lets me know she does not want me there.
    That I find upsetting--something fishy too. I'd want all the help I could get if MY patient was deteriorating.

    I've learned I can not save all my patients but can give them wonderful comfort care when condition is endstage. It is thru situations like these that we learn ang grow as a nurse. This is a situation were discussing this case with the RN later after dust settled, or with charge nurse is waranted "so I can be better prepared next time" is warranted.

    {{{{{nurse2002}}}}} to you for getting this patient HELP!
  4. by   Agnus
    She was like that a few minutes ago!!! AND???? What did she do about it? Sounds like nothing from what you say.

    This nurse is liable
    Whether or not she was refusing the NG She needed to have sats and vitals checked when this was first discovered and O2 turned up, HOB up, and the MD notified, and ......

    Reinserting the NG at this point probably would not have been out of line if as you say she could not refuse.
    This was an emergency and in such an emergency I might reinsert it even though earlier she had refused. I would much rather be reprimanded, go to court or what ever, for reinserting a tube on an unresponsive patient who did not want it previously. Then face a patient dying or just being injured due to my inaction.

    When this patient refused did the nurse explain the consequences of refusing and did she document that the patient was able to show that she understood the consequences as explained? If she did then she is justified in not reinserting when when the patient had obvioulsy aspirated and was unresponsive.
    In any case she needed to treat with O2 elevate the HOB. Call the MD Stat. and Check vitals, & neuro, etc.

    You had exposed her neglect. That is why she did not want you there. She will probably not be friendly toward you now.

    This nurse showed very poor judgement in not asking, if she did not know what to do for this patient. She should have known, but assuming she did not, she had a responsibility to get help.

    It is sad that she will probably never see the inside of a court room over this, that she will probably never have to explain her lack of action to the family. And she will blissfully go about her business.
    Last edit by Agnus on Apr 26, '03
  5. by   canoehead
    The patient WASN'T like that a few minutes ago.

    I see no problem with the care if the MD was aware that the pt had refused the NG. I think there might be some tension btwn you and this other nurse, and if I was you would get to the bottom of it so that you can help each other out in situations like this.
  6. by   Agnus
    OK I re read the original post you said the nurse said "the patient was not like that a few minutes earlier."
    Well she is now. Other than that my post stands.
    She needed help all that she could get.
  7. by   P_RN
    With a sat of 60 she was in respiratory distress.......frankly I'd have called a code right then. Sometimes a little bit of adrenalin will get a nurse hopping who is a little slow on the uptake.

    You did fine......wonder why she felt so threatened.
  8. by   nurse2002
    Originally posted by Agnus
    She was like that a few minutes ago!!! AND???? What did she do about it? Sounds like nothing from what you say.

    This nurse is liable
    Whether or not she was refusing the NG She needed to have sats and vitals checked when this was first discovered and O2 turned up, HOB up, and the MD notified, and ......

    Reinserting the NG at this point probably would not have been out of line if as you say she could not refuse.
    This was an emergency and in such an emergency I might reinsert it even though earlier she had refused. I would much rather be reprimanded, go to court or what ever, for reinserting a tube on an unresponsive patient who did not want it previously. Then face a patient dying or just being injured due to my inaction.

    When this patient refused did the nurse explain the consequences of refusing and did she document that the patient was able to show that she understood the consequences as explained? If she did then she is justified in not reinserting when when the patient had obvioulsy aspirated and was unresponsive.
    In any case she needed to treat with O2 elevate the HOB. Call the MD Stat. and Check vitals, & neuro, etc.

    You had exposed her neglect. That is why she did not want you there. She will probably not be friendly toward you now.

    This nurse showed very poor judgement in not asking, if she did not know what to do for this patient. She should have known, but assuming she did not, she had a responsibility to get help.

    It is sad that she will probably never see the inside of a court room over this, that she will probably never have to explain her lack of action to the family. And she will blissfully go about her business.

    BINGO

    I dont think the patient had a clue what was goig to happen or what might happen without the ng. I spoke to a nurse that had her the night before as a patient and she was beside herself. She could not believe that this woman would refuse a potentially life saving intervention.
  9. by   hoolahan
    Exactly P_RN, she seemed threatened didn't she. I think angus is onto something, everyone knows a pt condition can change in a heartbeat, so why say a silly thing like "she wasn't like that a few minutes ago" What is she trying to do, make sure everyone knows she checked on the pt, and that something YOU did made this happen??

    It will bother you to be sure, but don't worry, I bet her co-workers already have her number.

    I agree w Karen, a sat of 60 warrants an emergency, don't worry about what this nurse thinks, you did the right thing.

    Isn't there a system for determining if a pt is DNR?? Like a special armband or something? Precious time is wasted in hunting down the pt nurse or chart. All the hospitals I was in had a color-coded armband, or an orange dot on the pt footboard or SOME kind of marker that would tell you automatically if a pt was a DNR. Suggest it to the manager as an important safety concern.
  10. by   Furball
    The marker idea is a good one. I remember walking by a pts room once and just noticed they didn't look right. ...went in and sure enough the pt had coded....hollered for help and started cpr.....his nurse came screeching in screaming that he was a DNR..how the hell should I know? If there were a neon pink dot on the bed or bracelet I would've known.
  11. by   Agnus
    Our hosptal uses a red arm band for DNR.
  12. by   Agnus
    God why are humanbeing so afraid to ask for help? Why do we think we must appear all knowing in front of other humans?

    Especially when everyone knows that no one is.

    Ask questions. Ask for help. And the saddest of all is that those who are most likely to try to appear to know everything are those who need help and answers the most.

    If I get in a situation like that PLEASE help me out. Hurt my feeling and my pride; they need to be.

    I used to work with men and I thought this was just a male thing. It is not.
  13. by   Danamegg
    Uuuuuuuuuuuuuuuuhhh ... what is a DNR?
  14. by   Buddha
    Do not resustate. Do Not preform CPR.

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