So wondering what I should have done. I was at my 3rd clinical, first semester nursing in a long term care unit. I was told to go practice taking vitals. Not too many nurses or clients were around because they were at a Halloween party. I tried taking radial pulse and O2 levels on a nonverbal man, and they were both very low. Radial pulse of 48, and his finger said it had 69% O2. I couldn't believe it (and this device has always been reasonable) so took it again on another finger and it was similar. No nurse or instructor in sight to tell. His hands were very cold. I wondered if he had peripheral vascular disease and this was normal for him, and not maybe a big deal? When I saw my instructor at post conference I told him, and he seemed to think it was unbelievable, and must be my device. He added that I should take it on an ear lobe next time, and said that pulse can vary and I should have checked what it was normally (but he wasn't my patient and I didn't know his name or room number to check). When I asked my anatomy professor later that day since we were talking about a cadaver who had terrible circulation, she seemed to think I should have immediately notified some one who worked there. What would you have done?
You didn't notify anyone? Seriously?
Really poor judgement- whether or not the reading was correct, ALWAYS (as a student) notify the nurse of abnormal ANYTHING.
Thank you! I will do that next time. When my instructor didn't seem to be alarmed I wasn't sure.
Should I have found the charge nurse, an LPN, or who? I also thought my patient was developing pressure ulcers and told my instructor, but didn't know if I should have notified someone on her floor. It wasn't on her chart.
Quote from BookishBelle
When I asked my anatomy professor later that day since we were talking about a cadaver who had terrible circulation
Really? A cadaver with terrible circulation?
Haha, oops, could have put that better! The anatomy professor told us a black area of the cadaver was where the preservative had not fully gone in properly because of poor circulation there when she was alive.
Make sure to very, very clearly reach an understanding from your clinical instructor how they want you to handle communication when you see an abnormal in the clinical setting. Do they want you to come to them, and only them, when this happens? Or will they allow you to communicate with staff, if a staff member is the first person available？ Very, very important for you to do this.
Was this gentleman alert? Did he obey commands? Was the rest of his body cool? Just the one extremity or all? How was his breathing? Any changes in LOC is a significant finding and needs to be reported asap.
I would have tried a different machine and put warm blankets on his hands to see if you get a better reading. If the patient had a decreased loc, I would have done a full assessment to find out why. I would have reported it to the nurse you were working under. You can qualify it with "Mr. As o2 seats were 60% but his hands were cold. I've done x,y,z..." Worst case scenario and you can't get a true reading, you can get an RT to do an ABG.
I'm rather concerned that you made the assumption that the patient was fine and that it was the machine being faulty instead of following up with some assessments and not notifying anyone. It's unsafe behaviour.
Here are some suggestions for assessment and how to handle this in future. I assume you are a first semester student?
Assessment: The patient is non verbal, he can't tell you how he feels BUT what does he look like? Are his eyes closed? Is he concious or unconscious? what does his color look like? skin, lips, cap refill? Are his respirations normal or abnormal? shallow, cheyne stokes, irregular? Was his hand cold when you put the pulse ox on it? (cold hands can sometimes cause a low reading). His radial pulse was 48, was it regular or irregular? Did you listen to his apical pulse for a full minute? regular/irregular, strong/weak. What was his BP? If you took signs with an automatic machine you should have confirmed them manually.
Now for what you should have done in that situation: You should have immediately notified the nurse, given him/her the vs along with any of your assessment findings. ALWAYS ALWAYS ALWAYS report abnormal vs. IMO opinion your clinical instructor was incorrect in how he handled this at post conference. He did not lay eyes on the patient, or have any idea if this patient might have been in a critical situation. So in future what are you going to do? You are going to report abnormal signs to the nurse caring for the patient.
You've gotten good advice from others here but I will say this:
1. As a student, ALWAYS ALWAYS report abnormal vitals and changes in patient condition.
2. If you are getting a funky vital sign reading, stop messing with the machine and look at the patient. Turn on the overhead light and talk to him. Within 3 seconds you can get a general picture of "is this patient sick or not sick"? What is level of consciousness? What is his skin color and temperature? How is he breathing? This type of assessment will develop over time, and it will let you know if you need to be concerned.
Yes, you should have found someone, believe it or not they will not come looking for you. The pressure ulcer suspicion should also have been reported, pressure ulcers can go really bad really fast. If you had reported these things you would have looked like a star. So if you think something is off, or wrong, or not right with a patient report it, this is the start of developing critical thinking skills, your judgement will get better as the semesters move on but think of yourself as a patient advocate. Often nursing students notice little things that busy nurses miss and can help prevent a bad outcome.
Thank you all for helping me learn! Does it matter which nurse I find and tell? Should it be a CNA, an LPN, or the RN? I did tell my nursing instructor, who is a DNP, when I saw him and we were still in the hospital so please don't think I kept it to myself. I was with another nursing student and I had her recheck my results on the other side. I think part of the reason I didn't go into the dining room and start trying to find out who was responsible for him was that he seemed exactly the same as he had been for the last 3 hours, and had been the week before. (Not that I was ever his nurse or introduced to him) but he was sitting right by the nurses station playing with some screws on a table. Even though he never replied verbally to any of my questions, his eyes were bright, his good hand was constantly fiddling with things, and when we asked if we could take his blood pressure he gave a tiny nod. The hand I took his bad oxygen levels on was the one he didn't use, and the fingers were a little curled in. His fingers were cold, but no colder than my nursing student partners'. He was sitting up unaided. If anyone had been around I would have grabbed them and asked about him, but there was no one. I think my instructor was upstairs heading things. The charge nurse wasn't in the dining room or in the halls or by the nurses station. Maybe in the bathroom? Do they get lunch breaks? I wasn't sure about asking the CNAs in the lunch room, but maybe that's what I should have done? I know they don't do assessments, but maybe they could have told me who to tell next and where to find them.
Nope, don't approach anyone in the lunch room. It's not HIPAA compliant, PLUS staff is off the clock during lunch.
I wouldn't notify the CNAs at all though -- assessment findings need to be reported to a licensed nurse. The LPN is fine if s/he's the one taking care of the resident (s/he can then notify the RN if the issue needs to be investigated further), but if you see the charge nurse first that's fine too.
They were probably all tied up at that moment. The floor is NEVER going to be unattended.
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