Situation: pt has chronic a-fib with new orders to hold Coumadin x4 days.. Its been held off and on the past few weeks due to PT/INRs.
Walked down hallway to talk to nurse and found said pt lethargic,labored breathing,pale. Asked nurse what she new about pt. she stated "oh, shes been like that for weeks" and walked away..
I grabbed my stethoscope and went to listen to lung sounds - she was wet in all lobes, but when i got to her heart it made my jaw drop. She was just all over the place- no beat at all really. Ran to get the nurse in charge of pt- told her to listen to pts heart. Nurse placed stethoscope for probably 4secs and asked "what am i suppose to be listening for?". /facepalm.
VS 140/58, pulse 37-140 on machine, pulse ox was 60% with no O2, resp 30. Dr said to send out immediately.
Question is: what do u guys make ur nurses do daily on a-fib pts? Currently our facility relies on common knowledge (which obviously not there) and s/s in care plan (which no floor nurse looks at)
Aug 4, '12
Holding warfarin is not as important as the patient maintaining a minimal therapeutic level.
A thorough cardiac assessment should be done on a regular daily basis, at least. The findings of the assessment should be documented somewhere so that one can look back for easy reference. Once the patient started complaining of SOB and you noticed a change in condition the patient should have been sent for a STAT cardiac eval.
Pat yourself on the back, you may have saved your patient.
Aug 4, '12
she had been like that for weeks? and no assessment was done? wow. thats scary.
at bare minimum we do vital signs for pretty much everyone on my hall - i talk to
each of my patients - i make every attempt to see them at the beginning of my shift
before i start blood sugars - i try to look at the vital sign sheet after the cnas do vitals
but they are also pretty good about telling me if they fiind something abnormal.
i will say that i dont know every bad sound that i am supposed to be hearing when
i am listening to lungs/heart sounds but if i question it i always get the supervisor. ive
been a nurse for 2 months now. its disheartening that the supervisor didint know what
to listen for.
Aug 4, '12
It seems our nurses are relying on the pulse ox monitor to give them the pulse instead of actually listening to the apical pulse.
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