I came in to work one day and got report from the day shift nurse that a resident's wife thought he wasn't acting right and wanted to know if he should go to the hospital. The day shift nurse assessed him and couldn't find anything really wrong so she just reassured the wife that since he'd just had a stroke, that his symptoms were synonomous with that diagnosis.
So here I come to do my assessments. After checking his vitals, his respirations were 32/min. but his O2 sat was 99%. We got him up for supper and he did really well (I documented all this carefully). After putting him to bed, I went to check on him b/c wife said she would call at bedtime. I noticed he was having 20-30 sec. periods of apnea and wasn't responsive. I was unable to get a B/P on him and his pulse was nearly non-existent. I checked his chart and he was a full code, so I immediately called the ambulance, gathered up the crash cart and placed him on O2. We transferred him to our local hospital (rural) and they then transferred him to a bigger city hospital.
My DON wrote me up for not recognizing the early symptoms of respiratory distress, as evidenced by the resp. rate of 32 initially. She said I should have called the doc right then and there and placed him on oxygen. My only argument was that his sat was 99%. Does this write up sound valid?
