When a patient states "something isnt right..."

[turnforthenurse]

And try just cannot put their finger on it, what do you do? I have encountered patients like this and was told to never ignore it, because usually when patients think they are going to die, they do. Thankfully nothing has happened with these encounters. I try to get an idea of "what is wrong" but the patient doesn't know. Usually VS are WNL, might be a little tachy from anxiety or something. Upon assessment, everything just seems benign.

So what do you do?

[artsmom, BSN, LPN]

As everyone has said- always listen to them. It means something. I was working in LTC and a resident said something is wrong. Vitals and assessments were WNL. So, I asked the patient what she wanted to do- she asked me to send her to the hospital and call her daughter. I did just that and a week later the daughter came in and asked me how it felt to save someone's life. Her mom ended up having both her lungs collapse and was vented within a few days. But, when I listened her lungs were diminished- not abnormal for her. She pulled through and successfully weaned from the vent after a while also which was awesome.

[Esme12, ASN, BSN, RN]

There is something called a “sense of impending doom” in medicine. It is a symptom that patients describe that is distinguishable from a panic attack. Sometimes as a health care provider, you just get the vibe that something very bad is going on. In any case, when this is present, you pull out all the stops to figure out what is going on Many patients having a heart attack will also have that "feeling of impending doom". Listen to your patient.

There is a vast difference in the high drama patient clutching their chest screaming "LORD here I come" and the patient that quietly tells you...I don't think I'm going to make it out of here. Restlessness, anxiety, sweating, maybe some SOB they may not know what is wrong. I have seen this with Acute MI's, Pulmonary embolism, Anaphylaxis. Every initial test may be negative but there are times that nagging feeling won't go away. Monitor your patient closely.

I have also gotten the feeling that something is just not right with the patient. and been persistent to the MD that something was wrong. Many years ago I had a patient that came in with an acute MI...she coded in cath lab and went to the OR. They place a balloon pump expecting to have issues getting her off bypass and they KNEW she would have a poor post op course. Post op she did AMAZINGLY WELL! They pulled the balloon pump first post op day. No drips, extubated within 16 hours of the OR.

The second post op day they spoke of transfer soon.....that night she just didn't feel right. I had an order to shoot one more cardiac output and pull the Swan.....the dangle and get her in the chair. The waveform of the CO looked funny I actually called the MD and told him it looked like a particular cure you seen in cath lab when there is a ventricular septal defect. He laughed and told me that the Swan was bad pull it...so I did. I still had the feeling I couldn't put my finger on.....she didn't feel right, but after what she had gone through who could blame her. We went to dangle her, she coded. Blew a whole in her ventricle. She went to to OR and ultimately did go home.....but all she told me that night was something wasn't right.

Parents will also tell you that something isn't right especially parent of chronically ill children. Listen to them closely...they know their kid.

There isn't necessarily anything you can do....per se.....but monitor them closely. Get ABG's, maybe a 12 lead EKG maybe some enzymes check their blood sugar. But the point is to hear them and listen.

[nurseprnRN, BSN, RN]

I reviewed a medical record where a man told his nurse he felt like he was gonna die. Alas, all the charting she did was one word: "Listened." He did-- massive, undiagnosed postop infection. Undiagnosed because he was immunosuppressed by meds and nobody thought to look beyond no fever and no elevated WBC.

[Mommy&RN, BSN, RN]

Another pt that comes to mind, I was a very green nurse. I went to a room because other nurses were calling for help. I was talking to the pt and it was obvious at any given moment he was going to code. I was talking to him and trying to keep him calm. He kept telling me, "please don't let them take me to ICU. I don't want to leave right here." I kept telling him that he needed closer monitoring and more 1:1 care than we could provide and that it was important that he go to ICU. I still remember him begging me to not make him go. We had already called the code team because he was declining that fast. Got some attitute about not knowing when to call a code because the pt was still alert.

The pt coded in the elevator on the way to ICU. Went they intubated him he bleed out.

I think the "something's not right feeling is something that most of us have. Even if not in the nursing/medical field. It is a feeling you have to learn to trust.

What is the worst thing that can happen if you follow your gut? The MD/NP/RRT/PA, etc may be "put out" but always trust your gut!

[Wet Noodle]

Listen to them and watch them like a hawk! And if they tell you 'now it's time to call son in Boston', RUN, do not walk to make the call to Boston.

This is spooky, because it was precisely my mother's scenario. She was in a nursing home under hospice care and asked if she could borrow someone's cell phone to call me-in Boston. The staff seemed to have no idea what was going on. She died an hour after she made the call.

I received a call a little later from someone at the facility that she had died, and they assume that I somehow knew. No one there had a clue, much less were attuned to subtle cues from the patient.

[Paul'in'FL]

I agree....as long as the patient has an underlying illness or pathology of some kind, or is an inpatient.

As opposed to the ED patient (always female) who has been tested for everything by 17 docs in 2 years, and still insists "I know my body and something is wrong!" Sad for them, frustrating as all heck for everyone around them.

[merlee]

I have called codes on 2 patients who were still AAO when the team arrived - but both ended up being intubated within minutes - 1 was going into anaphylaxisis, the other had 2 units of blood and was fluid-overloaded, nearly drowning. Docs yelling at me until pts starting frothing at the mouth.

Sometimes you just know that something bad is about to happen. Listen to your instincts, and when the hair on the back of your neck is standing on end, PAY ATTENTION.

[MinnieMomRN]

I reviewed a medical record where a man told his nurse he felt like he was gonna die. Alas, all the charting she did was one word: "Listened." He did-- massive, undiagnosed postop infection. Undiagnosed because he was immunosuppressed by meds and nobody thought to look beyond no fever and no elevated WBC.

Yup. Listen, fully assess, monitor, and document like heck!

[biblepoet]

I agree my last time it happened the patient eventually died in ICU.

[KelRN215, BSN, RN]

I've had several experiences with this... as the nurse and as the patient. Seen many parents bring their kid in because "something just doesn't seem right" and come to find out they have a whopping brain tumor or some horrible degenerative disease or something. If a kid is already inpatient and the parent says "something isn't right", they're usually right. I've had parents say that and an hour later, the kid's emergently on his way to the OR.

As a patient, I once spent 9 months saying "something is WRONG!" to a whole medical team. 5 months into this, I was diagnosed with Diabetes Insipidus and 4 months after that, Renal Tubular Acidosis.

[umcRN, BSN, RN]

As a patient, I once spent 9 months saying "something is WRONG!" to a whole medical team. 5 months into this, I was diagnosed with Diabetes Insipidus and 4 months after that, Renal Tubular Acidosis.

Guess I also experienced this as a patient too...but silly nurse me, I tried to ignore that something was wrong for a long time. When I finally saw different doctors though they didn't believe me, kept diagnosing migraines, stress, caffeine withdrawal, fatigue from working night shift, etc etc. When I finally found a neurologist who would listen to me (after 7 months of symptoms and 5 months of going to doctors) I was diagnosed with a brain tumor & had surgery a few days later.

[Jackfackmasta, ASN, RN]

I had a patient with a brain bleed who was still intubated but other wise stable after the bleeding stopped. Her neuro side had improved. In report the nurse told me she had desaturated for no reason down to the 80s but came back up quickly. Then she desaturated once when they were turning her but other than that she had not done it again. VSS.

I had her the two days before and her desating for some reason I felt like something was not right. We were repositioning her an hour into shift change before she desated again but came right back up. The doctor did not think anything of it because we were moving her but I kept talking to him that there's something wrong and we need an x ray and abg minimum.

I'm glad I pushed him because she slipped into ARDS that night. Family pulled support the next day. This was my first incidence of gut feeling. My preceptor had told me it was probably from moving her but the fact she desated twice during the day shift and never before alerted me to something was wrong.