When a patient states "something isnt right..." - page 4

by turnforthenurseRN 9,522 Views | 37 Comments

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... Read More


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    Quote from Pistachio
    I have most frequently found this to be anxiety in my patients, I have yet to have one go bad or code after saying that. However doing vitals signs and a quick reassessment helps to rule out any problems that might be detectable and to reassure the patient. I've learned though just to ask then if they mean they want anxiety medicine first.
    Pistachio, While you may have found this to be true so far, I would urge you not to become complacent. As most of our fellow posters have also found to be true, in my 30+ years of nursing I have witnessed this phenomenon many, many times. If I have a patient tell me something, I believe it. Hands down. I once worked a second job at an LTC facility and had this young 14 y/o girl who had this really rare neurological condition, at the time their were only 6 or 7 patients in the state that had it and she and her younger sister were 2 of them, but anyway, it was extremely debilitating and the mother had finally placed Dottie in the LTC,(she's long since expired) but Dottie used to tell me she had a strange man in her room sometimes, this worried me at first, because of security, and Dottie was blind because of her illness. I told the staff they needed to take particular attention to her room and watch if she had any strange visitors. I also told Dottie if her strange man came back, to use her call light and let me know. The next day I was getting report and Dottie's call light went off and I ran to her room, and there was no one there, I asked her why she used her call light and she said he was there, standing in the corner, and there was no one there. Long story shorter, it turns out that Dottie's visitor was in her words, "a nice man named Gabriel, and he was there to protect her." Dottie died a few weeks later. No one else ever saw or heard of Gabriel again that I know of. While this story may not be clinical in nature, there are plenty that are. I just thought this one was interesting and somewhat on point.

    ANYWAY, as soon as you fail to heed the words or your gut feelings one day, someone is going to die, and it will be needless because you will have had the tools you need to prevent it. It may well be anxiety, hell, it could just be gas, we all know what hospital food is like, but if your patient tells you something isn't right and I just can't put my finger on it, what harm does it do to take a few minutes to check it out, so you have to spend a few extra minutes you didn't count on, chances are you would have gotten tied up somewhere else doing something you hadn't counted on doing something else anyway, isn't that how it always works, we're Nurses, sure it is.
    Last edit by FMF Corpsman on Sep 26, '12 : Reason: spelling
    Nurse MikeyBear and umcRN like this.
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    This is where the saying that "it won't hurt you if you take some time to check out their complaints rather than to be sorry later on for not doing so" comes in, taking simple things for granted is not the proper way of handling complaints as a nurse. Specially with parents , a large percentage of their gut feel or intuition is based on the bond that connects a parent to her child that not even a doctor may detect.
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    I kknow I'm kinda cynical but spending a little extra time periodically re-assessing your pt, maybe advocating for a lab or two and paging an MD if need be takes WAY less time than running a code..
  4. 0
    Here is an interesting article relevant to this topic:

    'Gut Feelings' Matter in Dx of Kids' Infections
  5. 0
    Check everything, Vitals, Lab, head to assessment, call MD. Stay with patient.
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    I recently had a patient who was demented at baseline, confused and at times agitated, all which was normal for her as per the family. She kept trying to get out of bed but later calmed down, then she fell asleep. Then about an hour later I went to check up on her innocently and she gives me this wide eyed look and starts saying ''I'm scared'' I reassure her but something in me thought ''what was that all about'' I thought she may have been saying she's scared because I moved her to a different area of the ED, her family had left and maybe she needed re-orienting. (she was stable btw) But I figured she was demented and etc.. and maybe was just having one of her moments of confusion. She was too confused to answer anything appriately and couldn't say if she was in pain or not. She went back to sleep, no longer agitated AT ALL and was quiet (hint/hint)

    3 hours after I get ready to go on my break I give report to the nurse who's covering me. I make sure this woman has her fluids going (she had choleliathiasis). I re-take her VS just because she looked off to me somehow (just a feeling I got, but couldn't pinpoint anything), her vitals were WNL.

    I come back from break an hour later. The woman is in full blown hypovolemic/septic shock. Tachycardic up to the 150's, bordering hypotensive. Lethargic, but arousable. Got intubated and everything.

    I then realize what she has said to me almost 5 hours ago ''I'm scared'' and also remembered questioning myself as to why she was no longer her usual confused self (this was the hint/hint in hindsight) but had gotten so quiet. You see at the start of my shift this pt was very talkative, confused, trying to get out of bed, but progressively became quieter and less mobile in her stretcher. I mean this is what you would want for a confused pt right? for them to become calm. But now in hindsight, those were huge red flags!

    It gets harder to pick out a crashing pt when they have certain co-morbidities like altered mental status. On an A&O pt they can much better tell you that atleast ''they don't feel well'' or they pain is getting worse, or you see a change in mental status. But when the pt's mental status is already altered how can you tell. Maybe her acting ''normal'' was an impending sign. Maybe although confused, her saying she was scared was her only way of indicating the events to come.
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    Pain or impending conditions are expressed by patients indifferent forms, others express them directly,some with different emotional reactions, panic, quietness or anything out of the normal routine. So make sure to check out everything and always be on alert with patients , specially those in special or critical conditions.
    Nurse MikeyBear likes this.
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    I had to beg for a cardiac cath. Terribly fatigued, no other symptoms. Surprise! Three blocked arteries - 2 stents later, feeling like a new person. Said to the doc later "Told you I was sick'.

    ALWAYS listen to the patient.


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