V-Tach or NOT?
So do you treat the monitor or the patient first? I have to say this patient taught me a lesson by using humor. Do you run all night and fight the monitor or do you assess your patient first? In this one experience with my new admit I learned a valuable lesson with humor infused.
Working nights can be very interesting and challenging at times. It can also be very exciting and fast paced. I was working one night from 7p to 7a. My co-worker and I had our night planned, report taken, all patients were stable and our shift was set for a nice quiet evenng. Or so we thought.
It was a small bed unit, only 6 beds but high acuity patients since it was a bone marrow transplant unit. Our census was four patients with one being a newly admitted patient from the day shift. We also had two out-patient infusion rooms that were currently empty, and no one scheduled to come in this shift. We both performed our rounds on our two patients. I had a rather stable patient and the new admit.
My main goal for the evening was to begin the chemo on the new admit and do all the patient teaching. So I was going to be with this patient for awhile. My co-worker understood this and we made a plan how to meet the needs of the other patients.
I begin my teaching and answering all the new admits questions. He had plenty which they all do. Explained the chemo he was going to receive would require him placed on a Cardiac Monitor. So I placed the leads on his chest, pre-medicated him, and began the chemo. I stayed for a few minutes to make sure everything was running properly and then went out to the nurses station to chart. My co-worker and I were chatting about the new admit and how nice he was, when the cardiac monitor alarmed "V-TACH!!" We looked at each other and ran to his room. He was sitting up in bed watching TV and after a vital sign check it was determined he was stable.
We went back to the nurses station and before we could sit down again, "V-TACH??" Again, patient was stable. When this happened a third time I had my suspicions. I didn't charge down the hall to his room but quietly entered his room and immediately noticed exactly what I had suspected was happening.
He was tapping one of his leads on his chest causing the arrhythmia. He saw that I had caught him and immediately looked like he had been caught with his hand in the cookie jar. I tried hard to maintain a straight face but it was too difficult. We both started laughing and from that point forward it was practical joke city between myself, my co-worker and the new admit. He would not play jokes on day shift. Only on night shift he felt comfortable enough.
He taught me that I should not take life too seriously in light of the situation you are in at the time. He taught me that there is always a light at the end of the dark tunnel and to enjoy what time you have. The big lesson was to "Check the patient NOT the machine!!"Last edit by Joe V on Jun 3, '12
I was a Bone Marrow Transplant nurse for over 8 years. I presently am in school for my MSN. I currently teach nursing to students in a Vocational Nursing Program. I love NURSING!! Can't imagine doing anything else.
Joined: Jun '12; Posts: 6; Likes: 15Jun 3, '12::snerk:: Nice.
Had a patient (Cardiology NP), who (whom? Paging Fairy to the Courtesy Desk, please) was also one of my instructors in , decide to do something quite similar to me while I was the one providing her care. We had developed quite a camaraderie and understanding during that time and enjoyed playing practical jokes on one another so it was no surprise to me when she started futzing with her leads. The only catch was she had drilled the whole "check the patient, not the machine" bit into me to such a point that when her monitor would start to honk, I would buzz over the little speaker, "Ma'am, you're killing me. There are others that need their green jello--kindly desist your arrhythmia." I could hear her laughing to herself clean down the hallway.
Heaven help me but I miss that crazy woman.Jun 3, '12Its always important to check pt first. I have seen asystole and vtach several times because of problems with leads.Jun 3, '12Working in pediatrics, we'd more or less ASSUME it was a lead problem and not an actual cardiac problem. I've seen many asystolic 3 year olds doing cart-wheels in their beds or riding tricycles around the room.Jun 3, '12Years ago I was working IMCU....an ICU step down. We had a sick call so an ICU nurse was floated to the floor. The ICU nurse was in the nurses station when the monitor alarmed and I heard the ICU scream V Tach room XYZ....we then heard "Code Blue Room XZY, Code Blue room XYZ" I thought.... code blue I just left the guy.
I stopped what I was doing and ran down the hallway and as well as we all arrived, en masse, with all 30 people in a day turn code blue bombarding the room....we ripped open the door to find the patient with his toothbrush in his mouth....his mouth full of more toothpaste than I had ever seen and his telemetry leads draped over his arm.
With a stunned look and foaming at the mouth he asked through the toothpaste...."What's the matter?"
The monitor stip? The prettiest sustained V.Tach I had ever seen. I am a firm believer.....take your own pulse first, then check your patient second....react third.
She hasn't lived it down to this very day.....Jun 3, '12I'm thinking a good 300j defib would help point out to this patient how much fun his little joke was. Not an option, too bad. You took it in better grace than I would have. It would be fun to point out to the patient that another patient had thier IV infiltrate while you were enjoying his little joke and now was going to loose his arm- a shame you were so busy with his v-tach....Jun 4, '12Had a patient (Cardiology NP), who (whom? Paging Grammar Fairy to the Courtesy Desk, please)
Do not fear! The Grammar Fairy is here! You were right with "who". Thought I'd weigh in on your reply because as an unemployed new grad, I don't have any expertise in nursing to add to the original post.Jun 6, '12Thank you. I love it. I also am a firm believer in living your life with lots of laughter. We never ever know how much time we have left to put a smile on someone else's face, so why not give it a go.Jun 6, '12Quote from grnteayep- been there, seen that (med-surg here), also tach d/t scratching an itch, or laughing. (i owe a couple of my gray hairs to just that phenomenon). you still have to check the patient instead of the monitor but w. a pt who's not really high risk and has been stable and asymptomatic i've been known to call in on my way down and ask "feeling alright in there? are you by any chance brushing your teeth or scratching yourself?"toothbrushing tach is a major differential diagnosis in most ccus. :dJun 7, '12It was an interesting stories what I have read in here.I could learnt things from your experiences.If any in my future journey, i might also have one like yours, at least i will be reminded of it...
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