Im a nursing student and i have to write a paper regarding a nurses professional values, the ANA code of ethics, the NPA and how all these things relate to this case study.
in order to help me write it, i was hoping to get a few profession opinions on what the RN should have done in the following situation (specifically, did the patient belong on the unit in the first place? or at what point should she have been moved).
68yo woman admitted to intermediate care unit with SOB for one day. history of COPD, CHF, and diabetes. she was alert and oriented but couldn't complete a full sentence due to lack of breath, her resp was 10 and shallow, diminished breath sounds in all lobes. her pulse ox was 84% on 2 liters ox, BP 135/90, pulse 110, 3+ edema both legs.
the next thing it says is that the nurse called the admitting dr because she was concerned, he said "thats why i admitted her, increase to 4 liters and ill be there later"
a half hour later her resp was 8, cyanosis of the lips, and couldn't be aroused. The RN called a code and the patient was resuscitated to her baseline admission.
the RN requested the dr transfer the pt to the ICU but he left her on the unit. the nurse expressed concern to the charge nurse who said "we have to do what the doctor says so just watch her close".
when the nurse came back the following day, the night nurse gave report that everything was fine and gave no other details. after report, the nurse found the patient confused, cyanotic, resp of 8, pulse ox 79% on 4 liters. the night nurse said the patient was fine at 0600 meds and that she told the PCA to monitor the patient and report any problems. the rapid response team came, intubated the patient, and sent her to the ICU with respiratory failure.
so thats it, that pretty much sums up the whole case study. so was it wrong for the nurse to call the dr the first time? or ask that the patient be transferred after the patient coded? is there something the nurse, or charge nurse should have done? (NOTE - this is simply information ill use as a starting point for my paper, I'm not asking anyone to do my homework for me. but you can if you want to haha)
anyway, i hope someone answers this. THANKS!
Pt needs lasix for CHF and is probably receiving too much oxygen (CO2 retainer?) which is decreasing drive to breath resulting in low resp. rate and low o2 sats. The charge nurse should have encouraged the nurse to advocate for the patient....not just do as the Dr. said....trust your instincts and don't worry about "bugging" the Dr.....
Last edit by lovemaine on Dec 3, '10
: Reason: more info