Boneheaded Nursing: A Cautionary Tale

UM Review RN, ASN, RN · Mar 2, 2005

Had a under-40 yo patient who had pain from pancreatitis and whose resps were 40+ all night long. Not asking for much pain control either, just about 25 Demerol q4h. Belly distended & tender in the UQs.

"He's like that," was what I got in report.

We called the doc in vain for hours to get this patient transferred to the unit. Finally around four hours later and after pleading, the doc allowed the patient to be transferred.

The young father of 3 died over the weekend.

gypsyatheart · Mar 2, 2005

What a situation! I hate walking onto messes not addressed by previous shifts! Sounds like both the previous shift and the doc dropped the ball on this one....I mean the doc just assessed him and missed his s/s also?! Wow. I hope he does OK. The patient, I mean. :chuckle

And thanks for the reminder...check and double check the report you get, as we all know, sometimes it is less than accurate. Maybe we need to start holding each other accountable, I mean, if you have a pt who is symptomatic or has something "abnormal" going on....shouldn't we be following up on that, not just handing it to the next shift....?

Interesting discussion anyway.

Here's how even experienced nurses can get into trouble:
Yesterday at the three PM shift change, I picked up four new patients and a student, all of whom were in need of something or another that the 7-3 nurse hadn't got to yet. During report, she mentioned that the patient in 221 had a heart rate in the 150s, but it had been that way ever since he was admitted the day before, he was asymptomatic, and that was "just the way he is, I guess".
My student had this particular patient, so after checking on him, I left her to do his assessment and went on to deal with the 48-year-old TKR patient whose pain level was still 7/10 despite BID doses of Oxycontin and a PCA pump, the lady with septic arthritis whose sister had about five bazillion questions, and the fellow who still couldn't void after having had his Foley pulled at 0600. It wasn't until about 6 PM that the MD who was looking in on the fellow with the rapid heart rate corralled me to ask why on earth everyone was charting it in the 150s when his actual apical pulse was in the 80s when HE listened to it........were they just using the machines, or did they actually listen to his AP?
Now, I hate few things worse than telling a doctor I don't know something, but I had to admit I had no idea what anyone else had done......all I knew was what I'd been told, and that wasn't much. He wasn't impressed one bit with my lame explanation (I wouldn't have been either), and he ordered telemetry and asked me to call him back when I'd verified a rhythm with the ICU.
So while the student was locating a tele unit, I went in and listened to the patient's heart myself, which of course was what I SHOULD have done in the first place after hearing the early-shift RN's report, and sure enough, he was taching along at over 150!! Then when we got the tele on, it took no time at all to learn that he was in SVT, with some atrial flutter thrown in just for fun..........AAAAAAAAGGGGGGGGGGHHHHHHHHH!! I called the MD back to report our discovery and to ask for a theopphylline level since the patient had been taking it for quite some time, and he agreed, but of course it was necessary to transfer the patient to the ICU because he was becoming symptomatic about this same time..........diaphoretic, nauseated, SOB, etc.
Well, as you can probably understand, I'm NOT happy with this outcome, and I share it with you as a cautionary tale to warn both new and 'used' nurses about being too complacent. Just because a nurse with about half a century more nursing experience than I have told me not to worry about the patient's fast heart rate, doesn't make it OK that I dropped the ball.........as did she, and the night shift nurse who admitted him. Hopefully he'll be OK, although his full-code status as an 89-year-old COPD/CHF'er brings up some concerns about how realistic he is about what we can do for him medically. The point is, never ASSUME anything ............you never know when it'll come back and bite you in the butt!! :uhoh21:

gypsyatheart · Mar 2, 2005

Wow! how sad is that, and could've been prevented probably....what is with these docs??? We had a close call last week w/one of our pre-termers, PPROM, barely missed delivering her 27 wkr in the bed in our hi risk ante partum unit cause the docs (read: residents :uhoh21: ) didn't believe that she was contracting, in pain, etc. They held off getting her into L&D all night until finally that am after 2 RN's and the Charge had to push it, she went over. She delivered minutes after getting there....babe is in NICU of course; however can you imagine her delivering alone, no newborn resus at the ready?? :uhoh3:

Had a under-40 yo patient who had pain from pancreatitis and whose resps were 40+ all night long. Not asking for much pain control either, just about 25 Demerol q4h. Belly distended & tender in the UQs.
"He's like that," was what I got in report.
We called the doc in vain for hours to get this patient transferred to the unit. Finally around four hours later and after pleading, the doc allowed the patient to be transferred.
The young father of 3 died over the weekend.

allnurses Guide · Mar 2, 2005

Had a under-40 yo patient who had pain from pancreatitis and whose resps were 40+ all night long. Not asking for much pain control either, just about 25 Demerol q4h. Belly distended & tender in the UQs.
"He's like that," was what I got in report.
We called the doc in vain for hours to get this patient transferred to the unit. Finally around four hours later and after pleading, the doc allowed the patient to be transferred.
The young father of 3 died over the weekend.

What was the actual cause of death?

steph

UM Review RN, ASN, RN · Mar 2, 2005

What was the actual cause of death?

Never got the details on that after the patient was transferred. I'd guess it was from some complication of the pancreatitis.

allnurses Guide · Mar 2, 2005

Never got the details on that after the patient was transferred. I'd guess it was from some complication of the pancreatitis.

The way the stories have been going, I thought maybe it was something someone missed.

Thanks - :)

steph

UM Review RN, ASN, RN · Mar 2, 2005

The way the stories have been going, I thought maybe it was something someone missed.

JMO, but someone with resps of 40+ should've been transferred to the ICU a lot faster than this patient was.

dustydog · Mar 2, 2005

Thank you mj, I appreciate and respect you posting your experience here so we can learn from it.

webblarsk · Mar 3, 2005

Thanks for sharing. Makes me more aware!

pediatriclpn · Mar 15, 2005

Worked a subacute unit of LTC, new hip replacement, been there 3 weeks, blood in urine x 3 days, incontinent. DON finally heard about pt condition, checked chart, no PT/INR done since 3 days in. Pt on heparin sc. (Not my patient, thank God)

Working agency LTC, come in Monday day shift, get report. LOL with flu s/s, started Abx, and cough syrup on Friday. LOL complaining of extreme lethargy, and dizziness since Sunday evening. Asked offgoing nurse about cough syrup, had never heard of it before, she did not look it up, did not know what it was. I immediately looked in med book, dosage ordered was 4x recommended dosage. Nurse who took phone order took it wrong, pharmacy filled it wrong (label even said wrong order). Called MD, he dc'd order. Came in that morning and tried to rip into me. I promptly handed him the chart, said I am the one that caught this, not the one who gave it. He apologized. Pharmacist in that am, he called his staff and gave them heck. ALWAYS check new meds!!!!!!!!

CardioTrans, BSN, RN · Mar 15, 2005

This may or may not go along with these lines, but also do not believe that all MI's will present in textbook fashion.

True story, 2 wks ago I went to see a pt ( I work home care), her daughters were telling me that about 15 min before I got there that "mom had a breathing spell". Pt said that she got short of breath and had a pain shoot through her chest that took her breath, but no numbness or tingling in arm or jaw.....I took her vitals.... all normal........ pt denied pain. While I was there, she had another "spell" I immediately took her vitals again, her BP had shot up to 160/110, her HR was 112. It lasted about 1-2 min. I was talking to her about other symptoms, all of which she denied. And none could be seen. She had a 2nd episode.... I got on the phone with the MD and told him that I thought she needed to be evaled in the ER because this was not "normal" for her. MD said "it doesnt sound like a heart attack" While I was on the phone she had another one. I politely told the doctor that I was sending her to the ER. Fast forward 6 hrs......... the lady had been taken to the local ER, had to have NTG on the way, was transported to a larger hospital. Underwent an ateriorgram the next day....... wound up in ICU.... and died this past Thursday from a massive MI.

Textbook is not always real life..........