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:
