Can there be labored resparations (not agonal) with a pulse??

[1CAnursepain]

I have a situation that I would like a professional opinion. There was an incident where a CNA (at a LTC) where I had just started registry work. There was a change of condition with one of the patients. She was unresponsive to verbal or painful stimuli. She was breathing (not agonal breaths) but labored breathing. She also had a pulse. I counted about 60 per minute. The parametics arrived, and applied the telemetry monitoring. They initiated CPR at that moment and asked why I had not started CPR. A blood pressure was attempted, but unsuccessful. My question is should I have started CPR?

The parametics arrived about 5 minutes after the event occurred.As a nurse for 17 years this was not my first emergency. As the only RN (as opposed to LVN's and CNA's) the patient was my responsibility. Please advice, as this is very troubling for me. The patient did pass.

[TheCommuter, BSN, RN]

I believe just about any LTC has an AED.

I worked in the LTC industry as a floor nurse for six years (2006 to 2012) in Texas, and not a single facility where I worked had an AED on the premises.

I realize it may be immensely difficult for some acute care nurses to envision the lack of resources in healthcare settings outside hospitals.

[CoffeeRTC, BSN, RN]

Sounds like in those 5 minutes the patient lost their pulse? So then yes..CPR was warranted. A lot can happen in 5 minutes! Breathing and pulse, no CPR. No breathing and pulse...rescue breathing. No pulse CPR.

Not all LTCs have AEDs...most do. Most are located on each unit, close to the nurses station. If it is a large facility, they normally have them one each unit, near the front lobby and or in the dinning hall or activity room. As soon as things start looking bad, I would grab it and a cart if you have it (ours has a suction machine, O2, ambu, back board ) and head down to the room. Don't wait until things worsen. Now....the tricky part is having some one use a phone to call 911 etc. The phones in our hallway only take calls in bound. To call out, you need to head up the the desk or yell for help.

[Here.I.Stand, BSN, RN]

Interesting...every school I've been to, and even many retail stores have AEDs. I know LTC facilities have few resources compared to hospitals, but no AED seems very odd.

[Been there,done that, ASN, RN]

I worked in the LTC industry as a floor nurse for six years (2006 to 2012) in Texas, and not a single facility where I worked had an AED on the premises.

I realize it may be immensely difficult for some acute care nurses to envision the lack of resources in healthcare settings outside hospitals.

I believe you Commuter, and I am shocked, Bet they have them in prisons .

[Susie2310]

What was the patient's medical history? Did the patient have a history of diabetes/hypoglycemia? The patient had a change of condition and became unresponsive, slightly diaphoretic, with a palpable pulse of 60, and labored breathing. Although breathing, the respirations were inadequate. The patient was experiencing inadequate perfusion. They continued to deteriorate, with an O2 sat of 82, and became pulseless. I am wondering if the patient could have been severely hypoglycemic during your initial assessment, and then continued to deteriorate. Did anyone check a blood sugar? This would have been appropriate with a sudden unexpected change in LOC and inadequate perfusion (inadequate respirations, diaphoresis). You (or another nurse) could have done this after you had checked the patient's vital signs.

I agree with the poster who suggested taking ACLS even if you are not required to have this certification. I believe this will be helpful in future situations like this.

[ComeTogether, LPN]

Just saying, LPNs are more than capable of administering CPR and determining if it should or shouldn't be given.

At my facility, the RNs aren't more or less in charge of patients unless they are part of their patient assignment, as a rule.

No, you shouldn't have started CPR while the patient was breathing and had a pulse, but clearly you missed the part where the pulse was absent and the patient stopped breathing, so I'm thinking someone should have been checking vitals more often between calling EMS and when they arrived.

[TheCommuter, BSN, RN]

I believe you Commuter, and I am shocked, Bet they have them in prisons .

Yep...all of the LTC facilities where I worked had no AEDs, yet WalMart and all of the local McDonald's locations had them...

It is one of those things that make you go, "Hmmm..."

[mrsboots87]

I have also not seen AEDs in the 2 LTCs I've worked at. The one I currently PRN at, is in the process of getting some and updating the code carts. And it's a 5 start facility. I think, though, that when over 90% of the residents are DNR, many facilities have a hard time justifying the cost of obtaining the equipment and then ensuring the staff are properly trained in use. Medical facilities outside of hospitals do not have the same requirements and not nearly he resources of acute care environments.

[mrsboots87]

Just saying, LPNs are more than capable of administering CPR and determining if it should or shouldn't be given.

At my facility, the RNs aren't more or less in charge of patients unless they are part of their patient assignment, as a rule.

I believe his has less to do with RN v. LPN skill in a code and more to do with facility policy. In my LTC, an RN and supervisor must be present for all COC. All but 2 of the supervisors are RNs so it's not usually an issue. When the LPNs are in as supervisor (both of which worked ER before LPNs were effectively kicked out of hospitals), the RNs from rehab or the floor come to any fall, code, AMS, whatever.

[SmilingBluEyes]

Thank you for responding SmilingBluEyes. Yes, this was covered in Nursing school. I am asking because I am questioning my actions minute by minute to find out if my actions could have been done sooner or differently in order to see if the outcome could have been better. I was looking for support and confirmation from my fellow nursing professionals.

I am sorry you felt I was not supportive. It just seemed from the title you did not know a basic concept. I was reading the title and some limited information in your first post and responded accordingly. As you further posted, more information was forthcoming. It seems to me, your LTC is not equipped very well to deal with a situation, like said before me, has occurred before and will again.

LTCs are infamous for being poorly staffed and equipped. I worked LTC so I know. I don't anymore, and this is but one reason why.

Anyhow I was not meaning to be unsupportive, but going by what you said in your initial post. Thanks for clarifying. Anyhow, like already said, you need to be ready for this will surely happen again.

[SmilingBluEyes]

But what about those who are full code or visitors and staff? Some of our residents where I used to work were quite young (40s and 50s for example) and were full code. So, NO AED for them? Seems criminal to me. They have them at airports and grocery stores, for Heaven's sake. I wonder if the CNO/CEO arrested, if they would feel differently about the importance of having an AED and staff trained to it more readily.

I have also not seen AEDs in the 2 LTCs I've worked at. The one I currently PRN at, is in the process of getting some and updating the code carts. And it's a 5 start facility. I think, though, that when over 90% of the residents are DNR, many facilities have a hard time justifying the cost of obtaining the equipment and then ensuring the staff are properly trained in use. Medical facilities outside of hospitals do not have the same requirements and not nearly he resources of acute care environments.

[ComeTogether, LPN]

I believe his has less to do with RN v. LPN skill in a code and more to do with facility policy. In my LTC, an RN and supervisor must be present for all COC. All but 2 of the supervisors are RNs so it's not usually an issue. When the LPNs are in as supervisor (both of which worked ER before LPNs were effectively kicked out of hospitals), the RNs from rehab or the floor come to any fall, code, AMS, whatever.

Ahhhhh,OK. My facility is totally different.

I understand now, sorry OP! Didn't mean to sound as snotty as I did.