Can't stop thinking about it.

Specialties Geriatric

Published

Specializes in Alzheimer/Dementia.

Yesterday was my 5th day of orientation. I did everything on my own except 2 insulin checks my first med pass, and my second med pass I did everything except give 5 residents their medications (the nurse who was orienting me did it because I was running behind on time)... so I nearly did everything on my own. I got out 2 hours late... so not too bad.

What I can't stop thinking about is this Res who was my Res and ended up in the hospital. I checked her BS and BP (both were WNL) and gave her 745pm meds which included a BP pill... at 930pm I gave her a Tylenol PM she requested and her scheduled lantus. She was fine at 930pm, I said goodnight and moved on. Around 1030p her BP was 100/70 in her R arm and like 80/40 in her L arm and her BS was 80. They sent her out to the hospital (they as in the charge nurse, on my hall there are two floor nurses passing meds, and a charge nurse doing admits/dr phone calls).

I just keep thinking about her and I know I didn't do anything wrong. But I feel like I must have for that to of happened... :confused:

She ended up being just fine, the charge nurse told me to make sure she is eating her bed time snack, and she was brought back a few hours later... but yeah, I just keep thinking about all of that and can't figure out what went wrong or if I somehow did something wrong...

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Specializes in Critical Care, Nsg QA.

I don't think you have done anything wrong. Bad things sometimes happens. As the nurse you are responsible to vigilant for signs and symptoms of potential problems. Rather than worrying, pat yourself on the back because a potential bad outcome was avoided. You did your job!

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Why did they send her out? What else was going on beside the low bp?

You took her bp and blood sugar before the meds? Sounds like she needs a med adjustment with the bp meds.

Doesn't look like you did anything wrong. It is good to always make sure your diabetics are getting their pm snacks. Was she getting enough fluids?

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Specializes in Alzheimer/Dementia.
Why did they send her out? What else was going on beside the low bp?

You took her bp and blood sugar before the meds? Sounds like she needs a med adjustment with the bp meds.

Doesn't look like you did anything wrong. It is good to always make sure your diabetics are getting their pm snacks. Was she getting enough fluids?

Well she was hard to wake up which is what worried the NA and made her get the charge nurse... but that was because of the Tylenol PM... Nothing else was going on.. And yes I did take her BP and BS before giving her meds..

She drank 2 full cups of water (700ishcc's total) both times I came in, and had fluids with her meal... so she was well hydrated my entire shift... the shift before didn't say anything about her not drinking or anything, so she was getting enough fluids. But yeah- she is suppose to get a snack at bed time.. .and I will be sure to watch her start eating before administering her lantus and make sure she knows how important it is to finish her snack, and follow up later to make sure she did.

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Specializes in chemical dependency detox/psych.

Sounds like b/p meds need adjusting. Any idea if after sitting up for a bit if her b/p came up? Don't kick yourself over this--sounds like you did everything right.

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Specializes in Med/Surg, Tele, Dialysis, Hospice.

ITA with the others, you didn't do anything wrong! A BS of 80 is low, but it isn't critical, as long as she got something like OJ right away, and the others are right, maybe the doctor is to blame for ordering too large of a dose of BP med. I have worked with the elderly for years, and one thing I can tell you for certain is that an elderly person's health status can turn on a dime sometimes and no one can anticipate it. It's just part of living in a body that is wearing out.

Don't be hard on yourself. We nurses tend to beat ourselves up too much, I know I do. You sound like a good, conscientious nurse, and the fact that you didn't complain about having to stay over two hours says a lot about your commitment to your patients. Best of luck to you! :)

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Specializes in Pediatrics, PICU, tele.

Honestly, it sounds like she may have been rushed to the hospital for no reason. An asymptomatic BP of 100/70 (or 80/40, for that matter) isn't an emergency, especially if the person is sleeping heavily (which elderly people will do after a Tylenol PM.) A BS of 80 is perfectly normal and doesn't need to be treated. Depending on why she actually takes the BP meds, she might need them adjusted...but if she's taking them for CHF instead of HTN, she may not even need that. As long as someone has signs of good cardiac output, a low BP isn't usually something to worry about. On my cardiology floor we give Lopressor and Lasix with BPs of 100/70 all the time, provided there is no contraindication (like s/s of low cardiac output.) If she was REALLY hard to wake up, it may be time to lay off the Tylenol PM. But BP and BS wise, she sounds like she was fine.

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Specializes in Alzheimer/Dementia.
Honestly, it sounds like she may have been rushed to the hospital for no reason. An asymptomatic BP of 100/70 (or 80/40, for that matter) isn't an emergency, especially if the person is sleeping heavily (which elderly people will do after a Tylenol PM.) A BS of 80 is perfectly normal and doesn't need to be treated. Depending on why she actually takes the BP meds, she might need them adjusted...but if she's taking them for CHF instead of HTN, she may not even need that. As long as someone has signs of good cardiac output, a low BP isn't usually something to worry about. On my cardiology floor we give Lopressor and Lasix with BPs of 100/70 all the time, provided there is no contraindication (like s/s of low cardiac output.) If she was REALLY hard to wake up, it may be time to lay off the Tylenol PM. But BP and BS wise, she sounds like she was fine.

Yeah.. I think what had everyone freaked out was that she wasn't responding to the NA or charge nurse. Then the charge nurse came to me and I told him I had given her a Tylenol PM just an hour ago.. but he still called the Dr. and had her sent out... so yeah. But she has trouble sleeping and always wants her Tylenol PM at 9p.

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Maybe I'm missing something, but isn't it a little unusual to only have a low BP in just one arm? Shouldn't your BP be pretty close to the same in both?

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Specializes in LTC, Memory loss, PDN.

One of my favorite quotes. " a good nurse knows when to send the patient to the hospital - a great one knows when not to "

Without history (what's pt.'s usual B/P on present regimen), I cannot say if B/P was an issue, but if the pt. is a walkie I'd probably do a tilt for fall risk assessment.

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Specializes in OB, Peds, Med Surg and Geriatric Nsg.

Things happen that are beyond control. I had a patient before that was fine for my shift till during the shift change. When the afternoon nurse came to her room and checked her FSBS. Until this patient told her that she's not feeling well and that her left arm is flaccid. Next thing I know she came running back the station, calling MD and spoke with the clinical director with the door closed looking at me. That resident had a stroke. Then the clinical director came out and talked to me asking if I noticed wrong with the resident. Told her she complained nothing when I gave her morning pills and when she came back from lunch. But hey, it was beyond my control. Let it go. You assessed the resident to the best of your ability.

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