CKD, Liver Disease, & heading for ICU

[OncNewbie]

I HAD A HORRIBLE NIGHT... When you can count the years of nsg experience of your current night staff on one hand, we're in for a rough one if something goes wrong! I get onto my shfit & my patient is somewhat somnolent after 4 mg Dilaudid, serum ammonia of 93, liver & renal disease. Lactulose q 2 hours, ok. Lungs starting to sound very junky, I think I'll call the hospitalist & let the charge nurse know I don't have a good feeling. 40 mg Lasix IM, 2 liters of oxygen, HOB up 30 degrees, no void; no void in over eight hours, bladder scanned for 524ccs... Lungs get junkier, oxygen up to 4 liters; hospitalist livid because he has to come down & see the patient, why didn't I ask him to see the patient sooner... Treatment: IV, IV lasix 40 mg, insert foley, stat ABGs, & ship him to the ICU. Wife of patient comes up to the unit & tells me she wishes I was a better advocate for her husband, I cry.

I hate being a new grad. Why didn't I have the balls to tell this prick doctor, (who should already know by what I've told him that he should see the patient) "PLEEASSSEE come down to see my patient, I think he's getting worse..." until **** hits the bucket.

The patient is stable, he's being treated as we speak in the ICU somewhere in America... But I feel like I should have stuck up to this prick of a doctor & said he's going bad, something needs to be done, instead of waiting for **** to hit the fan. Also, I went to my charge nurse who wasn't very helpful; she was basically indifferent, I don't think she knew what to do & the hospitalist didn't want to stop surfing the internet... What's wrong w/ this picture.:angryfire

[ERNurse752, RN]

It sounds like you did everything you could.

And it sounds like your charge nurse should have been a better advocate for YOU, especially as a new grad.

Don't beat yourself up.

You recognized the problem and you acted on it - that's awesome.

You can't force other people to do their jobs. :trout:

[EmmaG, RN]

Does your hospital have a rapid response team? If so, consider calling them in the next time you find yourself in a situation like this. You can also call in the supervisor if your charge nurse isn't giving you the support you need.

[withasmilelpn]

You were terrific! Hospitalist was looking to shift guilt and blame on you. You reported the facts to him, it is his job to interpret what needs to be done, not yours. Wife also is just scared and taking it out on you. Not fair but that is frequently the case.

[Virgo_RN, BSN, RN]

I've been in almost that exact same situation as a brand new LPN. I've been assigned to patients that are beyond my educational level and outside my scope of practice, and have received little support from my CN and criticism from the doc. It's not fair.

[martymoose, BSN, RN]

you did quite well- give yourself some credit- at least you were aware and anticipating where things were headed. and one must not forget- this patient is very veryy sick already. and as the family member's comment- i'll bet the doc said to her he should have been called sooner. which we all know you tried to do. when this happens ( hopefully it doesnt happen again, but , you know) make sure you document document document- chart that you called doc, etc, timeframes. too bad your charge was no help, as prev poster said, call the supervisor then, or call in a rapid response personel. Hang in there- this part of the job stinks, but you will get stronger over time. Good Job!