Today I had to transfer a patient back to the hospital and I'm not sure I did the right thing in advocating for the transfer...perhaps I still have new grad informationitis from studying so much to pass NCLEX. A brief HIPPA safe (I hope) background:
D arrived yesterday with a history of Afib, Heart valve replacement, and a Non STEMI MI during this latest hospitalization. In addition her Troponin levels were still critical and her PT/INR levels were no longer in therapeutic range. Early this morning the night nurse called the doctor because the patient was diaphoretic and her vitals were all elevated. In addition the patient c/o reflux and epigastric pain. The doctor ordered reflux medication which was given with a very small amount of relief.
I took over at 0630am. The patient continued to complain of epigastric pain increasing from a 5 at 0800 with morning meds (including Carafate) to a 10 at 1200pm after the second dose of Carafate which had not worked. Vitals were elevated (BP 137/87 when it is normally 100/60, HR 92-normally around 60, O2-93 on 2L NC-it was 97, and her MAP was 112). I called the doctor again because I felt those levels were serious and the patient showed distress. The doctor ordered the patient to be transported to the hospital for evaluation.
My questioning of my decision comes from the administrators wondering why I even called the doctor for what was in their minds "just reflux" because according to their paperwork the MI was in the distant past though when I admitted the patient last night the hospital said it was what she was being treated for and her Troponin was critically high.
Was I right to think because women often present with epigastric pain and "bad reflux" that evaluation was a safer option than assuming the patient was okay and it would go away with enough antacid?
Yeah, I just didn't get a chance to post since my week was hell. She came back after 6 days with a diagnosis of Epigastric pain-unknown cause. She still has severe reflux and spends her mornings almost vomiting from the amount that she is spitting up throughout the day but this time at least the reflux medications seem to be doing something.
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.
You did the right thing. Pt c/o chest pain and had acute changes to VS. If you hadn't sent the pt out and a bad outcome had occurred, the liability would be yours.
I knew a nurse fired for ignoring pts changes to VS and c/o chest pain. I don't know her rationale, she was a good experienced nurse.
As an LVN and CNA in SNF settings, there was a video the state of CA required us to watch about a nurse who ignored the pts c/o chest pain. The pt died and the state went after her for negligence.
As an ER nurse I can say you definitely did the right thing. We get patients from LTC that are sent for normal chronic complaints without ANY intervention prior to calling EMS...you saw a change, you did the interventions available to you so yes, you were completely appropriate. That sort of patient is a slam dunk EKG and troponin maybe even admission at some hospitals.
That's why there is admin and bed side nurses. I would take your judgment over them any day! You know your patient they know numbers. Always err in the side of caution. Good job!
Specializes in Cardiology, School Nursing, General.
Not a nurse, but CMA. But I think you made the right call if patient is still complaining of reflux that went from pain scale 5 to 10. Hopefully they come out all right. :3
AvaRose
191 Posts
Yeah, I just didn't get a chance to post since my week was hell. She came back after 6 days with a diagnosis of Epigastric pain-unknown cause. She still has severe reflux and spends her mornings almost vomiting from the amount that she is spitting up throughout the day but this time at least the reflux medications seem to be doing something.