Did I do the right thing?

NurseOnAMotorcycle, ASN, RN · Mar 3, 2012

Not "idiot". How many seizures have you come across? My guess is not many. Sounds like you had a cruddy night. Good on you for monitoring your diabetic. Good on you for staying with the other patient when all you had to go on was a "feeling" that something was wrong (especially because it's hard to stay when they are asking for privacy!).

Have some deep slow breaths and read up on types of seizures since not knowing what kind it was bugged you.

And hope for a better day tomorrow.

Aurora77 · Mar 3, 2012

Our badges that say RN have the criteria for calling a RR. One of them is "the nurse is concerned about the pt." That's it. The motto underneath is "if you're concerned, so are we." The heck with anyone who wants to nay say. It's easy to say you shouldn't have called after the fact when the pt is fine. You were in an unfamiliar situation with a pt who wasn't doing well. You made the right call, in my opinion.

Do-over, ASN, RN · Mar 3, 2012

When in doubt, call the RRT. If I had a patient flopout on me in the bathroom you better believe I am calling it.

wish_me_luck, BSN, RN · Mar 3, 2012

I don't think you did anything wrong. Rapid response is there to prevent any further deterioration of the patient. Actually, not long ago, RR was called when a pt had a seizure. There were other things going on like bleeding issues, but if you are unsure, you need to call. I mean, think about it, if you didn't call and something happened to him, then they would have said "why didn't you call?" and it would have been on you. It's a catch twenty two. Better safe than sorry.

Oh, and the seizure thing and not knowing, don't worry about it. I know when I was a tech, I got a pt to the bed side commode and they bled and started having changes in their respiration pattern and LOC changed. RR came and all I did when they asked was imitate the respiration pattern. I couldn't think of the pattern right off (and I am in nursing school!) I think it's the adrenaline rush and some degree panic.

DixieRedHead, ASN, RN · Mar 3, 2012

Think of it this way. Suppose you had needed the RRT and not called. Would that same nurse be backing you up saying, "Oh I didn't think we needed the RRT either."

Not!

Better to call.

As for the insulin, honey that's why God made D50 and glucagon.

FutureRN_NP · Mar 3, 2012

Let me tell you I have had one HELL of a night!!! I'm seriously contemplating not coming to work tomorrow. First off I had a pt that gets like 30 NPH at night, this AM his BG was 54. They made him NPO at 1800 and I gave 30 units of NPH tonight. Just as I finished pushing on the plunger it hit me. So I called the doc and have been checking BG frequently, pt has been ok. No need to rag on me I know that it was wrong and I need to think more, I made a mistake we are all human and it happens. Thank god the pt was ok. Then my other pt has some crazy electrolytes stuff going on Na 123 after two serial NA's, fluids (then no fluids, then fluid restrict etc )low dilantin ( gave 300 mg PO at 2100), high K etc etc. Pt has been a little confused since I came on. Needed to get up to use bathroom. A little unsteady on feet but moves with one assist. Goes to bathroom (something told me not to leave) pt was yelling at me to give them privacy and I just stood there. Got up from bathroom bobbed and weaved leaned against door jam and went non-responsive. I screamed for help and when the other nurse got there pt had a 3 second seizure. I yelled to call a rapid response. Got him in a wc and back to bed. By the time the calvery showed up pt was alert and oriented, does not remember the seizure but ok. So I have a nurse that is mad that I called the rapid response. She was the other one in the room and she told me it was unecessary to call. Oh and he has not had any seziure activity in ten years so it was not like I should not have got them up because of previous seizures. Am I wrong? Did I do the wrong thing? I have had two RRT calls this week and they were my first two EVER! I'm over it seriously.
Then I also feel stupid because they asked me what kind of seizure and the only thing I could think of saying at the time it that he was "shaking" IDIOT!!! Guess it is time to brush up on my types of seizures.
Thoughts?

I think you did the right. Don't beat yourself up for this. If I was the pt's family member I would really and greatly appreciate that you did follow that route not leaving my family in danger. It is better safe than sorry.

KelRN215, BSN, RN · Mar 3, 2012

I work in Neurology and I can say with some level of confidence that what you describe would result in a code blue or a RRT on just about every other floor at my institution. We don't call codes for seizures on my floor unless the patient has respiratory compromise and/or we can't stop the seizure... usually we've gone through 2 or 3 meds before we call a code or an ICU but a good 1/2 of our patients have seizures and we're comfortable with this. There's nothing wrong with calling for help if you're uncomfortable. Isn't it better to have more people there and have to send them away than to not have them there if the patient respiratory arrests? You didn't know when the seizure began how long or short it would be.

Just want to comment on this statement, too, though: "Oh and he has not had any seizure activity in ten years so it was not like I should not have got them up because of previous seizures."

Even patients who have active seizure disorders need to get up. Anyone with a seizure disorder (or actually anyone at all) can have a seizure at any given time and it's not necessary to prevent them from doing things like getting up to use the bathroom. If the patient had a low Dilantin level and hyponatremia, each one of those would increase his risk to have a seizure independently but, if the patient was ambulatory and needed to use the bathroom, I would still get them up to go and stay with them, just as you had done. Heck, we have patients with invasive monitoring grids surgically implanted and off their anti-epileptics and we still let them get up to the bathroom.

Peeker19 · Mar 4, 2012

I work in Neurology and I can say with some level of confidence that what you describe would result in a code blue or a RRT on just about every other floor at my institution. We don't call codes for seizures on my floor unless the patient has respiratory compromise and/or we can't stop the seizure... usually we've gone through 2 or 3 meds before we call a code or an ICU but a good 1/2 of our patients have seizures and we're comfortable with this. There's nothing wrong with calling for help if you're uncomfortable. Isn't it better to have more people there and have to send them away than to not have them there if the patient respiratory arrests? You didn't know when the seizure began how long or short it would be. Just want to comment on this statement, too, though: "Oh and he has not had any seizure activity in ten years so it was not like I should not have got them up because of previous seizures."Even patients who have active seizure disorders need to get up. Anyone with a seizure disorder (or actually anyone at all) can have a seizure at any given time and it's not necessary to prevent them from doing things like getting up to use the bathroom. If the patient had a low Dilantin level and hyponatremia, each one of those would increase his risk to have a seizure independently but, if the patient was ambulatory and needed to use the bathroom, I would still get them up to go and stay with them, just as you had done. Heck, we have patients with invasive monitoring grids surgically implanted and off their anti-epileptics and we still let them get up to the bathroom.

Thanks everyone for responding after some sleep I am feeling much better about itKelRN- The nurse that I was referring too said that because he was somewhat weak that I should not have gotten him to the bathroom and because he had a previous history of seizures and the dilatin and hyponatremia it was a bad call to get him up and walk him to the bathroom. I should have gotten him a BSC. So that is where that came from. But it would not have mattered whether he was in the bathroom or using the BSC, yes it would have been easier to get him back to bed but did I know he was going to have a seizure on me? NO or obviously I would have planned better. I am with you that they need to get up just like everyone else and use the bathroom whether they have a seizure disorder or not. I just wanted to clairfy that is where that comment came from.I am alot more clear headed today and feeling better so thanks again everyone for your input and support! I love this site! It makes me feel safe to ask questions that I do not feel safe bouncing off of fellow co-workers!