Did I do the right thing?

CT Pixie, BSN, RN · Sep 7, 2015

You did the right thing. You assessed your patient, informed the doc of your findings, and was told to send the pt to the ED. Thankfully, for the patient it was nothing. But had it been something and you didn't do what you did, the results would have been much different. Don't waste one more second questioning your actions..you did right! :)

Just as a side note, I did have a patient very similar to yours..known hx of anxiety attacks who was sent several times to the ED for chest pain, SOB and abnormal vitals. Always nothing and never any new orders for anti-anxiety meds or anything from the pts doc. This one evening same thing happens, chest pain, SOB, vitals off. He was acting no differently than the previous times when he was dx with anxiety attack at the ED. So as with any change in status, I called the pts doc. He told me 'its just another anxiety attack'. I asked if he wanted to order any anti-anxiety meds for him and the answer was 'if i wanted that I would have said it' and hung up. I just didn't feel right keeping him there. I called 911 (per protocol) and shipped him out. Got a call from the ED, they were admitting him...he was having an MI.

If your gut is telling you something is wrong..go with your gut.

djh123 · Sep 7, 2015

I think you did the right thing. I've had TWO situations like that in the past year or so. Both were chronically-something-is-always-wrong types of residents, but as you allude to, you can't always think 'oh, Ms. so-and-so just always does that', because what if it's an actual emergency? It's kind of like the 'boy who cried wolf' story, but all we can do is take their VS, assess as best as we can given their history, Dx, and the way they're currently acting, and call the dr. if we think it's necessary. None of us want to send people to the hospital unnecessarily, but at the same time, I'd rather do that than not send them when they really need to go.

Horseshoe, BSN, RN · Sep 7, 2015

Yeah, I think you should have rolled your eyes. It would be the right thing to do every time with this patient.

Until she actually does have an MI, and the record shows that you did nothing for this woman but roll your eyes and throw a xanax her way. Enjoy the lawsuit in that situation.

Sarcasm aside, you DID do the right thing!

Been there,done that, ASN, RN · Sep 7, 2015

You absolutely did the right thing. Chest pain needs to be evaluated each and every time. You have identified that it may be anxiety related.

Please ignore the eye rolls. Call a patient care conference.. as to how to handle this resident's repeated complaints of chest pain. Your director, the resident's physician and the nursing staff, need to develop a plan to address this issue.

Agree it is most likely anxiety related, and the resident would benefit from an anti-anxiety agent.

That requires evaluation from her primary provider. THEY are letting this go on.

Throw the ball .. into the right court.

lunchboxRN · Sep 7, 2015

I like to live by the question, "what would a prudent nurse do?". I have had situations where family got mad at me after the pt was sent to ED for "nothing" and pts that reluctantly go and then die in the hospital. While I don't care to get reamed out by families, I would rather work to protect my patient (and myself) and be wrong, than do nothing and be right.

Edit:

Even the time with the CHFer w/ the massive generalized edema, struggling to breath with 02 sat in the low 80s, and blue oral mucosa. Neither pt nor wife knew if he was hospice (I had a inkling he was), but couldn't find any hospice docs or reach other family. Called 911, sent to hospital. Next day Hospice and family were annoyed at me, too bad!! I worked with the info I had and stand by my call.

Riawahine, BSN, MSN · Sep 7, 2015

It's not about all the times it turns out to be nothing, it's about that one time it is something.

I totally agree. You did the right thing.

Kooky Korky, BSN, RN · Sep 7, 2015

You did exactly the right thing. The heck with those who put you down. It wasn't their license on the line.

Kooky Korky, BSN, RN · Sep 7, 2015

You absolutely did the right thing. Chest pain needs to be evaluated each and every time. You have identified that it may be anxiety related.
Please ignore the eye rolls. Call a patient care conference.. as to how to handle this resident's repeated complaints of chest pain. Your director, the resident's physician and the nursing staff, need to develop a plan to address this issue.
Agree it is most likely anxiety related, and the resident would benefit from an anti-anxiety agent.
That requires evaluation from her primary provider. THEY are letting this go on.
Throw the ball .. into the right court.

I fully agree. The Doc, the team need to develop an approach that will keep the resident safe and keep you out of their sight.

I have worked in facilities that expect you to know whether there is a fracture or displacement without

x rays, infection without testing, etc. They get mad at you for not having x ray eyes or being a mind reader, etc. Fooey on them. My license comes first, right up there with pt well-being. Just keep on keepin' on, friend. Imagine what would happen if you guessed wrong. NOtice the doc covered his tushie.

HDHRN · Sep 8, 2015

You did the right thing! I worked in AL for almost 4 years and had a sweet little lady who I took care of. She was not herself one night and when I assessed her she was very SOB. He o2 Sats were in the low 80s. She didn't want to go, but I sent her because I knew if I didn't something was going to happen and I was not about to put my license on the line. I didn't even call her doc until after I sent her. He was our facility's medical director and knew these pts well and always trusted our judgement. He told me he would've wanted her to go to the ER anyway. Well turns out she had pancretitis. I believe she wound up passing away. I was so upset it ended that way, but I would've been in deeper doo doo if I had not. Please don't beat yourself up over it.

Angelicpurl · Sep 8, 2015

I worked where doctor suggested to patient they should take their NTG and quit crying wold when their chest hurt. Coroner case 3 days later....neighbor found them dead (quite grossly so because of heat).

rheath22 · Sep 8, 2015

I also work in ALF. One time the nurse thought the resident was having a anxiety attack, he was really having a heart attack. Always send.

vintagemother, BSN, CNA, LVN, RN · Sep 8, 2015

As a more experience nurse told me, "when in doubt, send them out."

Plus, it may help to look at it this way, as a nurse, you reported the PTS s/sx to the md. That's our job, to document and report. Then the md gave an order to send her out. (That's how it worked in my facility) Your eye rolling boss can take it up with the MD.