Hi all. I'm a new grad, and have been working on a medical oncology floor for about a month now. Our floor gets anyone who has a medical issue, as long as they were diagnosed with cancer at one point or another in their past.
Recently I was on a night shift. The hospital I'm at does obs at about 8pm, then policy is not to do any more until 6am. I have some reservations about this, because a lot of these people are not all that well, and I would like to know about any potential problems more than an hour before I am due to go home.
That said, I took obs on one guy. Old, about 78, hx lung cancer, admitted with SOB. O2 @ 2L via NPs. Obs at 8pm fine, no problems. He slept well all night, observed to be settled on all rounds, O2 in situ.
By 6am, his heart rate was 161 and his BP was 98/64. He had a low BP historically, but this was a little bit lower than usual. I knew he had a history of AF, and was on digoxin. He didn't feel dizzy, sick, hot, cold or anything unusual; in fact, he felt fine and wanted to stand up for a shower. I asked him not to stand up until I came back. Because I am new and still quite unsure about my judgement skills, I checked with my mentor. She basically said "If you think he's OK, then he is, it's not unusual for AF pts to have HRs that high". She' an awesome nurse, she knows EVERYTHING (or so it seems!). Fair enough, thought I.
I found out today that the oncoming shift decided to make a MET call (rapid response team/Medical Emergency Team) call on him. The team just gave him some MgSO4 and trundled off again, so he was fine.
But... and here's the point... do you think I should have called a MET myself? Our criteria say you can call a MET for a pulse >140. I didn't feel it was warranted. Did I miss a GIANT red flag? Could this guy have died if the next shift didn't make the call? I'm looking up stuff about AF now to see if I can find some info about appropriate management, but I want your opinions, too.
Thanks.