Hi guys. Little background I am a novice nurse working in LTC. Been a medic since I was 21 and was also a pct since I was 18 so I am not "stupid" but sometimes I feel that way when I send PTs out to ER.
tonight I sent a pt with hx of HTN, and a-fib and a newly fractured femur to the ER. My reason, her HR was more thready and irregular than usual and her BP was 160/110. I didn't want her to have a stroke.. She's got the a-fib, fracture and high BP risking her for blood clots and stroke. So although her family was against it I sent her out. The ER nurse in report said, if she has a hist of a-fib then the irreg heart beat isn't so much of a concern. I said yes but I am more worried about her BP and risk for clots. She is on warfarin for the fib but still, better safe than sorry. Or am I wrong?
i send out people because I do not have the resources at my facility do treat people as an ER would but I only send them for really abnormal or major things..
im just trying to get oter people's input to see if I did the right thing or if I am being over-caughtous and dumping on the ER?
Wow! At first while reading all of the responses, I was going to agree that those symptoms alone should not have required a trip to the ED. Your instinct to worry was on target though! Even though the symptoms you sent her out for are not concerning to me, you obviously had an inkling something was off and the patient was lucky to get sent out so quickly.
That patient should not have been sent to the ED, and that that BP was not emergent enough to do anything except have dayshift call the doctor during business hours for an adjustment in po medications - especially if the patient was already anti-coagulated. Good for you for not ignoring issues like so many do in LTC care, but your decision making process wasn't the best in this case.
Specializes in Infusion Nursing, Home Health Infusion.
I think what happened here is that you knew the patient and you knew something was wrong but of course without more tools and information you could tell what was going on.Her diastolic was high...was not responding to 2 doses of antihypertensives and did not seem to be caused by pain. Had you waited she probably would have begun to have more symptoms. Women with Acute Coronary syndromes present differently than men and I think she was just starting to have very subtle symptoms
There won't always be an RN in the building 24 hours a day when you are in long term care. It is only required for 8 hours of the day in my area. Either way, whether she is an RN or LVN, she is a new nurse and I would be scared to death when I was a new nurse being alone in the building.
If the pt is not always in afib, which I suspect due to the Coumadin, then her elevated troponin could be contributed to her going into afib, not necessarily an NSTEMI- any irritation/stress of the heart muscle can cause an increase in troponin. I would be interested in her actual result. They may not even do anything for her but adjust her medications- perhaps a cath, but I suspect they won't due to her history.
I've seen people with comorbidities admitted for less than that. I probably would not have thought much of it as an er nurse, but that doesn't mean they won't admit to monitor. Obs/ medsurge monitoring has resources and staff so far beyond what a ltc can have.
I've had so many dump jobs from ltc places. They don't sound anything like the op. They go like this: unresponsive, dka, major urosepsis, huge decube's that seem to be in weeks old dressings.
Btw unresponsive could be hypoglycemia, oversedation, sepsis, dead (yup).
Sounds like a nurse sent someone to the Ed cause something wasn't right. Turns out this time it was a big deal, and shouldn't have waited until the am.
Good for you OP! You'll raise that flag a lot and it will be nothing. Enjoy the time it mattered and keep trusting your gut!
nutella, MSN, RN
1 Article; 1,509 Posts
I am wondering how come that there is no RN in the building - just you and CNA?