I feel so dumb... I got flustered - about a patient in respiratory distress

Specialties Emergency

Published

I can't believe I'm posting about this considering I've been an ER nurse for 4 months now... but i got really scared last week and I need advice.

Last week I was coming on shift and getting report about a patient who has a hx of pneumonia x2 weeks ago. She came to the ED that day with difficulty breathing. Her room air sats were at like 88%, she was put on 2L via NC and her sats went to 92%. If she did any sort of activity her sats would go to like 82-85%. She was then put on 4L NC. Her sats rose to 94-95% if she was still and the head of the bed was at like 90 degrees.

Anyway, her chest xray showed a mild pneumonia developing in her left lung, her hemoglobin and hematocrit were in the toilet and she needed blood and in a bad way. SHe had an IV, but it was a 22g in her AC and it wouldn't draw worth dirt. We needed to type and cross her, but she was a tough stick and the previous nurse couldn't even to a blood draw. She had 2 doses of abx and 2 neb treatments at this time but her breathing sucked. Finally I got type/cross and blood was ordered.

The reason I am writing this is to figure out what I could do for her breathing. I know that giving her blood would help her tremendously, but in the mean time, what do I do. She was getting all worked up and anxious because she couldn't catch her breath and I was silently freaking out! I'm sure she was getting septic because she met at least 2 of the SIRS criteria. I was getting SO scared that she was going to quit breathing and then I would panic and forget everything I've ever learned about nursing.

My question is: If a patient is in respiratory distress, what do I do especially if the MD is nowhere to be found and my RN co-workers are busy with their patients? I'm new and I don't want people to die on my watch.

Thankfully for this patient, she got an ICU room before her breathing got too bad. She was also perfusing fine and her O2 sats were reasonable if she wasn't doing anything. I'm just scared for when I get a patient who is in respiratory failure and I have nobody to turn to. PLEASE HELP ME!!

There is definitely no need to panic, remember when your patients see you acting anxious, or nervous it makes the situation worst for them. If a patient's sats is dropping below normal levels, breathing pattern is irregular, poor cap refill, irritable, skin color changing and barely relieved with O2 2L get the MD or anyone who can provide further help. In the emergency room is where you try to save a life, point is what could be more important than a patient who's stats are declinig so if the situation arises again do your part as the nurse then get help immediately.

We learn everyday so find something positive out of the situation and dont feel bad!

There is definitely no need to panic, remember when your patients see you acting anxious, or nervous it makes the situation worst for them. If a patient's sats is dropping below normal levels, breathing pattern is irregular, poor cap refill, irritable, skin color changing and barely relieved with O2 2L get the MD or anyone who can provide further help. In the emergency room is where you try to save a life, point is what could be more important than a patient who's stats are declinig so if the situation arises again do your part as the nurse then get help immediately.We learn everyday so find something positive out of the situation and dont feel bad!
Absolutely. This is why you must present your assessment data to the doc, np,pa... If you go to them w/ one or a few pieces of information, it doesn't mean as much as when you cluster data and present the picture w/ the relevant information.

Just look at all the nurses that have responded to your post. If we all see the picture as you presented it, and we all mostly feel like this pt needs an abg, etc, what makes you think the doc, np, or pa won't as well?

Nursing is about knowing your stuff and advocating for pts and families. You can do it. Go get em!

Specializes in Emergency Dept. Trauma. Pediatrics.

In this situation my first call would have been to RT and second call to my charge while I stayed with my patient. I am a huge fan of utilizing our ancillary staff and it took me a while but I became a big fan of utilizing the charge. In fact, I would have had my rear end handed to me in this same situation had I not called the charge. I walked into a patients room once and she started tanking right in front of me. I started doing what I could, (she was septic and was going hypotensive) I got her trendelburg and was hanging fluids while calling my charge and right away they were in there (it was shift change so she was giving report to the new charge) and we grabbed a tech and they got the doc and we got another line in there and more fluids and I had the help and support to make me feel like I was not alone. Afterwards the Doc came to me and gave me a hug and thanked me for being on top of the patient and saving her life by realizing what was going on and being on top of it, especially during a busy shift change. Since then I have never hesitated to ask for help if I felt out of my league.

Specializes in ED.
You page the MD and get your co-workers to help you. I don't care what they are doing. If someone is circling the drain, you go grab someone. If they feel inconvenienced, too bad.

-----

In your situation, I would've called RT to assess (and draw an ABG if not already done) and worked on getting a large bore IV in her while you had another nurse find the MD to come assess.

Communication is key! Tell your charge nurse if your coworkers aren't available. The CN can eval the situation and make that pt a priority so that another nurse can come help you. Plus most ED CNs are experienced enough to 1) Know what to do, and, 2) Not freak out.

But I wholeheartedly agree. Get RT in there right away. If the pt really is circling the drain, if you can't reach anyone, another RN, CN, RT, doctor, push 'the button', whatever you have for an emergency notification. That will not be ignored. Better to have to explain why later than to have the pt go south.

MOST important: Relax. Over time such things will be like a day at the fair for you. Give it about a year in the ED. That's what I was told by coworkers when I started, and darn if they weren't right.

DC :-)

Specializes in ED.

Additional thought inspired by what someone wrote above. Yes, nursing is about knowing your stuff. That comes with time. But IMHO even more important about nursing is knowing what you *don't* know. Then call for help. MAKE someone help. Doing so takes guts, so work on that aspect of your working day.

DC :-)

Call respiratory for a stat albuterol then while the RRT is assessing the patient for a pneumothorax explain to the M.D. how you saved the patients life thanks to your impeccable assesment skills.

Specializes in Critical Care.
Call respiratory for a stat albuterol then while the RRT is assessing the patient for a pneumothorax explain to the M.D. how you saved the patients life thanks to your impeccable assesment skills.

Are you replying to the OP or a different post in the thread?

+ Add a Comment