Feel like a horrible nurse!

[Verygreennurse]

Last nights shift made me feel like i never even even to nursing school!

I have a pt with esrd and heading for dialysis at 0800. He has many serious problems but this is what i am focusing on. His bp rises around 0445 to 166/89. I next check it around 0545 and its 168/98. I get hung up on a note in the system saying notify physician is systolic is >200 or diastolic is > 100. I decided to call at this point figuring it was close enough and im becoming really nervous about it. I bring up the nephrologist note again and realize is says diastolic > 115! I started talking it over with another nurse and we are pulled away. By this time its around 0720 and the np is 170/101. The attending is there; i showed him the note that i saw and that the pt was going to dialysis and i was concerned with bottoming him out. He said i should have called when his diastolic was >90. He put in prn meds and added another bp med. He was really nice, took time to talk to me about it

The note was by the nephrologist. Not the attending.

I still feel crappy. 1) should have went with my gut i thought the note was ridiculous. I was suppose wait till he was in crisis mode to call?! 2) i should have talked to my coworkers about it more to make a better decision about that note 3) should have went to my charge 4) i know better!!!

Its my 6th shift after orientation which was 6 weeks. My first nursing job! I work on a tele/stroke unit.and i love it! Just feel so inadequate. Feel like i miss a lot. I knew i would feel this way just starting out and some days are just harder than others. I feel like i am getting more organized and finding my groove, then this happens amd i feel lile a horrible nurse. Ill of course harp on the mistske from last night and forget about all the good i did.

Nursing is hard.

[AgentBeast, BSN, RN]

High blood pressure is generally only a problem when it is chronically elevated, or in the setting of some other pathology ie Aortic Aneurysm or ICH. They like a slightly higher BP in ESRD patients to better perfuse what little functional kidney is left, again given no other underlying pathology.

[RNikkiF]

Sounds like you did find. Your preceptor is right. Trust your gut. Even if call parameters aren't met, if you feel something off, call.

[OncoRN84]

That first year will make or break you but your judgement sounds reasonable. I really wouldn't be terribly concerned about that pressure for an hd patient awaiting dialysis that morning. Be kind to yourself! Normally, I hold meds until dialysis is over as it will drop their pressure anyway. It sounds like the attending and nephro need to talk to ensure more consistent care. It'll get better- I promise you- tincture of time....

[kjb_lpn]

Generally speaking, friend, there will be days when you feel like you don't always catch something, or that somehow you should be better. The trick is not to let them get you down, remind yourself you're Human - and that you can but try. Accept these as learning experiences and take what you can from them. You'll pick up seasoning and learn more with time.

One Thanksgiving night, I had a pt begin to vomit; coffee ground like substance. I actually called the doctor after it happened a second time and didn't realize until later I should have realized the first time what it meant. Yes, I felt like a terrible nurse. But I also remembered that lesson.

Good luck!

[RobbiRN, RN]

High blood pressure is way overrated as something that needs an immediate fix. Half the country is on 4 to 5 BP meds running around with numbers like the ones you were worried about. Your own BP might have been higher while you worried about calling. This is an oversimplification, but just remember the basic formula: It takes time for really high BP and high BS to kill people. Really low BP and low BS can kill them in minutes. Those are your emergencies.

Caring and focusing on your patients will make you a great nurse. You're on the right track.

[chris21sn, BSN, RN]

I don't think you should feel bad at all. Firstly, his blood pressure will go down regardless because of his dialysis. I believe some nurses even hold bp meds if a bp is moderately highish - just because they wouldn't want to send a dialysis pt of 150/85to become 135/75 and have him coming back at 70/90. Plus you followed the parameters of the orders. I think you're doing fine! No worries

[Karafair]

At the hospital I work at, the perimeters that are pretty much the same for everyone, including dialysis patients is call if over 170/100. Dialysis patients almost always have higher bp right before dialysis. That being said, the nephrologist's perimeters were kind of low.

[Orion81RN]

You know what good nurses do? They reflect on what they should have done and list 1. Yada yada 2. Yada yada. 3. Yada yada. And then talk to peers about it. And that is EXACTLY what you did. Now you can put this behind you and know you are not a horrible nurse, you did what any good nurse would do. Reflect and think of what to do next time

Chin up. ;-/

[Alexxoxox, BSN]

The fact that you feel bad about this just goes to show that you are a very caring, dedicated nurse. It's the nurses that don't care about issues like this that are not meant to have gone to nursing school. This is just a lesson, and one that you will be sure not to repeat again.

[connectchoicecareme]

Usually when we send a dialysis patient for hemodialysis.We usually hold the blood pressure medications because the bp tend to drop after the hemodialysis.But sometimes there are expectional cases in which the doctor might order to give blood pressure medications even though the patient is going for hemodialysis.

Or there are written instructions of what to do by the nephrologist during hemodialysis.If you as a dialysis nurse was supposed to call when diastolic is >115.Why then should you call when is >90.Some doctors will want you to look and feel stupid.When in doubt talk to your honest,reliable experience colleagues.

Don't take it personally.Some days are bad and some days are good in nursing.Nursing is the way to go.Do your job in the hospital go home, shower,eat dinner and make love with your partner.

As an adjunct professor, you finish work at school,you are still taking work to your home. You have to grade,post grades and answer phone calls from the students.

As an acute care nurse when you are done for the day you are done.How cool is that?

Don't you love it?