First Encounter, Help

[Guest1119933]

I know this is long, but I need some help. I don't know if how I am feeling is normal?

When I started nursing, I had envisioned a career that would be filled with happiness and confidence. That is how it was, at least for the first six months. On the sixth month, I encountered my first adverse event with a patient.

I was on the geriatric unit by myself with a nurse split between the geriatric and adult psychiatric unit. I had a full team of patients. One of my particular patients complained that she did not feel good that day and felt her COPD was acting up. We took her morning vitals and everything was in normal range. I allowed her to stay in her room to rest instead of being up in the dayroom with the rest of the patients. We continued to check on her periodically, as we were supposed to. When it was time for her 11 am medication, I decided I would go back to her room and give her medication to her and obtain her vitals. My techs were busy getting patients up for lunch, so there was no reason to interrupt them when I could do it myself. I went to the patients room at 1145 and told her I had her Cardizem 60mg IR. She stated she still did not feel well and I reassured her that this medication would make her feel better. I had already checked her morning vitals and the previous shifts vitals, her vitals were consistent and ran about the same. I handed her the medication and began to take her blood pressure. She took the medication. Right after she took the medication, I heard the completion of the blood pressure machine reading and the alerting of an abnormal reading. I looked at the screen at it read 77/44. I immediately began to panic. I knew this couldn't be right as this patient was sitting and talking to me and displayed no symptoms of low blood pressure. I leaned out in the hallway and asked my tech to obtain the blood pressure cuff. When she arrived to the room, she informed me they had been using a child size cuff due to how small her arm was for an accurate reading. I attempted two times to get a manual blood pressure reading. I was for sure getting a bottom number reading of 58 but was not certain of a top number reading. The second time I attempted to obtain it, I was almost certain I obtained the reading of 110/58, but I was still in panic mode thinking I had just gave this woman this medication with a blood pressure this low. I was too ashamed and scared to ask my tech standing there to obtain her blood pressure as I wasn't for sure what I was getting. At that point, I remember saying to myself you have two options. You can go ahead and call the doctor and tell him that her blood pressure is possible low or you could continue to monitor her and you would know if her blood pressure was low. I made the choice to watch her. The techs came into the room and helped her up for lunch. She ate a few bites off her tray but stated she did not feel like eating. About 30 minutes after the administering of the medication, I sat across from the room she was sitting at charting and observing her. I noticed her starting to nod in a sleepy manner. At that point, I decided to go ahead and call the physician. The techs obtained a current set of vitals, one manual and one automatic. They both registered the same 90/60 and a pulse of 70's. Her vitals were within normal limits. This had reassured me for a little. I still proceeded to call the hospitalist and inform him of her complaints of not feeling good and her current vitals. I informed him that I did give her the Cardizem about 30-45 before that. He said her blood pressure was still in range, but he would put in for some testing to assure everything was okay. He ordered an EKG, Xray, and bloodwork. We immediately obtained the EKG and I called him with the results. The only thing it read was a weak QRS, but otherwise normal. He informed me call him when transportation got there and he would meet the patient in xray to observe her. Within 30 minutes the ambulance arrived and I called the physician to inform him. After a short period of time, he called me back. He stated he observed her, listened to her, and she was denying anything was wrong. He assured me she sounded fine and he did not see any present issues. He informed me she would be returning to the unit momentarily but just continue to monitor her. She arrived back on the unit and was assisted back to her room. At this time, it was a little after 3pm and it was time for the techs to start obtaining evening vitals. I reminded the techs to use a smaller cuff on the patient, and if anything was abnormal to alert me immediately. They obtained her blood pressure around 315 and it was still within normal limits at 110/75 and pulse of 78 but stated the had a hard time getting a temperature on her axillary or orally along with an oxygen reading because her fingers were so cold. We placed the oxygen probe on her ear and obtained the reading of 94%. I informed the techs to get a temperature rectally. It was 97.1. I knew this was lower so I immediately called the physician. I informed him of her current rectal temperature and vital signs. He informed me to transfer he to the medical floor as she was "not stable" enough to be placed on our unit. I immediately called nursing supervision and called an ambulance for transportation. Around 345 pm the charge nurse on the other unit came over to inform me of staffing when the techs, who were still obtaining vitals, was beside the patient's room and yelled for help. The stated she had just slumped over in the bed unconscious. Both the charge nurse and I ran back to her room, and he began to try and stimulate her. I immediately ran back up to the nurses station and called the physician. The techs had brought me a reading of her current vitals which had plummeted. Her oxygen was at 78%, her blood pressure had plummeted, and her pulse was weak and thready. He informed me to get an ambulance there immediately to send her to the ER but continue to use the ambubag on her until they arrived to keep her oxygen up. I immediately called the ambulance back and informed them we needed an ambulance stat as she was unresponsive. They arrived within the next 10 minutes and took her to the emergency room. The physician called me about 530 from the ER and informed me that it did not look good. He was assuming at the time it was a calcium channel blocker/ beta blocker overdose but was not certain. At that point, I wondered if that medication I gave could have caused this in anyway? What if instead of her blood pressure dropping, it had an adverse affect caused her blood pressure/pulse to elevate because it had to work harder (even though that is not what the medicine does). Over the four days, I put myself through hell. I debated on turning in my license and resigning as I had convinced myself what had happened was because of me. On that next Tuesday I went and spoke with my manager and informed her that I would be resigning and that I felt it was my fault. She went over the chart with me and informed me that all my t's were crossed and i's were dotted. I had informed her that I was not for sure if the vitals I entered in when I gave her the 1145 medicine was correct and felt that she could have had an adverse reaction. My manager told me that was not plausible, that even if her vitals were abnormal, this medication would have not caused what happened. She informed me after reading through the chart, the physician suspected a pulmonary embolism to be the cause. Still, in my mind, this wasn't a definite. She reassured me to learn from this event and use what I learned to treat future patients.

Over the next few months I began to see therapist, psychiatrist, and talk to pretty much every medical person I could. They all reassured me that my thought process was not plausible. All of the medical staff I talked to almost immediately informed me that it sounded like a pulmonary embolism after I told them the sign and symptoms.

To this day, this is something that will not leave my mind.

[DextersDisciple, BSN, RN]

Wayyyyyyy too hard on yourself. Glad (but kinda surprised) you are in therapy. You did everything you were supposed to do. Next time don’t let your emotions get the best of you and make a quick/irrational decision (ie resign).

I’m glad your manager had a chat with you and convinced you to stay (well that’s how it sounds). You did stay correct? There’s actually a similar thread floating around with the same probable outcome (PE).

These things happen. It is not your fault. Take your colleagues advice and be kind to yourself. Hope you feel better soon and learn to not be so hard on yourself. ❤️

[DextersDisciple, BSN, RN]

2 minutes ago, DextersDisciple said:

There’s actually a similar thread floating around with the same probable outcome (PE).

Wait a minute- YOU posted the nearly identical thread in June. The first one was a man but other than that the scenario was the same. Did this happen twice on 2 different patients?? Or did you just post this again? And if so- why??

[Guest1119933]

Dexter,

Yes, the other thread was mine but I didn’t feel I told the whole story. This only happened once. I appreciate your comment. No, I did not leave because I feel it is my passion. I have heard I am being too hard on myself. I just think where I am a newer nurse that did not have much medical experience, I am just not convinced this medicine did not cause it. I have heard it just takes time.

[DextersDisciple, BSN, RN]

Just now, New_Nurse_18 said:

Dexter,

Yes, the other thread was mine but I didn’t feel I told the whole story. I appreciate your comment. No, I did not leave because I feel it is my passion. I have heard I am being too hard on myself. I just think where I am a newer nurse that did not have much medical experience, I am just not convinced this medicine did not cause it. I have heard it just takes time.

You also changed your username. Why did you change details ie gender, omission of afib hx? I don’t think the responses you receive now will be much different than the ones you already received back in June. Everything okay..?

[DextersDisciple, BSN, RN]

Btw there is absolutely no reason to think a calcium channel blocker would cause a PE. Your thought process Tells me you have not learned and grown from this yet. Maybe you should look up patho of PEs and adverse events/mechanism of action for this kind of drug. Cold hard facts should change your mind.

[Guest1119933]

Yes, I felt I needed to change my username. And like I said, I have had a lot of questions regarding this that I can’t seem to answer. Everything is the same except this was a female instead of male. I just felt the need to post a truth.

[JKL33]

@New_Nurse_18, according to your two accounts (and reading between the lines a little), I believe you are having a hard time getting past this because you believe you would have liked to have done some things differently (whether they changed the ultimate outcome or not).

I think that you surely know that you didn't cause this patient's demise, so the lack of closure is coming from somewhere else. I suspect it is because you want to understand (?maybe improve or learn something from) your actions even if they didn't cause this...because you are not satisfied with them.

There is nothing wrong with critiquing yourself. But it's a little pointless unless you plan to make something positive out of it.

If you would like to talk about what specific things you aren't happy with, we can do that.

Disclosure: I find it useful to review my actions. When I suspect I could have done better, it bothers me even if I know it wouldn't have changed anything, and I wouldn't find it ultimately very useful for people to point out that something wouldn't have changed anything (if/when I know that I'm disappointed in my actions).

So...why don't you move past "did/didn't 'cause' this" and move on to what's really eating you, which is your disappointment in your actions.

[Jedrnurse, BSN, RN]

You started off by saying that you envisioned your new career as being "filled with happiness and confidence". That's not how the world of work (often) is, esp. the latter part, particularly for a new grad. Did you perhaps idealize the concept of being a nurse?

[K+MgSO4, BSN]

Few things

No job - nursing, beauty therapy, astronaut are not going to sunshine and roses everyday. There are boring, annoying and downright horrible parts to all jobs.

"Dream jobs" don't exist - see above.

You are fixating on issue that multiple people have said is not your fault. You need to get over this or you will never progress.

The only thing is if you have a doubt about something ask for help, but trouble shoot issues yourself first.

Find one person e.g. your therapist and work on getting over this incident. It sounds like you have a good boss who is not letting you resign on such an incident.

[Angela Willson]

nursing is not an easy job. Just make sure you are working in a area that you really enjoy. Working at a nursing home is the worst place you can work; It's so understaff and you are being pulled in 50 different directions by patients and staff. The easiest place you can lose your license. You have no support. Good job while everthing is going okay. But hell to pay when something goes wrong. Documentation and assessment is at the top of the list. Can't express enough document, document and document. This can make you or break you. Also if you are in it for the money there will always be problems. Peace of mind makes your day. Well a good paycheck also. Make sure you are happy and enjoying what you doing.

[Nurse SMS, MSN, RN]

Note for the future. Any time you envision ANYTHING to be "filled with happiness and confidence" you are in for a really, really hard fall. There is nothing on this earth that fulfills that kind of idealism. Not marriage, not parenthood, not religion, not home ownership and most definitely not a job. The only thing that comes close to that is living debt-free and even that is iffy. ?

Asking someone else to verify results of a BP or any other assessment is definitely not something to be embarrassed about. Its called collaboration. It validates the other individual that you trust their clinical judgment and need their input on the care you are mutually trying to give your patients. That is the backbone of what we do.

You did nothing wrong. People die. 100% death rate for the human race and the body wears out more and more with age. If you go into this thinking your job is to "save" people, you are going to be in therapy a long, long time. It is your job to assess and intervene based on your assessments. You did that.