I am a new RN of approx. 5 months. I work on the Medical floor normally night shift. I worked Tuesday night and I had this pt.--he is 38 years old, quadraplegic, has a suprapubic catheter, turn and reposition q2hrs and family that threatens to sue every nurse that comes in the room. Got to his room around 19:45, did assessment, and took VS. BP was only 67/42..(Pt. alert and oriented talking to me and family...states "BP always runs low"). I thought 67/42 was way low and called MD. MD gave orders to give 500CC NS bolus X 1...gave bolus...BP up to 148/84..good gave 2100 scheduled meds...percocet, valium, zanaflex, oxycotin, rifampin, neurotin, and more that I cannot think of at this time.BP remeained stable remainder of shift. Pt. went down for surgery Wednesday for left AKA and was then transferred to the surgical floor. Well, Thursday night when I went into work I was pulled to the surgical floor and guess who I had for a pt...this same man. Went in to assess pt. @ 1925(family not there), pt. was very lethargic, eyes rolled back in head, hard to arouse and only mumbling words, respirations were only 12, BP 89/60, no blood drainage from AKA. Went to look at MAR to see what meds given on previous shift, @ 1500 rec'd scheduled percocet 10mg, oxycotin 80mg, valium 10mg, and others and @ 1730 rec'd 2 Darvocets PRN. Pt. had percoet, valium, oxycotin, neroutin, zanaflex, rifampin and other meds ordered to give @ 2100. Talked with charge nurse and she told me to pull all of the 2100 meds out of PYXIS and just stagger times that I gave meds. I did go ahead and pull all meds out of pyxis but before giving ANY meds I retook pt. BP...BP now 64/43..did not give any meds and immed. called MD on call...order for NS bolus 500ccX1 and to hold ALL 2100 PO scheduled meds. Gave bolus and BP only 70/49. Charge nurse got upset with me and said that the pt. was going to have to have his Valium for muscle spasms sometime during the night..told her that I was following MD orders and would not give the Valium. Around midnight pt. woke up enough to ask why he didn't get 2100 meds... explained that his BP was low and he was lethargic and MD ordered for the meds to be held. Pt. went on to inform me again that his BP always runs low and that we didn't know what we were doing. At 02:30, pt. demanding pain med. BP 94/63 talked with overhouse supervisor (since charge nurse basically washed her hands of the situation after the incident with the valium) and overhouse said to give 1 Darvocet PRN...gave 1 Darvocet...pt. took. Needless to say this man was asleep everytime I went into room to turn q2h. Went in around 05:00 to turn pt. pt. was very upset still about not receiving 2100 meds and stated that he had been laying suffering all night and all that I would give him was 1 darvocet for pain. Informed pt. that I was only following MD orders. Pt. then states that he is going to hit the MD when he comes in the room and that when his sister-in-law gets here she will give him his home meds. I felt really bad about not giving meds but I couldn't see loading this man upon pain meds when after bolusing BP was only 70/50...After the bolus on Tuesday night his BP came up good, but I figure Thursday night that the anesthesia may not have been out of his body good.
Opinions, please. I am dreading going back to work b/c I know that his family made a big deal out of all of this.
