Patient decompensated on the floor, sent to ICU, Have you had this happen?

Nurses General Nursing

Published

Hi-

Have you had a patient decompensate?

Specializes in Oncology.

This happens quite a bit, actually. Some patients are just way sicker than they originally appear. It sounds like you did all the right things!

I appreciate this. I have been thinking about this for days to the point I've given myself a stress headache!

Specializes in Med-Surg, Wound Care.

Thousands of times.....always trust your gut if you feel a patient is going downhill.

Specializes in Acute Care Cardiac, Education, Prof Practice.

Even though it is stressful and scary, I take a lot of pride in successfully transferring a patient to the ICU on my shift.

I work nights, so in order for a patient to get to the unit I have to make a lot of assessments, and then line up the right people to get that patient downstairs. Not to mention waking up and translating effectively the state the patient is in at the moment to a physician.

The only patient I felt bad about when she went to the unit, was one that went into flash pulmonary edema. Some nurses (and a nephro doc who I think was just ****** I woke him up) lead me to believe that the pain medications and sleeping pill I had given had caused decreased respirations, which lead to respiratory decline and in the end a bipap and ICU stay for the night. However this patient was also an extremely fragile kidney/everything else wrong patient, and there was no telling if it would have gone down the same way despite the meds.

Tait

Wow, I haven't heard of "flash" pulomary edema. Did you feel somewhat better when you found out it wasn't the meds?

Specializes in Public Health, TB.

I kinda assume monitoring my patients for any sign of decompensation as one of my primary job functions. Hopefully I catch an decline in time to treat on the floor, but as previous posters have stated, sometimes it happens crazy fast, like flash pulmonary edema, or septic shock.

Unfortunately, sometimes it takes a sledge hammer to get the doctor to understand how sick the patient is and that they need a higher level of care than can be provided on the floor.

Specializes in ICU.

oh wow, what happened to the post?

Specializes in ER, Step-Down.

I worked in step-down prior to ER, so I saw quite a few transfers to the ICU from my floor. Of course, I can't tell you how many Rapid Responses and Codes I heard called between 0630 and 0700 from the med/surg floors. Funny how they always happened during those times...

I work in an ICU and our pt's decompensate from time to time. . . except there's no place to move them. . . we are it. I floated to a med/surg (but only 4 pt's a nurse, kind of a 'holding floor', if you will) where all four of my pts were able to get out of bed, use the bathroom, feed themselves, etc. and I was totally freaking out. I could not see them from the nurses' station. None of them were on tele monitors; while the other nurses were taking a break or going about routine business, I was peaking into my pts' rooms (it was night shift) just to make sure they were all still breathing!

I was freaked out because even though they were less ill than my usual pts, I knew that if something started to go wrong I had a LONG way to go before I could get them the the point of maximum intervention. In the ICU, even though the pts are critically ill, I know every little thing that is going on with them. I know if they are breathing, what their heart rhythym is, I can see them all from where I sit, and if something goes wrong they are already where they need to be. Kind of funny I guess, being more comfortable in the ICU than with 'walky talky' pts.

What I hate is when we downgrade someone an move them to a new floor and then later that day or within a couple of days they come back to us. Kind of depressing. But don't feel bad about having a pt decompensate. That's why they are in the hospital and not at home.

Specializes in Acute Care.

Better the ICU than the morgue. ;) It happens fairly often, someone takes a more or less sudden downward turn. It sounds like you did the right thing.

Specializes in ER, IICU, PCU, PACU, EMS.

It's better to notice a patient decompensating and transfer him to the ICU than to not catch it in time and call a code.

People get better, people get worse ~ we are there to assist with either direction and note the subtle differences.

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