What went wrong?

[nurse2002]

As an agency nurse I work for a small community hospital at times

(Home health is my reg job). This is my fave facility. I had a bad experience. Here goes.

1) I hear a pump beeping in a patients room.

2) I enter the room to see if I can be of assistance.

3) The patient looks BAD

4) I try to get a response from the patient. (zero response).

5) I find the patients nurse quickly and ask if said patient is a dnr and tell her the shape she is in. That it sounds like she has aspirated something.

6) The nurse states "She wasnt like that a few minutes ago".

7) I go into the room with o2 sat to check and the nurse comes in right behind me to take vitals. The patients 02 sats are 60. I tell the nurse. Who basically lets me know she does not want me there.

8) I go out of the room. The code is called by yet another nurse. I get the cart in the room the code is started.

Well to make a long story short the patient expired.

I find out. The patient had a ng tube to suction and pulled it out and that she refused to have it reinserted. By the time I saw her she was in no shape to refuse the ng tube. If this were my pt I think I would of reinserted it at that point. ( My god, the amount of fluids was unbelievable). Then sent her to the unit and intubated.

I dont know. It just seemed like a really messed up situation. I do believe the patient would still be here if the ng were reinserted to suction.

[nurse2002]

As an agency nurse I work for a small community hospital at times

(Home health is my reg job). This is my fave facility. I had a bad experience. Here goes.

1) I hear a pump beeping in a patients room.

2) I enter the room to see if I can be of assistance.

3) The patient looks BAD

4) I try to get a response from the patient. (zero response).

5) I find the patients nurse quickly and ask if said patient is a dnr and tell her the shape she is in. That it sounds like she has aspirated something.

6) The nurse states "She wasnt like that a few minutes ago".

7) I go into the room with o2 sat to check and the nurse comes in right behind me to take vitals. The patients 02 sats are 60. I tell the nurse. Who basically lets me know she does not want me there.

8) I go out of the room. The code is called by yet another nurse. I get the cart in the room the code is started.

Well to make a long story short the patient expired.

I find out. The patient had a ng tube to suction and pulled it out and that she refused to have it reinserted. By the time I saw her she was in no shape to refuse the ng tube. If this were my pt I think I would of reinserted it at that point. ( My god, the amount of fluids was unbelievable). Then sent her to the unit and intubated.

I dont know. It just seemed like a really messed up situation. I do believe the patient would still be here if the ng were reinserted to suction.

[NRSKarenRN, BSN, RN]

The patient had a ng tube to suction and pulled it out and that she refused to have it reinserted

If the patient is competent to make a decision and refuses a procedure (explanaxtion of consequences/outcomes done), then inserting an NG tube against patients will is considered assault and battery---a crime.

As adults, we have the right to refuse medical care.

Maybe this patient had been sick awhile and decided that she just couldn't stand the tube being reinserted ? Tht you don't know.

What most concerns me is your statement:

The patients 02 sats are 60. I tell the nurse. Who basically lets me know she does not want me there.

That I find upsetting--something fishy too. I'd want all the help I could get if MY patient was deteriorating.

I've learned I can not save all my patients but can give them wonderful comfort care when condition is endstage. It is thru situations like these that we learn ang grow as a nurse. This is a situation were discussing this case with the RN later after dust settled, or with charge nurse is waranted "so I can be better prepared next time" is warranted.

{{{{{nurse2002}}}}} to you for getting this patient HELP!

[NRSKarenRN, BSN, RN]

The patient had a ng tube to suction and pulled it out and that she refused to have it reinserted

If the patient is competent to make a decision and refuses a procedure (explanaxtion of consequences/outcomes done), then inserting an NG tube against patients will is considered assault and battery---a crime.

As adults, we have the right to refuse medical care.

Maybe this patient had been sick awhile and decided that she just couldn't stand the tube being reinserted ? Tht you don't know.

What most concerns me is your statement:

The patients 02 sats are 60. I tell the nurse. Who basically lets me know she does not want me there.

That I find upsetting--something fishy too. I'd want all the help I could get if MY patient was deteriorating.

I've learned I can not save all my patients but can give them wonderful comfort care when condition is endstage. It is thru situations like these that we learn ang grow as a nurse. This is a situation were discussing this case with the RN later after dust settled, or with charge nurse is waranted "so I can be better prepared next time" is warranted.

{{{{{nurse2002}}}}} to you for getting this patient HELP!

[Agnus]

She was like that a few minutes ago!!! AND???? What did she do about it? Sounds like nothing from what you say.

This nurse is liable

Whether or not she was refusing the NG She needed to have sats and vitals checked when this was first discovered and O2 turned up, HOB up, and the MD notified, and ......

Reinserting the NG at this point probably would not have been out of line if as you say she could not refuse.

This was an emergency and in such an emergency I might reinsert it even though earlier she had refused. I would much rather be reprimanded, go to court or what ever, for reinserting a tube on an unresponsive patient who did not want it previously. Then face a patient dying or just being injured due to my inaction.

When this patient refused did the nurse explain the consequences of refusing and did she document that the patient was able to show that she understood the consequences as explained? If she did then she is justified in not reinserting when when the patient had obvioulsy aspirated and was unresponsive.

In any case she needed to treat with O2 elevate the HOB. Call the MD Stat. and Check vitals, & neuro, etc.

You had exposed her neglect. That is why she did not want you there. She will probably not be friendly toward you now.

This nurse showed very poor judgement in not asking, if she did not know what to do for this patient. She should have known, but assuming she did not, she had a responsibility to get help.

It is sad that she will probably never see the inside of a court room over this, that she will probably never have to explain her lack of action to the family. And she will blissfully go about her business.

[Agnus]

She was like that a few minutes ago!!! AND???? What did she do about it? Sounds like nothing from what you say.

This nurse is liable

Whether or not she was refusing the NG She needed to have sats and vitals checked when this was first discovered and O2 turned up, HOB up, and the MD notified, and ......

Reinserting the NG at this point probably would not have been out of line if as you say she could not refuse.

This was an emergency and in such an emergency I might reinsert it even though earlier she had refused. I would much rather be reprimanded, go to court or what ever, for reinserting a tube on an unresponsive patient who did not want it previously. Then face a patient dying or just being injured due to my inaction.

When this patient refused did the nurse explain the consequences of refusing and did she document that the patient was able to show that she understood the consequences as explained? If she did then she is justified in not reinserting when when the patient had obvioulsy aspirated and was unresponsive.

In any case she needed to treat with O2 elevate the HOB. Call the MD Stat. and Check vitals, & neuro, etc.

You had exposed her neglect. That is why she did not want you there. She will probably not be friendly toward you now.

This nurse showed very poor judgement in not asking, if she did not know what to do for this patient. She should have known, but assuming she did not, she had a responsibility to get help.

It is sad that she will probably never see the inside of a court room over this, that she will probably never have to explain her lack of action to the family. And she will blissfully go about her business.

[canoehead, BSN, RN]

The patient WASN'T like that a few minutes ago.

I see no problem with the care if the MD was aware that the pt had refused the NG. I think there might be some tension btwn you and this other nurse, and if I was you would get to the bottom of it so that you can help each other out in situations like this.

[canoehead, BSN, RN]

The patient WASN'T like that a few minutes ago.

I see no problem with the care if the MD was aware that the pt had refused the NG. I think there might be some tension btwn you and this other nurse, and if I was you would get to the bottom of it so that you can help each other out in situations like this.

[Agnus]

OK I re read the original post you said the nurse said "the patient was not like that a few minutes earlier."

Well she is now. Other than that my post stands.

She needed help all that she could get.

[Agnus]

OK I re read the original post you said the nurse said "the patient was not like that a few minutes earlier."

Well she is now. Other than that my post stands.

She needed help all that she could get.

[P_RN, ADN, RN]

With a sat of 60 she was in respiratory distress.......frankly I'd have called a code right then. Sometimes a little bit of adrenalin will get a nurse hopping who is a little slow on the uptake.

You did fine......wonder why she felt so threatened.

[P_RN, ADN, RN]

With a sat of 60 she was in respiratory distress.......frankly I'd have called a code right then. Sometimes a little bit of adrenalin will get a nurse hopping who is a little slow on the uptake.

You did fine......wonder why she felt so threatened.