1. Brief history: 6 weeks orientation a med-surg/tele unit; 2nd week on my own

    I had 5 pt last night. 2 pts sats dropped at the same time (A-77 and the B=83). A 3rd pt IV infiltrated with vancomycin.

    i put A on a partial re breather, sats increased to 91; then put her back on N/C; sats dropped to 83; notified Dr. who was mad at me for something i really didn't care abt at the moment. He came, placed pt on venti mask 40% and wanted ABGs, CXR and other labs, mean while sats =84. Paged resp. for BIBAP( who has to drive 45 mins becos we dont have resp during the night shift). I told the Dr. the sats are still at 84 and he said "WAT SHOULD I DO"
    Ok i spoke with another nurse and we increased to VEnti 50%. SAts still 84-85.

    B: partial rebreather,0xygen-100%, then back to N/c- stayed at 91%. Ok 15 mins later -88, gave her albuterol coz she started complaining of SOB-told Dr. and Dr. assessed and said just maintain atlist 89%. OK back to A:respiratory guy here-drawn ABGs, place pt on BIBAP

    Fouth pt: Family members want Ativan for pt (COMFORT CARE). i asked another nurse to do that and please put new IV on infiltrated.

    B: Ask respiratory to please assessed B. States B has some crackles and and diminished in bases. Ok he would advise some lasix because of fluid. Ok that i did not tell the Dr.
    Back to infiltrated- nurse said the IV she put is infiltrated and i ask another nurse to put a new IV and then put warm pack on infitrated site.

    Ok so now i go home, slept, woke up and decide to read b4 going to work and realize that pt B may be having Pulmonary Edema: her sats dropped; she was having noturia and has ankle edema on left leg which is old but no coughing or pink frothy sputum or sweating but i am still worried becos what if and since the resp. guy told me abt the fluid.

    All this is so overwhelming. i am going back tonight and really nervous.
    Thanks for any comment.
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    About CTMMaine

    Joined: Mar '09; Posts: 52; Likes: 10
    from US
    Specialty: MS


  3. by   Be_Moore
    You made the right calls. Good use of time managment and delegation. On patient A, I would have left him on the partial rebreather (which maxes @ 80%) if that was maintaining sats > 90%. Unless he was a COPD patient (especially a CO2 retainer) in which case the Venti mask would be appropriate.

    Patient B in all liklihood has some pulmonary edema. Was the patient schedule to get an AM CXR? If so that will show it and they may have possibly diuresed her today. Pink frothy sputum is a late sign, so don't look for that....if you see that, it's been there for awhile. Changing O2 demands and crackles are your best signs, especially in a patient who may have been fluid overloaded (IV fluids, blood products).

    Realistically, you handled everything well. Other than forgetting to mention that patient B might be fluid overloaded, everything looks good to me. I'm assuming you are in a very small hospital (since you don't have RT)...but with patient A the only other thing really would've been considering xfer to an ICU type setting depending on response to BiPAP. You're doing fine.
  4. by   iluvivt
    Hang in there it gets easier with time...but this is really typical!!!! just for future reference ..most infiltrates are cool compress not warm....you can use warm on isotonic infiltrates.....research shows elevation may or may not help....so just elevate if it is comfortable for the pt,,,,,also can use warm compress on the vinca alkaloids
  5. by   CTMMaine
    Thanks for ur responses.

    Pt A sats dropped again and they ordered a CT and X-ray on my shift
    Pt B-got some lasix and is doing fine.
  6. by   Vito Andolini
    I'm super impressed. Realizing how long it is since I worked M/S and how I never mastered Resp. God, you guys are good! bowingpur:bowingpur