got called off and then pt went to the unit

[NurseBrittney]

I had my pt for the 2nd day.

Yesterday when we ambulated, just before shift change, he didn't tolerate it as well as the first time. However his sats were still in the 90s.

I received in report that he was desatting and they had to go with a veni mask at 30% and then up to 50%.

When I got him his sats were staying at 91%. He was wheezing on just 1 side (which i found to be weird). Respiratory came into to give him his breathing treatment and I was talking to her about his sat... and she just basically blew me off and was rude.

After we got him up in the chair, he had shallow somewhat labored breathing, but nothing I thought was out of the ordinary for him.

Meanwhile, throughout the entire morning his wife was being a royal pain. saying mean insulting things. And the pt refused to take deep breaths (he had a VHR).

I called the doc bc his bp was elevated 184/92, hr 120, and his labored resp and 90% o2. he ordered bi-pap and even though I asked several times about the bp and heart rate said he didn't want to treat it till he saw the pt.

Bi-pap was placed- his sats got up to 96% and then he and his wife started to complain about the bi-pap, then they removed it and refused to wear it... only to put it back on again.

They finally have it on. He gets back in the bed, and he appears stable to me with sats in the 95-97.

They called one of us off, so I volunteered, because honestly his wife was driving me nuts, and basically calling me incompetent to the point where I wanted to cry.

I called to check on the pt to see what the dr. wrote when he got there.... and they sent him to the unit.

Did I miss something? What did I do wrong?

[UM Review RN, ASN, RN]

Nope, you didn't do anything wrong, in fact I'd say you did everything right for what was going on with the patient at the time.

With labored breathing and failure to recover from exertion, along with the adventitious breath sounds, I might've asked for an ABG and a portable CXR, maybe some lasix, but it sounds to me like the patient was needing bipap and it simply wasn't enough.

The patient just didn't improve as the doctor hoped so that by the time the doc saw the patient, he needed more interventions on the unit, that's all.

Oh, and I'd chalk the bad behavior up to the problem, too. It's hard to be nice when you're really not getting any air. The pulse ox might not have been all that correct, as you know.