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How would you have handled this?

Has 12 years experience. Specializes in WOC, Hospice, Home Health.

So here's the basics-

Went to the home of a pleasant 90 year old woman today for an assessment and to set up her meds. When I get there she's not "herself"- a little more confused, stating she's more tired than usual, puts her head down at the table. She seems on the verge of passing out. HR in the 70s with slight irregularity (her baseline). I take a (manual) BP- at first unable to get one, then something along the lines of 30s/teens :eek:. She's conscious but lethargic. I try to reposition her to double check BP- she stands with her walker and suddenly starts shaking uncontrollably. I help her down to her chair and call the dtrs cell to take her to ER for eval- she doesnt have a car at work, so we decide I'll call the ambulance. Call ambulance. While waiting, I stay with her and recheck BP again- starting to come up (60s/30s). EMS gets there, we get her out, she's feeling better by this point and is like "oh, I'm fine now, I don't need the hospital". Recheck BP in ambulance- 90s/60s (her normal).

I'm feeling silly. Couldn't get a hold of the doc's office (couldn't get through) so went on my own judgement with the ambulance call. Ended up in ER, not sure if being admitted or just staying for observation. She does have a hx of syncopal episodes along with an extensive cardiac hx. My hubby says to stop second guessing myself and I did the right thing by calling EMS- I mean, I don't have an EKG or anything for further assessments. Nor do I carry IV sets on me for fluids. And at that moment I didn't want to "wait and see"...I mean, what if she went into a full arrest (Been in that situation in another home. NEVER want to do it again)?!

So- did I overreact? Or do the right thing? *Sigh* Almost 2 years as a nurse and still second-guessing myself. How long does that last? :)

roser13, ASN, RN

Has 17 years experience. Specializes in Med/Surg, Ortho, ASC.

"It" lasts as long as you're a conscientious nurse. You did the right thing.

Failing to obtain emergent assistance, given the current assessment, would have been negligent.

Sounds to me like you did the right thing. You had know way of knowing when you called the ambulance that she would get better so quickly. Also, there's know way to know if she wouldn't have another episode that may have been worse. Good call in my opinion.

ProBeeRN, BSN, RN

Has 12 years experience. Specializes in WOC, Hospice, Home Health.

Thanks. Had no doubt initially-- did an "oh s--t!" in my head and then kept my head together and took it from there-- it was trying to explain everything to the EMTs-- "but, but, she wasn't stable 5 minutes ago!!!" that made me feel silly. Had a detailed note with BPs, assessment, meds, etc for them to take into the ER though.

caeRn

Has 6 years experience. Specializes in ICU, Float RN , Quality & PI.

you did the right thing for the patient at that time. you will always second guess urself, atleast I do and have been nurse for 6 years. When another life is in your hands you always question should i could i etc etc. its natural. good call on this case.

Situation did not turn ugly because she was able to recover by herself. Say you delayed calling for help and she really goes bad. Then you are being negligent and you don't want to go there from a legal stand point.

Good call. You did the right thing. Your options were limited. You are not equipped for an emergency. Like you say, you don't have cardiac monitoring ability with you, you don't carry IVs and fluids, and you don't have emergency meds. Whats the worst that can happen if you called for help vs. not calling for help.

PAERRN20

Has 3 years experience. Specializes in ER.

ER nurse here- you did the right thing! We would admit her at my hospital.

I've been a nurse for 8 years and I still have situations where I second guess myself.

And as far as calling EMS, I think you were exactly right in what you did. It's always better to err on the side of caution.

Super_RN, BSN, RN

Has 12 years experience.

Definitely appropriate. I probably would have called 911 first because I would not be able to dial 7 numnbers, LOL! you'll second guess yourself many times over, but it doesn't mean you made the wrong choice :D

SpecialK38, ASN, RN

Has 2 years experience. Specializes in Critical Care, LTAC, Post-Partum.

I agree- you did the right thing! Don't doubt yourself- go with your training and instincts. I also agree it is always better to err on the side of caution.

littleannabell

Has 10 years experience. Specializes in Home Health, pediatric long term care.

I agree. you did right thing. I had a lady with 212/90 b/p and family prefered I call ambulance over they driving her. open heart surgery 3 weeks prior. dry heaving during visit. Paramedics made me 2nd guess also after telling family she will be discharged as soon as she gets there because that was not a dangerous b/p. Really!? Make you feel like a real heel in front of family. Pt was kept for several hours and released. Still I would not want something going south on my head!

realnursealso/LPN, LPN

Has 34 years experience. Specializes in Peds Homecare.

I agree, you did the right thing. I've been doing homecare for a long time. If my patient was doing that I would call 911, better safe than sorry. Quit worrying, you did a good job!

lots2care4

Has 10 years experience. Specializes in Geriatrics.

:yeah: yay! my thought process goes right along your lines! what if you had not called? you did the right thing; there would be no way you would have known she would come around. :redbeathe better safe than sorry! :)

nursel56

Has 25+ years experience. Specializes in Peds/outpatient FP,derm,allergy/private duty.

It's pretty common in home health to get some attitude from the EMS people- and they as a group are wonderful-- if the case isn't quite to their liking, but it's better to follow your instincts, and sometimes they are more stable by the time they arrive, it's just the way it is. She could just as easily have gone south on you, too.

annmariern

Has 30 years experience. Specializes in vascular, med surg, home health , rehab,.

follow your gut instincts, in nursing as in life, you rarely go wrong. You did what you needed to do. Relax.

ProBeeRN, BSN, RN

Has 12 years experience. Specializes in WOC, Hospice, Home Health.

Well here's an update-- patient was kept overnight for observation, sent home with a couple med adjustments. THEN yesterday one of the daughters calls my boss insisting that it was the agency's fault that this happened because her meds weren't being set up correctly! She was having a hissy fit about an outdated med sheet she found in the home (we are computerized so we use the computer med sheet for the most up to date info). Even after that was explained to her, she kept insisting that I had put 2 20mg lasix (order is 1) in the set up for the whole week (for date 3/26-4/1. Patient had the episode after I had finished her set up). Never say never, but I can't believe I could have made an error like that and not noticed. I offered to come out and recheck the meds. She said no, she had already "fixed" them. Luckily my boss backed me up on everything. I'm off today but another nurse is going out to check the ER discharge papers and double check the meds. And the thing is, even if by some chance I had messed up the set up on Thursday-- the patient wouldn't have taken any meds yet from that set up. Of course now there is the great unknown- DID I SET THEM UP WRONG AND VERY NEARLY CAUSE SOME SERIOUS HARM? I doubt it-- but you can be sure I will be checking my set ups 3, 4, 5 times from now on.

ARGH!!!!!! SO frustrated and now I have to continue to deal with that family! I'm offended too that they think I would drop the ball like that! I'm pretty picky about my med recs- always faxing updated lists to docs and calling if any discrepancies.

I'm on vacation all this coming week though-- hopefully I'll be able to sort all this through in my head and be more zen about the whole thing coming back.

You did the right thing ultimately however I wouldn't have considered having the daughter come and drive her in her own car with a blood pressure that low. What if she had arrested while the daughter or you and the daughter drove her to the ER?

nursel56

Has 25+ years experience. Specializes in Peds/outpatient FP,derm,allergy/private duty.

So for it to be even possible for it to be a med error on your part you would have had to mess up 2 "set-ups"? (because she hadn't started the 2nd setup yet)-

If it were me, I may not have offered to come in and re-check them yourself unless you genuinely believed you put 2 Lasix pills in her set-up multiple times without catching it. Sometimes agency managers can fall all over themselves apologizing to families and undermining their nurses, you are lucky yours backs you up!!!

Sorry this happened to you when in reality you went the extra mile for the lady, rather than neglecting the lady. Many nurses would have thought, syncope+very old=not surprising and left it at that. Families can really be working out various internal issues and use nursing staff as a foil, or a weapon. It'll blow over-- and it's never bad to be more careful, that's for sure!!!

jayne109, RN

Has 6 years experience. Specializes in ER/PDN.

Always trust your gut! You did what you needed to do and for that you are a great nurse.

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