This is LONG because I want to give a backstory on my patient so maybe you can see my thought process. :redbeathe
I'm a second semester nursing student on a cardiac tele/step down floor (depends on who you ask 
). One of my patients today was transferred up from the CCU last night. Her history-admitted for NSTEMI, also, HTN, high cholesterol, renal insufficency, and had had a stent placed in her LAD two days prior. She had a hep drip going, her 9 am meds were Plavix, aspirin, acetylcystine and metoprolol.
During AM shift report, the patients nurse and I were getting report from the night nurse. The patient's granddaughter came out and said her grandmother couldn't breathe. I followed the nurses in the room. They asked her if she was anxious. The pt said yes, so they got her some Ativan. you could her the patients wheezing across the room and she was obviosly having problems breathing. Anyway, i finish getting report. I had three patients, she was my first stop to assess because, well, she couldnt breathe!
I heard crackles in her both lower lobes and rml. She aslo had wheezing in her upper. She had thready pulse in all 4 extremties, her 02 sats stayed around 93%, her RR was 18, 90 HR, 112/75. She had a cannula on with 3L of 02 going. She complained she was still a little SOB, but besides that she was "feeling better" By that time her daughter had arrived and said "she must have been anxious, the ativan is helping"
30 min or so later, The CNA ask me to help her off the bedpan. Well lo and behold, there are giant clots of frank blood in her stool. besides the obvious black tarry GI bleed stool, I have never seen that much stool. Her doctor happened to be outside her room, so I told him that the patient has bloody stool. he asked if it was a lot, I told him i thought so. He looked at it himself and said "thats not a lot, but thanks for telling me." 
I thought it was a lot...but I also dont have anything to compare it to. The pts vitals were fine at this point, still a little SOB, but her 02 sats were fine and the wheezing had diminished, so I decided to just chcek on her often.
ANYWAY, i go to give her 9 am meds about 20 minutes after the bedpan, her BP was 118/78, her HR was 92. In the 15 minutes I was in there, she deteriorated. I made sure her cannula was on, not kinked, and in her nose, and raised the HOB up. She drank her aceytalcystine, took her oral meds, and the whole time kept complaing of SOB. her wheezing started back up again. then she broke out in tears because she was distraught that she couldnt breathe and she didn't know what was wrong with her. so I left to go get a pulse ox monitor. I was gone all of 1.5 minutes. I put it on her finger and it was 78%. 
I waited about 10 seconds to see if it would go up, and it got to 80%. No bueno. So i went and got the nurse. the nurse upped her 02 to 5L, raised the HOB higher than I had it and asked me to retake her bp and we moved her up in bed. The 02 sat got up to 90%, I asked the nurse if it was ok for me to leave since I was gonna be late with my other pts meds. So my nurse stayed and helped the pt.
So 15 minutes later I'm updating my insturctor that pt. She asked if I listened to her lung sounds and counted her respirations after i took her pulse ox. HER O2 SATS were 80%!!! I wasn't going to stand there and count her RR and listen to her lung sounds when the pt looks like death and the pts daughter asks me to get the RN!! My instructor got all melodramatic and used words like "abandonment" and putting your patient in danger. 
I'm a second SEMESTER nursing student taking care of a pt who should have never left the CCU to begin with, I am freaking out because I've never had a pt detiorate so rapidly. My main concern was my patient getting oxygen, so I went and got the more expirenced nurse. ***** Please keep in mind, it takes me 2-3 times as long to get RR and lung sounds because I'm a 'nurse-ling'. you guys might have been able to do it in 30 sec, but it would have taken me 2 minutes.
Well while my instuctor is ripping me a new one, the nurse and doc and charge walk by and apparently my patient is going back down to CCU r/t pulmonary edema. My instructor GLARES at me and says, "see, now she's going down to CCU" Again, ***!!!!! NOT my fault she had a new onset GI bleed that the doc wasn't worried about, and me listening to her lung sounds and taking her RR wouldn't have prevented her from having to be sent down there. Right?
Anyway, when the smoke had cleared, I asked the nurse. She said she was glad I came and got her because the patient had deteriorated so rapidly.
So, LONG STORY short...(not really lol), should I have stood there and taken her RR and listened to lung sounds, or was I right to get the nurse? My instructor made it clear to to listen to lung sounds and get RR . And even othough she is technically right, when you can hear the pt wheezing across the room and you can see that the RR is rapid and labored, and when you pt is going to sh*t, should I really take the time to that? :confused::confused::crying2:
*p.s. i'm still learning, so any CONSTRUCTIVE 
criticism is welcome"
blondesareeasy
61 Posts
Beta blockers can make you wheeze.
Anxiety feeds anxiety.
Visitors feed on attention.
You did fine.
This was nothing.
Wait til' you get an emergency.
Consider:
RT's have it made.
PT's have it even better.
Nurses get all the blame for the mistakes made by the above.
All bleeding stops eventually.
It is the rare nursing instructor that is constructive in an urgent setting. You'll meet the good ones along the way.
Screw the breath sounds...you heard the audible wheezes.
A heparinized GI bleeder...were they warding off a pulm embolism or treating an active one?
And Obama wants the fed government to run the hospitals...just think of how well they handle the post office.