My most critical patient

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Today i had a new first.

after taking hand over talking to my bank supprt worker i had 6 pt 2 of which i felt may need med review of which one had left lower quad pain.

All was good at 9 am meds done etc, until i recheck the bp of abode pain pt and sbp was 66 and rr 26 with unreadable sats and not able to feel a radial pulse.

my patient was treated as peri arrest, i have never had someone so sick i'm 5 months an RN on a rehab ward. whats worse when i left 2 hours late the medics still hadn't a diagnsis fllwing blods xray ecg but were treating as HAP. I'm so glad my colleagues helped me out as when it kicked off i didn't know what to do, as i felt i may be in the way.

I ran on adrenaline and caffine. i was told multiple times i did well, although more experienced hands seemed to be doing more.

next time i was told by the SHO(resident) i can call a crash(code blue) if bp is 66 and i will.

oh pt didn't crash and moved to heart care as no level 2 bed available, but is now dnar

I've used UK medical terms and tried t make is USA friendly.

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Specializes in CTICU.

Could you please write in whole words? I can't understand what your post is trying to say.

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Specializes in Advanced Practice, surgery.

Ayla is describing her first experience with a seriously ill patient. She works on a rehabilitation ward and has only been qualified 5 months. After taking report she felt that 2 of her patients needed a further review, and when she rechecked one discovered a blood pressure of 60 systolic.

She called the on call doctor who investigated and treated the patient as a peri-arrest and had help from the other staff on the ward to deal with this patient, she was also told that she can put out a cardiac arrest call if a patient is this unwell.

Ayla, well done for spotting a sick patient, you'd be surprised how many get missed. It sounds like you handled things very well, it's always difficult when you don't have a diagnosis to treat but as long as you stick to the basics in an emergency you won't go far wrong.

I always tell the staff I work with not to be afraid to put out a cardiac arrest call, even if the patient is not arrested, it's there to summon emergency help in situations where you cannot deal with how unwell your patient has become.

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Specializes in ICU.

Ayla, sounds like you did really well.

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Specializes in Telemetry/Med Surg.

I think you did a great job in identifying a sick patient!

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Specializes in Medical and general practice now LTC.

Great work Ayla

Believe me I would rather put a false call out than one that is too late. I think you handled this really well

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sounds like you did well. It's not easy, especially at first when dealing with sick patients. As I am a junior nurse on my ward, when pateints are like this then usually a more senior member of staff comes to help. I tend to become a good runner, going to fetch anything they need,running to ITU with the blood gas, phone the family etc.

Does your hospital have any system for getting a Dr quickly for a patient who is sick but not arrested? I love our system, it gets Dr, bed manager, matron (during the day) there very quickly.

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we are trialling a rapid response system but it not always on. I wish i knew what was happening as i'm off for the week. i have spoke to a staff nurse on my ward and the pt went to ct and then heart care as planned.

Whats gone through my head is not the dealing with the situation but did i get help in time this was an obvious catch as this pt was previous quite independent, could i have got earlier ? and did anything i did contribute to the situation mainly the prescribed meds i gave this pt was on high dose lmwh for a dvt(worked the late the night before check the dose with 2 other nurses) and 20mg od prenisolone for diverticulitis.

oh and that during the morning i wasn't recording full sets of obs just trying to getting bp down mainly.

Oh this pt not diabetic bm were between 1.9-3.4 the whole morning despite hypo treatments i couldn't get it up which probably is sign considering they were on steroids.

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Specializes in medical surgical ward and operating room.

you did a good emergency action...! keep it up...it will help boost your confidence....

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Minor update

went back to work after a week off. My ward manager said that she had been told by my colleagues that i had done very well with the pt who we have been informed did die. what was mentioned is that i stayed with the pt and kept notes.

She was also a lot more postive about my general nursing performance and that i seem to be doing well will have an assessment with the practice trainer soon and should be ok i hope, still working on time management and protization occasionally.

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Specializes in Advanced Practice, surgery.

That's fantastic news Ayla, it's good to get positive feedback and it sounds like you did very well

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Specializes in Medical and general practice now LTC.

Glad you had some positive feedback. Just takes time

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