My nursing judgement call.....thoughts?

xtxrn, ASN, RN · Aug 28, 2011

I had a patient that complained of sharp stabbing chest pain that started in his left pectoral area, then moved from there to his sternum and then back. I called the doctor and obtained orders, but before I could do so, his brother ran out of the room and told me that i was needed in the room right away. When I got back into the room, he was sheet white and told me it felt like someone was sitting on his chest. Naturally I called a rapid response (like a code, but is called when immediate help is needed. It's my hospital's way of trying to prevent code.) We transfered him down to the ICU in order to be treated. Did I do the right thing? Should I have called it sooner? I was wondering, since my charge nurse seemed more annoyed than anything else. What do you think?

It sounds like he had a change between the time you got orders and the time the brother got you- If his vitals were stable, and you were trying to get the orders done, I'd say it was ok to wait for the RRT. He changed. You responded to that..... jmo

brandy1017, ASN, RN · Aug 28, 2011

Sounds like you did the right thing and obviously the MRT team agreed and placed him in ICU. Now I wonder did he have an MI or aortic dissection? I wonder what they'll find!

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EleniRN · Aug 28, 2011

I would have done the same things that you did. I wonder tho, did you get vitals when you first were alerted about the pain?

It's really hard sometimes and I think that we nurses second guess ourselves constantly about decision making.

Helen

dadfirst · Aug 28, 2011

A charge nurse that makes you feel badly about being safe rather than sorry needs to be reminded of what it is like to be in your shoes.

cherrybreeze, ADN, RN · Aug 28, 2011

I'm not sure what else you think you could have done. He c/o pain, you called the doc, and the brother came out of the room and called you back in....that sounded like it happened pretty quickly, if you hadn't had the chance to initiate any orders. I think you acted appropriately.

Crux1024 · Aug 28, 2011

I feel you did the right thing as well. He had CP, you called for orders and then he continued to decompensate. Not your fault, you called the RR and he transferred. I usually grab vitals, an EKG and CEs while im on the phone with the doc. Also, usually administer NTG or MS04 but most of our pts come up with that already ordered and ready to give since Im on a Tele floor.

MN-Nurse, ASN, RN · Aug 28, 2011

I was wondering, since my charge nurse seemed more annoyed than anything else. What do you think?

Sounds like everything went as it should - except the charge nurse being annoyed. He or she was probably just annoyed the person needed a RRT and transfer, not annoyed with you for anything at all.

papawjohn · Aug 28, 2011

If your workplace doesn't allow you to do EKGs yourself, or order them stat prior to calling the MD -- which I guess is true, you did exactly what your Facility planned for this sort of thing. Nurses have great responsibilities and tend to obsess over them. Planners of institutions and administrators establish the rules and standards and policies that nurses have to follow and they sleep well every night because they hire nurses -- who obsess over their responsibilities.

You did not make the rules. You followed them very well, sounds like. Relax and go easy on yourself.

PapawJohn

Do-over, ASN, RN · Aug 29, 2011

I say, when in doubt - call the RRT - that is what it is for.

You don't say what type of floor, or what orders you received, (which I am curioius about) but it doesn't really matter - YOU perceived an emergency and acted accordingly. Your hospital has that team to be used. Good job.

I HATE it when I hear someone say a rapid response shouldn't have been called. I've had it happen to me, in a back-handed way. Next time? I'm going to tell them to go ahead and take the transfer, perform an assessment and then work on getting them transferred back if they think it was BS.

PS - We have signs up in the rooms instructing families on how to call RRTs.

knittingfan283 · Aug 29, 2011

When I was called to the room initially, his blood pressure was high, but nothing alarming. I think it was 159/96, which wasn't far from his baseline blood pressure with no telemetry changes from baseline (which was Sinus Tach). I work on a medical/surgical/telemetry floor. I had ordered a stat ekg and called the doctor to tell him that I was going to run cardiac enzymes and ask him if he wanted me to run any other tests. When the brother came to get me, I had just gotten off the phone with the doctor and the EKG tech was on their way. He originally came in for COPD exacerbation and had no cardiac history at all. This was new onset chest pain, and if it weren't for the RRT I wouldn't have gotten any help, because the charge nurse didn't help me, just ordered me around. We'd been having personality conflicts lately, which was partly my fault as well as hers. She told me later on that she didn't know what to do, and was glad I was able to make that judgement call. She has a BSN (nothing wrong with a BSN but she constantly rubs it in my face) and looks down on me because I have an LPN degree even though I am in school to complete ADN. So not only does she get ****** off when I am able to make sound nursing judgements, but gets ****** off because I am able to perform under pressure better than her. *sigh* Sorry for the immature rant.

nurseryRN14 · Aug 29, 2011

You called the Doc and told him the pt was having sharp CP and you order a stat EKG and cardiac enzymes. When was the doc gonna order anything for the pt for the CP. By the time you attempt to get a EKG and draw the labs the pt has potentially died. Why couldn't he have ordered nitro since the pts bp was stable, went ahead with the ekg and enzymes. Good thing that you called the Rapid Response when you did. When pts have those type of symptoms, we usually have a hospitalist that would immediately come on the floor to see that pt. Didn't seem like the doctor was too worried, unless the pain was only at a 3 or 4 rather than a 8 or 9.

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