My pt made me look like an idiot

Published

Specializes in Cardiac.

Long vent warning. :angryfire

I work 7p-7a in CCU, and am only a couple of weeks off orientation. The other RNs have been incredibly supportive and if I need backup, I'm completely comfortable asking for help.

So, one of my pts over the weekend was a 64YO man, CABGx4, POD #3. The day RN told me in report that he'd been intermittently confused since surgery but was easily re-oriented to reality and followed commands. He'd required few pain meds; his last was a Lortab 10/325 at 1200 (this was 1900). He also had not slept at all since coming out of surgery.

When I went in to assess him, he was oriented to person and time only, mumbling, and lethargic, dozing off as I assessed him. His wife, who had been staying at his bedside almost 24/7, stated that this didn't concern her as he tended to get "a little out of it" at night, even at home. (sundowner?) And he *was* exhausted.

He dozed off for a few hours. When I came in at 0030 to reassess him and give him a PO Lopressor, he was WAY out of it. He was mumbling, drooling, did not follow any commands, and couldn't focus his eyes on me or his wife. Giving a PO med was out of the question; his face was too flaccid to take a sip, let alsone swallow. He was moving all extremities and vitals were stable.

I went out and got the charge RN to have a look at him. She agreed that something was very wrong. The wife was freaking out; she said he'd never been this bad. She was crying and begging "do something, now, please!" I tend to put a lot of stock in what the family says; I've known the guy for a few hours while she's been married to him for decades!

So, I called the surgeon on call (not the one who did the CABG). He was half asleep and just mumbled, "check his ABG's and keep an eye on him." Lovely. ABG's came back showing respiratory acidosis. Called the surgeon again; this time he talked to me at length about hx, meds, vitals, O2 ... He didn't think it was a CVA but was fixated on a narc OD even though by now he'd had no pain meds for 14 hours. Told me to get him 0.2 mg Narcan, a neb treatment and then redraw ABG's. Narcan did nothing, ABGs came back even worse than the first set. By now the pt had recovered just enough language skills to lie there yelling out an endless stream of obscenities.

Soooo, I paged the surgeon a third time. He said to get a stat CXR, draw a BMP and BNP, and he'd come in.

45 min. later he walks into the room (I was still in there) and says, "Hello, Mr. Whatever, I'm Dr. Whoever. I understand you're having some difficulties tonight."

The patient looks up at him and says, clear as a bell, "No, there's no problem here. I feel fine." MD shoots me an unmistakeable XXX look.

I wanted to crawl into the commode. The guy insisted he was fine, he was having no trouble breathing, no pain, it's February and he's in X hospital because he had a heart operation. My only saving grace was the wife, who strongly insisted that her husband had been in terrible shape all night and she was worried sick. Her face was still swollen and tear-stained. She grilled the MD up, down and sideways as to what could have caused all this. He was patronizing, you could tell he didn't believe there'd ever been a problem to start with.

At shift change, the MD who'd done the CABG came in, looked over pt's chart, and talked to him briefly. I later overheard him talking XXX about me to an OR nurse, "yeah, some nurse had Whoever in here in the middle of the night over nothing again." Oh, yes, we all loooove to wake you from your beauty sleep when someone gets a hangnail at 0300.

The charge RN and respiratory therapist were completely scandalized when they found out what happened. I know they'd back me up if anything came of it, but it won't. The only thing that will happen is the surgeons now think I'm an alarmist dummy with no critical thinking skills. Exactly what I don't need as a newbie in a job that I otherwise love.

There's no way I was going to apologize. I believe I did the right thing under the circumstances and would do it again in the same situation. WHY do patients do this -- they're deathly ill in front of the nurse but when the doctor walks in, they suddenly deny that anything at all is wrong????? :angryfire

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Specializes in ICUs, Tele, etc..

You did the right thing, don't worry about it. He just prolly was annoyed that he had to come in, in the middle of the night if he has surgery next morning. But if he's on call then that's his responsibility. I'm sure he's thankful the pt didn't stroke out anyways.

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Specializes in ER.

you absolutely did the right thing for the pt, virtually everybody is grumpy at 3 in the morning. But I would have asked my charge nurse to come in and confirm my obsevations to the on call doc who came in. Better to convince him now in case the pt does it again, and establish your credibility, same the with the conversation you overheard, get in there and refer him to "experienced nurse."

Larry

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Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

1. You did nothing wrong.

2. You did everything right except I think I'd have taken that "doc***" out in the hall and asked him why he was denegrating me to others.

Then I'd have proceeded to tell him what actually happened and tell him what you wiill do under the next similar circumstances.

Oh and I sure hope you made out an occurrence report so that everything you did correctly is on record with the risk manager.

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Specializes in ACNP-BC.

You did absolutely nothing wrong. I would have done exactly what you did. This has happened to me before: I call the doc because the patient is in bad shape, they come by and suddenly everything is just peachy. Who knows what really happened. The point is that this guy looked like he was really going downhill fast and you did everything a prudent nurse is supposed to do, so too bad for the grumpy doc-it's his job to listen to your concerns and come check out his patient when something serious is going on. He should've been happy that the pt. was fine & not take out anything on you. I think it would be a problem if you were doing the opposite: if you were thinking, oh yeah, he must be fine, it's probably nothing...and then have something really bad happen. So bottom line is-you're a great nurse and that doc needs to chill out & thank you for doing your job. :)

-Christine

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Specializes in NICU.

You absolutely did the right thing. You used the chain of command and got your charge nurse involved. The wife was in agreement with you both that something was very wrong. Who knows what really happened in that man's head that night. But it wasn't normal, and don't feel bad for reporting it.

I'd rather have docs complaining that I woke them up at night for nothing, than to have them say that I let someone stroke out because I didn't know what the heck I was doing. Luckily everything is okay with the patient, and at the end of the day, that's what's important. You did a great job.

By the way, it's not just adults that do this. Babies do it too. In the NICU, I can be caring for a tiny baby that is just acting up like crazy. I'll be talking to the docs all night that this and that is going on. Finally, the baby will do something really bad (oh, like try to die or something) and I'll call the docs out to the bedside, STAT. They'll show up a minute later, rubbing their sleepy eyes...and in that minute, the baby will have stabilized and be completely fine. Sats that were in the 30's will now be in the 90's. A baby that has screamed irritably for 12 hours wll have curiously fallen asleep.

It's a strange phenomenon, but it happens to all of us! :rolleyes:

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Specializes in long term care.

I can only echo what everyone else has said - you did the right thing.

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You did everything right. You have the lab reports to show that there was a problem, as well as the wife's testimony. It could have been very, very serious and it's not worth risking your license to avoid annoying the doc. He gets paid very, very well for the inconveniences that come with the profession. Don't let this incident make you hesitate next time.

Lori

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Specializes in Peds - playing with the kids.

ditto!!

you did everything right! i have worked nights for a loooong time, and there are docs who are going to be cranky no matter what. oh well:rolleyes: . you get paid the big bucks for me to wake you up.

image what would have happened had you blown everything off...and things progressed downhill. you would have gotten :angryfire hell for not calling.

don't worry. pt adovocacy skills are top notch:yelclap: :yelclap: :yelclap: !!

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