Night Shift Nightmare

I've had almost the same thing happen to me and it haunts me to this day. I had a little lady who was being treated for HTN. She had ambiem ordered PRN and I gave it to her per her request. She was lethargic throughout the night and somewhat confused. All other vital signs were stable. No other Neuro deficits. I did call the doctor to report the confusion and we both agreed that the ambien was the culprit and I D/C'd it. Turns out, she had a stroke. I felt horrible as well. I've hated ambien ever since and only given it with great caution!!

Wow, I'm sorry to hear about both of your situations. With 5mg of Ambien I find that they're less out of it and if they're small in stature or confused to begin with, I'll give them 5 instead of an ordered 10. If they still can't sleep I could always give them the other 5. You couldn't have expected that either patient would stroke out in the middle of the night. It's just unfortunate.

My first (and, so far, only) code was similarly disturbing. Pt threw a PE despite conscientious thrombolytic therapy (SC heparin and SCD boots.) Made it to ICU, but passed by morning. Part of me knows, and others assured me, that sometimes there's just nothing anyone can do, but it's awfully hard not to wonder whether he'd be alive if he'd had a better nurse. One thing that still sticks is that I'd assured his wife that evening that it wasn't necessary to sleep in with him (she was exhausted) and that he was doing just fine. Ultimately, though,

you either learn to drive big rigs or take whatever you can from the experience and try to use it to be a better nurse. As nearly as I can tell, it doesn't sound like you did anything wrong. Another, more experienced nurse might have seen something you missed, but I suspect it's a rare and extremely lucky nurse (or a blind one) who doesn't know just how you feel.

I won't say don't second guess yourself. I think it's right to think it through and analyze what, if anything, you might do differently, next time. But don't beat yourself to death over it. Nursing, as they say, is an art and a science. The science you can learn, but the art you have to feel, and that takes time to develop.

I don't think you did anything wrong.

I doubt you would have been able to rouse the patient after the Ambien to really assess neuro status. I've taken it and won't take it when I'm alone because I'm afraid I would not wake up even to the noise of a smoke alarm.

Our patients don't always do well, and often there's nothing we can do about it. Don't beat yourself up over it.

Thank you for your posts! I am starting to feel a little better knowing that stuff happens. I have only been a nurse since June & passed the NCLEX in July. I just feel horrible! I enjoy hearing more experienced nurses crazy situations. I realize this won't be the only time something horrible like this happens, however, next time I will expect it! Thanks again!

this didnt happen to me but one of the nurses in the ltc i work in found a resident dead in his room, he was not even on 24 hour report, no signs of distress or illness, just found dead! i hope nothing like that happens to me, imagine having to call the family to tell them their family memeber died suddenly without a known cause!! you bet i make my rounds at night!!

this didnt happen to me but one of the nurses in the ltc i work in found a resident dead in his room, he was not even on 24 hour report, no signs of distress or illness, just found dead! i hope nothing like that happens to me, imagine having to call the family to tell them their family memeber died suddenly without a known cause!! you bet i make my rounds at night!!

oh yeah! that is the number one thing i learned in nursing school is to always check on my patients. usually at the beginning of my shift, i go to my patients rooms to introduce myself, ask about pain, etc. especially to make sure that they are alive & breathing. in the morning before i leave, i go through again (0500-0630) while passing meds, doing assessments, etc. to ensure that my patients are alive & well, because i have no problem staying a few minutes late to ensure that they are all alive, pain free, & happy. also, i try to go into each room (even when they are not my patients) at least q2hrs to ensure everyone is still breathing!

I'm a first year night shift nurse too. It sounds to me like you were doing all you could reasonably do. I get paranoid about something like this happening to my patients at night but the reality is that most patients are not going to appreciate being woken up for a neuro assessment q2hr throughout the night and it doesn't seem like anything about this woman would have led you to believe that she would need that. I think that it was just an unlucky circumstance for you and not really a reflection on your nursing skills especially if vitals were stable, pt breathing normally etc. Some people aren't easily arousable at night even without sleep meds. I work on a tele floor and I really appreciate the extra security afforded by being able to watch heart rhythms while people are sleeping. I'm sorry this happened to you (and the poor little lady).

Keri

I also hate Ambien. We had a rough patch where it seemed like evening shift was giving it to everyone (it's on our standard acu admit orders). Good for evenings. Bad for nights when they rip out their central line and run naked and bleeding out the fire door. Finally we got it across to (most of) the evening shift nurses that if they give out ambien we will hunt them down and kick their butts. I'll only give 5 mg and I won't give it to anyone who is over 70 unless they are really really with it and take a sleep aid at home. If they're 50-70 they might get one depending on my assessment. Ambien = Evil.

I also hate Ambien. We had a rough patch where it seemed like evening shift was giving it to everyone (it's on our standard acu admit orders). Good for evenings. Bad for nights when they rip out their central line and run naked and bleeding out the fire door. Finally we got it across to (most of) the evening shift nurses that if they give out ambien we will hunt them down and kick their butts. I'll only give 5 mg and I won't give it to anyone who is over 70 unless they are really really with it and take a sleep aid at home. If they're 50-70 they might get one depending on my assessment. Ambien = Evil.

LauraMT

I agree I will not give AMbien to anyone unless they are 100% with it and then only 5mg. I dont tell pt's they have it ordered. If they ask they may have it otherwise nope, a cool dark room usually does the trick. Our docs are good about ordering something besides ambien.

never heard of Ambien over here. very interesting. but the nurses are right Stepher, it certainly was bad luck, but nothing more sounds like you're gonna make a fab nurse tho! :)