Hello all, I don't post much but felt compelled to post after last night's debacle. Well I will try to explain this in the safest way possible and nurses do chime in and let's discuss this please.
Ok I have been a registered nurse for about 2.5 years.....May will be 3 years. I work on an ICU step-down floor. I had a patient come in with respiratory failure. Admission po2 35, CO2 73. Should have gone to ICU but that's another can of worms. Anyway....she was hypoxic,anxious and fighting the bipap all the way up to the floor. I got into a slight tussle with the patient, not in a harmful way but her lips were turning BLUE and she was trying to throw the bipap mask off. Long story short I had to give her Ativan to calm her....a smidgen dose half an mg which was just enough for her. She calmed down, remained on her bipap, and started to rest.
The RT comes in to give a neb and notes her breathing rate....ok. She had ativan because she was physically fighting me and her family on wearing the mask. The RT says "can we get her some narcan because she's not waking up" 10 mins after administering ATIVAN. I told her she didn't have a narcotic so no....she is fine. She was arousable but drowsy. She decides that since the patient's sats went from 40s to 80s she doesn't like that or any of the orders the MD put in so she runs some unordered ABG's. I say ok...that's your decision. At this point the O2 was set at 80% on the machine.
The RT then wants me to call the MD. My first THOUGHT is " you have a license like I do, YOU call the doctor they are your ABG's". But I agree to a certain degree because 80% wasn't getting her past 85% o2 sat so we get new settings from the MD. Now 100% O2 and surprisingly she did not fight but it did make her more drowsy. Ok so here is where the line was crossed.......
The RT, not ME, but the RT goes in my patient's room and tells the patient and the patient's husband that if she is refusing to be intubated if it came to that then she would die. It took me an hour to calm all the 6-7 family members down that came there afterward crying. I had to clarify that if the medical interventions that were currently in place for her failed and she began to deteriorate then we'd need to discuss with the chaplain and physician what kind of interventions, if any, we would need to do IF IT CAME TO THAT and she is refusing intubation. The RT tried to make it seem like she was going to die like.....right then. I had to put into words that they could understand. At one point we were both at the patient's side and she was saying all these things and I was trying to get her to shut up as she was talking over me. Even answering questions like "well if she goes on the vent, it could be long term or she could get better no one knows".
I charted everything...her name, position, and all she discussed with the patient. Not once did she mention discussing their decision or concerns with an MD. I had to clarify this with my own patient and the family. Outside of the patient's room I asked her if she would let me talk with the family about healthcare decisions such as advanced directives. She told the HS she felt she didn't overstep her role and that it needed to be discussed and it was discussed WHEN I ADMITTED HER. It's one of the admission requirements lol. I could not react the way I wanted to but I was able to put the family at some ease. No to give them false hope but to at least let them know all that we are doing and doing it aggressively with continuous bipap, IV steroids around the clock, and neb treatments q4. Was I wrong or should I have been more aggressive???
Nurses please, I would love to hear your input on this please!! Can we discuss this?
