Overnight concern on pt condition.


Had something bother me about a pt's condition. I'd cared for her 3 nights in a row, and on the third shift something wasn't right. Something was different. She'd been an in-patient for 2 weeks and I was familiar with her. SLEEPY the whole shift from start to finish which was totally unusual. Some sleep apnea which was new also. Her baseline was confused at night with repeated attempts to get out of bed. I monitored her every hour.......nothing I could put my finger on, or point to that was serious enough to wake a Doc at 3A. She was a COPDer on 02 with a history of crappy ABGs. Spent some time in ICU.

About 4Am I had to call about another pt, and while I had the MD on the phone I mentioned my concerns about the little old lady who kept wanting to fall asleep...even when talking. NNO of course, I didn't expect any. Just wanted to let the MD know somethink hinky going on since I would leave at 7AM and there was no guarantee the day nurse would report the increased lethargy.

So guess what. The little old lady wakes up at 6:30am, sits up in bed with no signs of the difficult to rouse pt I'd had all night. Of course my assessment skills would be questioned. The little old lady I'd stewed about all night was nowhere in sight.

Has this every happened to you? What did you do?


658 Posts

Specializes in CMSRN. Has 9 years experience.

I have seen this before. A 92 year old dementia pt who was still continent, walkie talkie but confused. One day she decided to fall asleep and not wake up with stimuli. Md's orderd full neuro work up etc. No new changes. Three days later she wakes up and is the same lol as usual. (Slept through her birthday)

This also happened to a 101year old woman. Family decided to let nature take it's course and again she popped out of it like she just took a nap.

I heard it happened a couple of other times from nurses too.

Easier to accept if it started at the beginning of my shift since I expect most pt's to be tired.

ckh23, BSN, RN

1,446 Posts

Specializes in ER/ICU/STICU. Has 6 years experience.

How had her sleep pattern been the prior nights you had her? Hospitals are not a great place for someone to get good consistent sleep. It's possible that it all caught up to her and after a recharge of the battery she was ready to go. Another possibility that comes to mind is if she received some meds before your shift that was not given in report.


25 Posts

Specializes in Medical-surgical. Has 9 years experience.

Ha, this totally happened to me, I worked a 12 hour night shift, the pt's family was there during the beginning of the shift, the pt just slept and slept, they weren't too concerned but then I tried to get her up for meds and she was unresponsive, VS all normal. The doc came, we did ABG's, CT head, labs, all negative. She woke up at at like 6am all bright eyed and bushy tailed and a/o x3.......apparently she needed some sleep.

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VivaLasViejas, ASN, RN

142 Articles; 9,981 Posts

Specializes in LTC, assisted living, med-surg, psych. Has 26 years experience.

I've seen this happen more times than I care to count. Those LOLs will make a liar out of you every chance they get! :lol2:


236 Posts

Things similar happen to me. They do different things overnight!

For all the emphasis that is placed on noticing early signs and symptoms, (esp any change in LOC or mood in the elderly)...most times I ever called a Dr. or manager to report early signs and symptoms of a change in pt. condition the same thing happens to me :)

Esp. frustrating when it is a patient that you know well and when you see certain changes then you know 'x' is starting. (such as respiratory infection, ect) Would Be nice to be able to address things from the early onset rather then waiting for them to get really bad, huh?

Specializes in Med/Surg, Geriatric, Hospice. Has 14 years experience.

Old people are fragile little things! I've had more than one LOL do this to me when they were retaining urine. I actually had one have what looked like a TIA or absence/focal seizure from which I couldn't rouse her; turns out she had 1200mL in her bladder. Emptied her out and she 'woke up'. She too had been drowsy and a bit more confused (more so than her baseline).