Phase II Question

[Phase2Pro]

I am new to phase II and I have a question maybe you can help me with. Sometimes it seems to me like one of the other nurses is so focused on getting the patients out the door that things are being overlooked that are detrimental to the patient. For instance, today once of our colonoscopy patients started complaining that their asthma was kicking up and the wheezing was audible without a stethoscope. Sats dropped from 97% to 86%. I asked her (stupidly I admit) if there were any orders concerning the asthma and she looked at me like I was crazy and said no they are here for the other end. I could not get it across to her that there was a problem going on because she was only concerned that it was post coloscopy and we just needed to get 'em up and things would probably clear up. Fortunately, they had their own inhaler with them and all turned out ok. I was not his discharging nurse but we do kinda share care in our phase II area. I am only 8 weeks into this area and it is totally new to me. Am I overly cautious or am I actually paying attention to my patients like I think I am? I am being told both things. If you think I am overly cautious...why is wheezing and a 11 point sat drop unimportant in someone just because the procedure they had involved the other end? Thanks

[WoosahRN, MSN, RN]

I will start off by saying I am not a PACU RN. I am looking into it so thought I would check out the forums for more info...

That said, I just wanted to respond to you. I am in critical care (we do some concious sedation, sedation drips, as well as some surgical recovery-although many come back intubated still) and regardless of what area you are in, the rule is always ABC's. No matter what, you can pretty much break it down to that. I can't imagine trying to discharge or push a patient out the door when they are wheezing, sats 86%, and no treatment. I would think that even though it is a secondary situation (the asthma), it is still part of their medical history and it becomes a primary problem in any situation much less recovering from a procedure (where, I imagine, resp depression or distress is one of the biggest things that is looked for). I wouldn't tell you to dummy down your assessment skills because of peer pressure. In that case I'm glad the patient had their inhaler with them. Glad it didn't get any worse. But glad you were there trying to advocate for them too. Hope it goes better and hope I didn't speak out of place since I am not technically knowledgeable in PACU.:)

[azhiker96, BSN, RN]

I am a PACU nurse and would never try to discharge a patient in that condition. I would call the anesthesiologist or surgeon and get an order for a SVN treatment. Most of our anesthesiologists would already have a prn Albuterol SVN on their orders if the pt had a hx of asthma.

[Charity, RN, APRN]

Short answer: We PACU nurses take care of the entire patient, not just what got operated on!

[All4Seasons]

In NO way were you being "overly cautious" to be concerned that a pt was being discharged in that condition - however your colleague was being way too dismissive,complacent,and,in plain English - stupid. Thank goodness you were there for her patient. Kudos to you.

[gwendelyn]

Sometimes you'll come accross nurses whose only goal is to go home at the end of the shift. I admit I feel that way sometimes but my nursing instincts kick in when a patient has problems. You were right to be concerned about your pt who had audible wheezes with 02 sats 86%..As nurses we are responsible for the safety of our patients..No matter which unit we work in, airway is always the number one priority.