Pneumonia and MI

Published Oct 8, 2013

16 Posts

I had a new admit come up to me the other night early on in my shift- about 2100 with a diagnosis of pneumonia. I had an orientee also with me that night and sent her off with one of our floor's senior nurses to work on admission paperwork and the admit. A few hours later I took over care of this patient as the admit process was complete. Patient had coorificeness in her lungs, however respirations were even/unlabored and sat was good at 94% on 4L of O2.

At 0400, patient became extremely restless, agitated, combative. She kicked, screamed, bite, and pinched- as well as now refusing her oxygen and pulling at her Foley. As per her LTC notes, this was her normal and she was frequently medicated for this with Xanax and Ativan. I gave her PRNs of Xanax and Ativan po and she continued to be agitated. At this point, I called our MD on staff and gave him the rundown. He gave orders for IV Ativan and Morphine, and IM Haldol if the agitation continued. In the end, it took ALL of the above (and 2+ hours of our time) to settle our patient back down and decrease the agitation.

Anyway, onto my issue. At the time of admission her Troponin was 0.02- considered negative in our facility. When the MD came and rounded at about Noon- pt had now become restless AGAIN and Troponin was positive. She was transferred into our ICU for continued monitoring, as well as one-to-one care. I had looked at her tele monitoring during her confusing during the night and there was no changes, but I still feel bad that I possibly/probably missed something. Was there anything more that I could've/should've done??

I should probably also mention patient is elderly- in her 90s and has a long term history of dementia and history of aggression toward staff- as well as schizophrenia and bipolar disorder. She has been at the LTC for 5+ years and per staff is frequently out of control.