I am a new grad nurse, I started on a primarily orthopedics however also a neuro/peds/med surg unit 6 months ago. It’s a lot mixed in one, but I feel I have gathered so much experience and knowledge. However yesterday, I think I may have caused more harm to my already sick patient. I plan on going straight to my nurse manager when I go back to work on Thursday, and if I am right and get the answer I am needing I will probably text her tomorrow. So here is the back story:
I apologize for how long this is going to be. I worked three in a row. I admitted this patient the first day. He was diagnosed with LLL PNU. Believe it or not, this is my first patient that I’ve had as an RN with pneumonia, we don’t normally get those types of patients on my floor because we have a specialty unit for that, which was full at the time. His RR was consistently 25-40 those whole 3 days. He was on 4LNC the first day, sounded very wheezy and crackly in all lobes, was getting nebulizers q8, and 2 different IV antibiotics. The 2nd day he seemed to be doing a bit better, wasn’t as SOB however I just still did not have a good feeling about him. I wasn’t comfortable taking care of him, with him constantly being that SOB I knew something was wrong, and with 5 other patients I did not have the means to monitor him the way he should have been. This is a constant problem in the hospital I work at. We are a pretty big hospital (the smallest of only 2 hospitals in a fairly big area) but we don’t have enough ICU/PCU beds, so these patients overflow in the med surg units. And I’m not just a nurse complaining about acuity, doctors notes specifically state that these patients would benefit from a PCU/ICU bed but there is just none available. This is where things go bad. The third day, after ambulating to the bathroom, his o2 sats would not come back up. He was in the 70s% on 4LNC humidified o2. The RT suggested a NRB. I have never had had to use a NRB on any patient, but I knew I had to crank it up to inflate the bag, so did that and I hooked it all up.. with the humidifier still attached.... I was texting the resident this whole time saying I was concerned his condition was worsening and that I felt like he needed to be seen, the resident then said a pulmonologist would be in to see him today, and to titrate the 02 to maintain sats above 90%. I’m standing at the patients bedside trying to monitor his 02, texting the resident, with my phone beeping notifying me of 3 of my other patients call lights going off, and a bed alarm. So I inform the resident he was on 9L NRB and was staying about 91% but that I still feel he needed to be seen soon, not just today. Finally, the hospitalist and resident come to see the pt, I rush into the room to see what they have to say. Which was nothing really, just wait for the pulmonologist. They went over to look at the humidifier and to see how many liters he was on, nothing was said. The pulmonologist arrives about 2-3 hours later and I’m caught up with another pt. The RT comes rushing to find to find me because the Dr wants to know who had him hooked up to the humidifier, me of course. The resident asked me the second day when he was on a NC to humidify it, and I didn’t even think about detaching it when putting on the NRB. I figured it’s a higher flow so yeah we need it, because he was already irritated by the 02 as it is. I told the RT I was not experienced with this, so could she please explain to me why we can’t do that. And she said that water bubbles could collect in the oxygen bag. I had no idea of know this. So anyway, the pulmonologist orders an echo and another cxray, and orders he be transferred to PCU. Do that, great. So as soon as I transfer him I get a post op so don’t really have time to process what happened. I am sitting in the back charting after everyone else from day shift left except one nurse. A night shifter asked what happened to him today, and the nurse stated she wasn’t sure but that she heard he had aspirated and then started whispering. They didn’t know I was back there so I was literally thinking what the hell he didn’t aspirate? But I got home last night and realized... could he have aspirated from the water accumulation in the bag from the humidifier?