Wolfmoon_

What's your facilities policy on drawing labs with patients on tpn? started at a community hospital and they had us hold it for 30 min then draw hospital after had us 1/2 it for 30 min then draw whats the most evidence based way to go about it to get an accurate draw and prevent hypoglycemia?

Hey yall, so I found a new job LOL Which I'm super nervous about, but I think despite this situation its time for me to leave. I don't really feel like I've grown much as a nurse from this hospital unit other than understanding the importance of documentation, but I haven't really gained any more skills or critical thinking knowledge. Onc and bmt is interesting but I'm stagnating and comfortable. And feeling comfortable and stagnating somewhere definitely leads to a decrease in quality patient care. in terms of the pip, they were like yeah we looked into the case and there wasn't anything you could've done for the patient but you know... take more vitals, sign here. ? happy nurses week anyways, some tips on starting a more difficult unit would be helpful! The new one is almost a step down according to the manager.

Hi yall, thank you for the comments with uplift and words of advice! during the time of lack of vitals, to make this clarification, he was agitated which became his baseline while in the hospital. I didn't check the vitals as frequently because the perception of his vitals being skewed because of this agitation was a major factor in my mistake. I did, hourly with the help of my charge nurse all night, assess his neuro status for any further acute changes. the patient ended up being maxed on pressers and passed the following night. as for my lack of vital assessment my manager is putting me on a performance improvement plan. She told me that when rapids happen in the morning it's usually a sign that something wrong happened on night shift. I asked her if there have been found any other issues with me care and she said she doesn't think so and is planning on having a meeting with me. while I do think that this patient was going to pass anyways from his condition I should have taken his vitals more frequently as sort of my full, more frequent neuro assessment to rule out any further ailment and ensure faster arrival to ICU/intervention.

The beginning of shift, I receive a report on a cancer patient, a&ox1, with prostate ca with mets to brain and bone Last week the patient was a&ox3-4, yelling for pain medication. He has been on a ketamine gtt and morphine IV. They had dc'd the morphine IV and switched it to po. Beginning of my shift the pt was asking for his po morphine ( which was scheduled for 2100, which I provided). A couple hours later the cp assessed his vs, she states highest was sbp. I do my assessment and find systolic 75 with a map of 45. I immediately tell my charge and call the md who orders a 250ml bolus, I hold the ketamine infusion and call supportive care who states it's OK to cont ketamine. I reassess his vitals, map 63 and sbp 93. Pt is still a&ox1, vss at this time. Around 6 am, which is 4.5 hrs later than my last vitals assessment the cp takes the bp again and it's sbp 75 with a low map but this time the patient isn't responsive. At 4am upon rounding on the patient he was responsive to me. We call a rapid response. The room was a mess and the pt had a bm which I didn't have time to clean yet and we had drew labs, started a new line, bolus and mitten restraints. We also narcanned him and stopped the ketamine. Throughout my shift I held his scheduled po morphine rt his 1x episode of hypotension. Dayshift charge comes in aggressively towards me stating the vitals are every 4 hrs and 6am vitals are too late. She also states we should've called a rapid at 0000, but from my perspective is that I received the order for the fluids and it works- also his orientation had not changed and he was asymptomatic. At 0700, change of shift I was trying to give report and clean the room up as well as document Dayshift called another rapid on the patient before I left, the charge RN was making snarky comments on what had happened on my shift and how "We don't leave patients with a blood pressure of 75". The patient was non responsive again. What could (as a nurse) could I have been done differently to prevent such an instance or is this a case of workplace violence?