PaigeRN90

Hi everybody..I am a new grad on a med tele floor. I recently (on my last day of orientation actually) had a new admit around 1am, a "frequent flyer" who came in with a diagnosis of pneumonia and respiratory failure. She was not admitted with any ABGs drawn and was not admitted on telemetry (not everyone on our floor has telemetry). She came with her home bipap machine which RT set up-her vital signs were fine, O2 sats were good. Around 5am I went to hang vancomycin and she was sleeping on an off. I went back about 20 minutes later to do something else (cannot remember what now) and the patient was in extreme respiratory distress, obviously fighting to breathe so I go an O2 sat on her and called a rapid response. Her O2 sat was 15% and she started turning blue and became unresponsive. We got a nonrebreather on her in time so she did not code (thank god) and by the time the rapid team got there her sats were bouncing around from 70s-90s. We did an EKG, ABGs, etc. and she was in extreme respiratory acidosis so she was transferred to ICU immediately. Long story short...I'm wondering what I can do in the future to better help patients like this? I just worry that had I not gone in to check that patient 20 minutes after I hung that antibiotic, she could have easily died since she was not on any monitors and was not able to yell for help (she had her call light but she was the most mobile woman because she was over 450lb+). Any advice would be great...I honestly cannot keep thinking about how glad I am that I went back in that room, but I want to make sure that I don't just get lucky next time!

I work on a med tele unit and during the day the nurses typically have 5-6 patients. I work night shifts and we typically have 6-7 patients but can have up to 9...which is so unsafe! As a new grad I would NOT feel safe taking care of 9 patients, and I have no issue letting patient flow know that when they continually let me know that I have admits all night long. It is for the safety of my patients after all!