This past weekend I had an oncology patient who was a full code. In the early morning hours about 0500 I was getting qshift VS and this patient's heartrate was 41. I looked at his chart and he was typically running in the 50's. B/P was normal. Patient denied, SOB, dyspnea, dizziness, palpitations, and CP. I spoke with my charge nurse and we decided to put him on tele to keep an eye on him. Well, it wasn't long until he started dipping down into the 30's and staying there. I called the attending which was his Oncologist and he ordered 1mg Atropine IV, I administered the drug and his heart rate came up into the 60's but by the time I was giving report to the dayshift nurse he was starting to dip down into the low 40's again. That day he had a cardiology consult, the cardiologist ordered a BNP and cardiac enzymes. That night I recieved report, labs hadn't come in yet and he was maintaining a HR of about 40. A couple hours into the shift his heart rate was averaging 25, labs came back his BNP was 970, suggesting CHF, and his enzymes were normal. Patient again was asymtomatic, B/p WNL etc. I paged his attending and notified him of the situation, he was going to order Atropine again, I told him it had been minimally effective last time so he told me to page the cardiologist. I did so, and he became very agitated with me stating, "He's asymptomatic, so I don't know what you want me to do." I stressed to him once again what his HR was, what his BNP was, that he was a Full code, etc. Finally he told me to call the oncologist to see if we could transfer him to PCU and the oncologist agreed. We immedidately transferred him he had a scheduled 2100 of Oxycodone which I did NOT administer because my charge nurse and I both felt it could cause his HR to drop even more. Once he was transferred I get a call from the PCU nurse, chewing me out for not giving this 2100, stating "He has cancer and is in pain he NEEDS his pain medicine, I don't understand why you didn't give it to him." I explained to her why, she continued to rant, until I cut her off and told her he was her patient now she could do what she wanted. Of course I didn't want him to be in pain but at the same time I didn't want to kill him either, was I in the right?
.png.1246e5be8d684efc6a7b2cd047f7b9e7.png)
