Really bad day.

[AmIsmartenuff]

I am a second semester student, and I made a big error. I had a client with metastatic brain cancer with unknown origin, and history of hypertension. Client had been confused and lethargic the day before, and had a lung biopsy and was npo for about 30 hours, including no anti-seizure meds or antihypertensives. Upon arriving to the unit, I was told not to take vitals, they were just taken. But the staff nurse wanted me to change her bed sheets. I decided to change her sheets then get vitals, before I could do that x-ray came to get client. Went with her down to xray where I immediately noticed Left sided arm strength was greatly diminished and client could not answer my questions. Back on the unit after chest xray, client was tearing up and whimpering, I asked if she had pain, her response was yes, although she couldn't respond to where or pain scale. I took vitals and all were within normal limits, except bp 145/107. I rechecked bp manually 142/105. Then looked at flow sheet diastolic had been elevated 100-102 all night. Still no fluids or meds. I assessed and noted dry mucosa, dry skin, cracking lips, no pupil reaction, no accomadation, couldn't follow six cardinal signs of gaze. Went to tell staff nurse and instructor, followed staff nurse down the hall to her other patients room (this patient was coughing, in pain, and bleeding from the nose) to tell her my client was in pain and my other assessments. This is where it gets bad, told her everything but forgot to tell her high diastolic. Continued to check on patient, pain was getting worse client was now holding left side, and about 2 hours later, I finally got the staff nurse to give pain meds, did vitals bp was 135/93. Told instructor I was concerned client wasn't getting fluids or meds. Wanted to know why, so I asked staff nurse and got no response. I continued the rest of my clinical, feeling very uneasy. Got home and my instructor called and asked me did I report a high diastolic to staff nurse... All I could say was no I forgot. Sick to my stomach, what if client seized, should I really be a nurse?

[ckh23, BSN, RN]

Calm down and take a deep breath. You should have explained to them the high diastolic, but in all honesty if they had been trending that way all night the nurse should have already been aware. The pain was the most likely culprit as the the BP decreased after meds. As to why they were not getting fluids...who knows. Generally patients that are NPO for procedures get some type of maintenance fluid, but there might be something else going on that contraindicates it.

Take this for what it is, a learning experience.

[AmIsmartenuff]

I definitely learned from my mistake, and will never repeat it. I knew nurses had the hardest job on the planet, it is amazing watching them keep it all together. Deep breathing helps!

[nurseprnRN, BSN, RN]

her vs weren't changed from the night shift's measurements, and the nurse already knew those. sure, you should have told her what they were...and she should have asked you.

look up cushing's triad and see if that helps you understand what's going on here. they might have been deliberately dehydrating her a bit for a reason, and holding her meds for a reason. i'm not thinking of good ones either way, and i'm not liking that the nurse couldn't tell you when you asked, but i don't see you did anything majorly wrong, really.

you might consider taking vs before you change sheets, so you get your patient at some sort of resting baseline. take them after to see what happens after you toss them around a little bit.

[Double-Helix, BSN, RN]

To add to what the others said, even if a nursing student is assigned to a patient, it's still the responsibility of the nurse to care for that patient. That means that the staff nurse should have been checking what the vitals were and doing her own assessments. You're a student, for goodness sake. You're learning. You aren't expected to know everything, and the nurse should not be relying on your information as an accurate report of the patient's status.

No offense, but I know how much stuff I missed when I was a student. I don't ever just take a student's work for it. If they tell me they found something abnormal, I will go and assess for myself. I make sure I know what the vitals are when they are taken. And if they tell me the patient is fine and everything is normal, you better believe I'm going to verify that for myself.

So learn from the experience. Yes, it's important to report abnormal vitals, but you went through all the correct steps that an RN would, recognizing an abnormal value, rechecking manually, comparing to past results and assessing the patient. I can't tell you how many times I've seen nursing students come out of a room and say, "The baby's blood pressure is 130/90!" and then I go in the room and find that they were taking the pressure on a screaming child who is kicking like crazy. So yes, let this remind you to always report vitals out of the normal range. But let it also remind you that, when you are a nurse, make sure you're checking on your patients yourself, even when they have a student assigned.

[AmIsmartenuff]

Wow, I have so much to learn. Thanks for the support and helping me put things into perspective. I reviewed Cushing's Triad and I have a much better understanding of what the doctor might have been thinking. I also learned a great deal about my weaknesses, I just really want to be a great nurse someday.

[PinkNBlue, BSN, RN]

I just really want to be a great nurse someday.

You will be. It takes experience :) If nursing were easy, everyone would be doing it. :)