lmccrn62, MSN, RN 384 Posts Specializes in Pain, critical care, administration, med. Mar 8, 2014 Another thought and experience with a patient was a patient in a sub acute facility. There for a new BKA. He has horrible DM amongst other issues. I was asked to see him by the NA because he was swollen. The attending saw him 2 days prior and ordered him to see renal and increased his Lasix. He also had a questionable CXR. The doctor wrote he was better. The patient had generalized edema a 30lb weight gain in 2weeks. Lungs were wheezes and rales. He was SOB he said for at least a week. His O2 sats were in the 80's. So to the ER I sent him. Why because he needed to be there and he was admitted. I had a second lady at subacute rehabbing after a CABG when I saw her her lungs had bilateral rales. Could have been effusion as often seen after CABG. I ordered labs and X-ray even though she looked good. BNP 800 and CXR showed CHF. The same doctor as above saw her and wrote lungs clear. She was treated and now getting better follow up. At this point we avoided a readmission. So being able use critical thinking and good assessment skills is key. Not sure extra clinical hours do that or even a residency.