The other night I had a patient that had me worried from the moment I got report. He was a young guy with a history of COPD, MI, smoking and ETOH, admitted for pneumonia.
Clinical picture, his pressures were fine, in the 130s systolic. Respiratory rate was 24-28, sustaining sats in the 90s on 2L NC. BUT he was tachy, in the one fourties sustained, febrile at 39C, his lactate was elevated, bowel tones hypoactive and poor appetite, and he was anxious.
Blood cultures were still out, but I knew this guy was septic and headed down a bad path. I called the MD with my assessment findings of elevated body temp and tachycardia, gave pressure and RR, and the MD said he only wants to know if the blood pressure drops and the patient has respiratory distress. No specific parameters. He gave me an order for APAP "if it will make you feel better".
I went to my charge nurse and told him my concerns, the doc's response, and asked if he would come take a look at the patient himself, which he did. CN tells me just to keep watching; that he doesn't want the patient to look any worse than he does, and when he starts to sustain a RR in the 30s, it's time to do something.
So, I watched. And waited. I knew. It wasn't til the end of my shift that things started to turn (of course!!!!).
The pressures had started to trend down even though the patient was getting fluids at 200mL/hr (lowest systolic was 118), HR was sustained in the 140s despite 2g of IV mag. Temp was holding steady at 39. UOP was low. Work of respiration increasing, but still not "distress". I called respiratory to come take a look and give me their opinion. This guy, IMO, was textbook septic shock-SIRS-ARDS-MODS material. Still not time to call the doc, but getting closer.....
So, in report, I passed it on. Had no choice, it was time to go, the patient was starting to turn but hadn't turned yet. I told the oncoming nurse "You need to watch this guy like a hawk. He *will* be going sour.".
I come in today and find out, oh....he was transferred up to ICU in the night. SURPRISE!
I was just dying to look up his chart on the computer to find out what specifically had happened, but I restrained myself. HIPAA, after all.
Wow that's really tough especially if the patients will be coming back to you post ICU. The one thing that I do like is checking up on my patients to see how they are doing.
If they're coming back, then ICU will give you a report. Checking up on former patients to see how they're doing is violating privacy.
If they're coming back, then ICU will give you a report. Checking up on former patients to see how they're doing is violating privacy.
This is true.
The only time I have popped my head in to say hello to a former patient has been a couple of times, when I took care of someone the night before their open heart surgery. I might pop my head in to their room a couple of days post op to say hello and give them some encouragement, but I am not looking in their chart nor asking any questions related to their medical status. Plus they are on the same unit where I work, so I am not going to another unit to seek them out. And of course, I only say hello from the doorway, and only if the door is open. I do not knock on closed doors nor enter the room unless invited. Usually if I do see a former patient, it's when they're ambulating in the halls, and they seek out all the nurses they know to say hello.
The only time I have popped my head in to say hello to a former patient has been a couple of times, when I took care of someone the night before their open heart surgery. I might pop my head in to their room a couple of days post op to say hello and give them some encouragement, but I am not looking in their chart nor asking any questions related to their medical status. Plus they are on the same unit where I work, so I am not going to another unit to seek them out. And of course, I only say hello from the doorway, and only if the door is open. I do not knock on closed doors nor enter the room unless invited. Usually if I do see a former patient, it's when they're ambulating in the halls, and they seek out all the nurses they know to say hello.
I agree; I've had patients have mention me or asked to see me, I take that as permission to stop in and say 'hello' if appropriate. In my specialty, we will see them on repeated admissions in any case.
EmmaG, RN
2,999 Posts