1st Time a pt went bad

[BlearnRN]

I was exhausted to tears yesterday.

A pt of mine who was a post op craniotomy day #5 went bad. It started out slow. He had a temp in the early am then by 11 a his temp was 100.8 tympanic. Of course I notified the doc right away and gave tylenol. Then I go back in and this pt was shaking and crying. - Bad for ICP - Notified doc and she came in. Gave 1mg ativan. Pt stopped shaking and calmed down. Called back into pt room so pt could use urinal. Pt had a hard time and missed. That wasn't normal for this pt, then I noticed blood on pt urethra and called doctor to beside again. Then I took pt temp again 102.9 tympanic. Called doctor to bedside again order to give tylenol.

While we were both in the room the pt vomited. I waited

for about 2 seconds to see what the doctor wanted. She just had a surprised scared look on her face. I said can we give the pt Zofran? A pile of my collegues show up from the woodwork - thank God! - and start helping me out. Then It was like I was running the show. Doctor was asking me how much zofran, nurses were asking me what I needed.----It was crazy!!!!

Wegot the pt 4mg ivp zofran and tylenol suppository, hooked him up to IVF. FYI this is not an ICU floor. But, we ended up sending him to one. Then of course it was change of shift. I gave report on all my pts. But was still activly involved with this one. I even offered to give report to the ICU. The nurse said no,....its okay....thanks for offering. Then I look in the computer and see that the pt pressure was 83/42 - jumped up and ask the nurse if she knew. She said yes and she was giving a bolus. She then explained to me that when I temp is that high you have to check th BP not just the temp. Oh crap, I didn't know. She said that it was okay but now I know. Then transport came and I helped get the pt on the cart.

--If anyone has some advice for a basically new RN on this situation or any other situation, please reply-

[AprilRNhere]

Wow...no advice but Kudos to you. Sounds like you handled it really well.

[Spatialized]

Sounds like you did great. Only other thing I would have been doing is checking on HR and BP - looking for sepsis with a temp. that high. I think you always remember the first one to go south, but you learn from them all.

Cheers,

Tom

[Glad2BAnurse]

Sounds like you did a great job.!Don't beat yourself up over this. You are going to have good days and bad days. The main thing is that you noticed the patients health declining and you took action. Remember to Always monitor patients vital signs closely. Best of Luck

[tamari07]

I work on a neuro floor and deal with crani's all the time... sounds like you did all you could do... I'm surprised they waited as long as they did to send this pt. to the unit. I'm sure as you know, neuro patients never go bad suddenly. Sounds like you took charge and did a great job... congrats!:)