Sure signs your pt. is sick

Specialties Emergency

Published

i'm new to nursing and working in an ER and just starting to pick up on the more obvious signs that my pt. is sick.

-chief complaint: apnea

additional obvious additions are welcome

dan

Larry77, RN

1,158 Posts

Specializes in Trauma/ED.

The best sign that your patient is sick is after you've worked the ED for awhile you have this sixth sense that causes the hairs on the back of your neck to stand up.

Just the other day I had a nurse come up to my desk and tell me, "I just have a feeling about room 1"...next thing you know in CT he has a run of VT and gets shocked, then ended up with 4 stents. Now this patient had great vitals, rhythm looked great, labs looked great, but she had a "feeling"...so we kept doing tests and thankfully delayed his admit to the floor.

Otherwise, you can usually tell if a patient is "sick" from across the room, the color, the expression, etc.

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Apnea is a very late sign.

GilaRRT

1,905 Posts

Elevated serum lactate. The definitive sign of shock.

Specializes in Med-Surg/Oncology.

There are very few "sure" signs that a pt is sick because the outward expression of illness varies greatly from person to person and its manifestation can be changed by anything from the pt's pain tolerance to their culture. The very few "universal" signs that exist are usually very late signs, as the poster above commented, and are usually very ominous.

Most, if not all, nurses are born with that sixth sense (as the previous poster also mentioned) - you have it from birth but it is only through experience that you strengthen it. In nursing you should always go with your gut feeling about your pt if you believe something is wrong, even if all other signs point to them being fine - its always better to overreact about a pt's condition than to shrug it off, you could very well save their life.

Some things that SOME patients may present with when ill are things like alterations in vital signs (high BP could indicate anything from pain to circulatory problems, low BP could indicate anything from shock to overdose of BP or other medication, etc), alterations in neurovascular things (pinpoint or fixed dilated pupils, lack of sensation in extremities, etc), pallor or flushing of the face or body, etc. You will learn to immediately notice when a pt does not look "normal" but remember that normal is completely relative... What is not normal for a healthy individual could be an ill person's "baseline", how they look all the time due to a preexisting illness (persons with COPD can have cyanotic fingers or toes or lips, and that may be normal for them depending on the stage of their disease).

The best way to determine if someone is feeling ill, in pain, or "feeling funny" is to talk to them, get their history, ask them why they came in today. Communication is essential, and remember that the pt will ALWAYS know what is normal and not normal for them!

catshowlady

393 Posts

Specializes in ICU.

From an ICU perspective: The more pumps and channels running, the sicker the pt. 1 pump, 1-2 channels = not very sick; 1 pump, 4 channels or 2 pumps, 5-7 channels, kinda sick; 3 pumps, 8-12 channels = SICK!

More than one pressor running = sick.

Needing more than one central line = sick.

In my unit (not a major teaching hosp or massive regional center), having a swan = sick unless a post open heart pt.

And I also agree, if the alarm bells are going off in your head and the hair on the back of your neck is tingling, pay attention.

Whispera, MSN, RN

3,458 Posts

Specializes in psych, addictions, hospice, education.

What do you mean by "sick"? I think I'm missing something here...but if a patient comes to the ER, that's a really big sign he/she is sick! Did you mean something more?

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
Elevated serum lactate. The definitive sign of shock.

True, but another late sign.

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.
From an ICU perspective: The more pumps and channels running, the sicker the pt. 1 pump, 1-2 channels = not very sick; 1 pump, 4 channels or 2 pumps, 5-7 channels, kinda sick; 3 pumps, 8-12 channels = SICK!

More than one pressor running = sick.

Needing more than one central line = sick.

In my unit (not a major teaching hosp or massive regional center), having a swan = sick unless a post open heart pt.

And I also agree, if the alarm bells are going off in your head and the hair on the back of your neck is tingling, pay attention.

I am thinking he wants to catch them before they end up on Leave-em-dead.

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

Go with your gut.

Don't dismiss complaints. INVESTIGATE (caught an MI before when a diabetic woman complained of pinky pain in the RIGHT HAND).

OBSERVE: Alertness, changes in patterns of breathing, slow drop in vitals especially SMALL i.e. SPO2 was 97 and how 92 over a period of time, not suddenly.

QUESTION everything out of the norm.

Be AWARE.

Don't PRESUME, ASSUME, etc.,

CHECK and RECHECK.

Those are simple things; but trust me many, many HCPs miss the signs of things that progress just because they take things for granted. Don't wait for the late signs. Too late to get them back if they are truly, truly sick.

Be_Moore

264 Posts

Specializes in Pulmonary, MICU.

The "Q" sign.

Larry77, RN

1,158 Posts

Specializes in Trauma/ED.
What do you mean by "sick"? I think I'm missing something here...but if a patient comes to the ER, that's a really big sign he/she is sick! Did you mean something more?

LOL...all patients in the ED are "sick"??? You must not work in the ED...are all patients on psych "crazy"?

+ Add a Comment

By using the site, you agree with our Policies. X