That nagging feeling...

[dudette10]

Ever walk into a room and think, "Something isn't quite right?" I'm sure you have, and I personally hate that feeling. I want to know WHY I feel that way, and sometimes, I don't! There isn't enough there to call a rapid response, and I often wish there was something--anything--to justify that nagging feeling...

A patient I had today gave me that awful feeling. I eventually acted upon it, and an ICU eval was in progress as I clocked out.

Ever just go, "Oh, I'm just gonna make the call and see what comes of it"? I hemmed and hawed on this guy until I made the call. I figured, "My job is to monitor and know when something isn't right; it's the docs' job to figure out what it is."

Give an example of when something "just wasn't right," and tell me how it turned out.

[nurseprnRN, BSN, RN]

Many, many years ago. Patient in isolation post transplant, I've learned from him that he didn't tell them preop that he'd had a gastric ulcer because he thought he wouldn't get the transplant if he did, and now he's stressed and on a lot of prednisone. He has really, really bad pain and a taut belly, and I can't get anybody to come see him. Finally I saw the chief of the service in the hall on my way to lunch and told him none of his residents are doing anything. Next thing you know the chief of GI is gowning up to see my guy and tapping his abdomen ....and getting pus and gastric contents. We both turned away and were glad we were wearing masks so he couldn't see out faces, because we knew what that meant... he had perforated his stomach and dies some days later of generalized sepsis due to his immunocompromised state. Dammitol.

Year later I was working agency and had a kid in a community hospital with CHF, about 26. I had worked in heart transplant and told the doc I thought the kid looked like he should be referred to the U for a workup. He pooh-poohed me but I played dumb and wrote my nursing note (S3, S4, 120mg of furosemide makes for 45cc of pee, wet chest, JVD, huge PMI...) in the PHYSICIAN's notes pages ("Really? I'm sorry. At the U we all use the same pages, it's better for communication...") Two days later I was at the U, and there was my boy, waiting for a new one.

Last story, same community hospital. 60ish guy with sharp mid-scapular pain, ruled out for MI. I begged and begged for them to do an US to look for what I was pretty sure was a dissection in his arch, but all I could get was an abdominal US, and that didn't look up high enough. Of course he was dissecting his arch, and died when it finally blew in the ambulance taking him to the U about six hours later.

[annaotis]

Had a twenty something patient that I had been taking care of for a couple of months. He was funny, sweet, always even tempered despite his hospitalization. Had assessed him just two hours earlier, he was fine. I walked into his room to see him and he was a "little cranky". That's it. Alarms went off in my head! Immediately took his BP, he was crashing. Called a code, he was vented and passed away several days later.

[nrsang97, BSN, RN]

There's a reason our hospital has "gut feeling something is wrong" on the list of reasons nurses can call for the emergency response team. Sometimes we "just know".

Ours is listed as "Staff concern".

[nrsang97, BSN, RN]

"There isn't enough to call rapid response"

I'm a Rapid Response nurse in an urban trauma hospital. From my perspective there's never a bad reason to call me. If you get a feeling, let me know and I'll come see your patient.

If you're right hopefully we can intervene early and get a good outcome.

If you're wrong (or maybe right but I don't see it yet) then at least the patient is on my radar and I can keep an eye on them.

So call me. I won't be mad and we might all be glad you did. I'll take 100 false alarms to prevent one code.

And if if someone tells you they think they're dying, tell me so that I can RUN.

Exactly. I feel the same way as an RRT nurse.

[explorereb96, ADN, BSN]

I, myself had "that feeling of impending doom," It's no joke. I was at home burping and burping ...then came the pain between my shoulder blades that crawled up my neck. My husband was wondering "what all the gas was about" I turned to him and said "if you don't take me to the hospital now, I am going to die" I was dead serious and he knew it. That FEELING. I can't imagine that people actually ignore it, but some do.

[thevez]

We got a burn in. 40%ish. He is a little drunk but many of our patients are. Denied a drinking or DT history. But I can spot a fellow drunk from a mile away. We admit as ICU and I am telling everyone that will listen that we need an aggressive AWAS order set because he is going to DT really hard. No one listens. He started seizing about 36 hours in.

What does DT and AWAS mean? thank you.

[thevez]

I've had this situation where my patient kept saying she's weak to the point that she couldn't do therapy. I scratched my head and went back to her history. She has history of hypokalemia, checked her recent labs, it was admission labs, and they were normal. But still, it didn't budge my gut feeling that there is something wrong with this patient and my gut said to check her potassium asap. Talked to the doctor right away, got an order for i stat chem 8 and like what my gut said the patient's K was critical low. Got an order for potassium right away. Patient started feeling better after a few days.

[wanderlustnurse88, RN]

I would rather walk down the hall to check on my pt 10 times just from that nagging feeling then to sit and wait for it to happen.

[typoagain]

My first time was one of the first nights I ever charged. It was a slow night on pedi-only 3 pts on the floor.

One of them just did not look right and I had no idea why.

Pt was in for RSV.

Had both the house-super look at her and the RT. No one could ever find anything wrong.

Finally at 03:00 I called the MD. I said I needed her to come in and look at pt. I had no idea what was wrong but something was not right. All she said was that she would be there in 15 minutes.

She went into the pts room, came back 30 minutes later and ordered a bunch of tests.

By noon the next day we had transported the pt 350 miles and the pts was having open heart surgery for a congenital defect.

Now I always LISTEN to that nagging little voice.

I have gotten griped out a few times, but I still listen!

It has been right often enough that I will always listen.

[typoagain]

If I ever have a fear about meds, I toss theright away and start over. Noone has ever faulted me for that.

[guest769224]

A few months ago the ICU charge nurse and I ran to a rapid response call on the cardiac step-down unit.

The patient was breathing very rapidly, was restless, and kept repeating "I feel like something bad is going to happen, I have a feeling of doom".

This was at 3 AM in the morning. They ran a bunch of tests and vitals were normal. The supervisor decided to move him to the ICU anyhow.

30 minutes later he went into cardiac arrest, and we intubated. It made me feel bad for him, seeing him so flustered and then having that happen.

The charge nurse taught me, "never ignore a patient when they state they have that feeling. Most times, they are not faking it."

[klone, MSN, RN]

I remember working in L&D. Healthy early 20s woman, just had a normal spontaneous vag delivery, no complications. A few minutes later she said "I feel like I'm going to die." Boy, did that get everyone's attention. Minutes later she started hemorrhaging. She went into DIC. We suspected amniotic fluid embolus. She survived, though.