It was one of those weekends! I had two falls of high risk residents on Saturday night. The Aide had forgotten to set one alarm and just let the other wander away. I lectured her on paying attention and resident safety and that was that. (I don't know what management will do as one required a trip to the ER for some stitches. At any rate, Sunday started well, she was on her game and we were having a great night. I was halfway through my charting when she ran into the nurses station and said the following:
"You are gonna be mad at me, I think she is dead"
It turned out to be a resident who has a tendency to lay down wherever and "play possum" but if I never hear that again it'll be too soon!
Actually, this is possible. I have charted a diastolic of 0 once or twice in my 6 years of nursing. If you are doing the blood pressure manually, sometimes you can hear it all the way down to 0..
Thats not compatible with life. Diastole needs to be a positive pressure to ensure perfusion. Think about what the diastolic represents.
- "He's/ She's on the floor!" - this usually makes me want to cry.
- "Come look at this bruise/skin tear/open area.. it wasn't here last night."
- "He/She wants to speak to the doctor right now!"
- "I have him/her on the toilet and the poop is right there and is not coming out.. can you give him/her an enema"- Bursts my bubble every time.
- "His/her foley fell out"
- "His/her blood pressure is 200/110"
" He/she is refusing to.. *food/toileting/care/heel boots/shower etc*- not flustered that the resident is refusing but more so that the aide thinks I can wave a magic wand and have the resident allow them to do what they refused. I wouldn't mind if they said to me, "Oh by the way mrs so and so refused to be toileted during last rounds." The first thing they tell you in school is the patient has the right to refuse. Which is my response to them every time.
I think I killed Mrs Y. (Vasovagal episode on commode after massive bowel motion)
This one wasn't a fellow CNA, it was a phone call I got from the local police station. "We have a Mr X here, he claims he lives there, can you pick him up please, he's been charged with drink driving on his mobility scooter".
I have a 3 syllable name--apparently the last syllable goes up in tone on the end and becomes drawn out if something is wrong. I've worked 3 places as a RN now and the aides have done it all 3 places. I don't know how many times I've taken off down a hallway from hearing "Tristannaaa!!!"
I also had an aide that would give me odd respers-- like 64. Everytime- even with rechecks, even after I'd tell her that person's norm and then go check it myself and have her check again 2 secs after I left. Sometimes higher than the pulse. I still have no idea what she was counting.
My other fav was the aide that said "she pulled out her IV and her wound vac" (semi-common occurance for this pt) me-"when?" "This morning" It's 1:55pm(aide shift change is at 2) me-"didn't think to tell me sooner?" "You were busy" Thanx for being thoughtful... :)
"i was counting the respirations for your patient in room x and i noticed that he is not breathing." actually i am glad i had that aid that day... the others on that particular floor don't actually count respirations they just write "20" for everyone. so, none of the others would have noticed.
That reminds me of what happened in a place where I use to work many many years ago. Mr. So and So had been dead for a week. However, his name was still on the vital sign list and even though he had been dead for a week his vital signs were normal that day. I said to the DON " This is amazing!Look here- He has been dead for a week but his vital signs are still normal" The DON turned bright red and became absolutely furious. I thought she was going to have a stroke! She angrily stormed off searching for whoever had done those vital signs.
PunkBenRN
92 Posts
Thats not compatible with life. Diastole needs to be a positive pressure to ensure perfusion. Think about what the diastolic represents.