I had a patients family member who was a doctor come up to me during my shift and stated that they just came to visit her dad and he is not recognizing anyone. The patient did not have dementia, and about thirty minutes earlier I went in and was having a joking conversation with this alert and oriented man. I was concerned so I came in asked him the usual questions, took vitals on him, and all he could tell me was his name, could not keep a conversation. His o2 sat was 81% on 2.5L which it was 95% earlier, and I cannot remember his exact pressure now but it was in the 90's. I work on a rehab unit so we don't have any monitors or anything like that but the pt had been transferred the day before just an hour after newly diagnosed afib. So I knew the 81% might just be are pulse ox reading incorrectly because of his afib. I called the doctor telling him that I was concerned about him not really able to talk to me or recognize his family. The only change in his assessment I could find was his confusion and vitals. The first thing my rehab doctor said to me was well, is the oxygen turned on? After trying to explain the changes in the pt, the doctor cut me off and said ok I get it. The doctor ordered some tests, I called our statcare docs to let them know and our rehab doctor came up in a few minutes. He spoke with the family and assessed the patient. He didn't cancel any of the tests after his assessment. He called the statcare doctors and he sounded concerned on the phone as well when speaking to them. About ten minutes later those doctors came up and sometime between when the rehab doctor came in and assessed them and when they did, the patient became a little more with it and he was speaking clearly. His ABG's came back and were fine and the statcare doctors basically said he was ok. After those doctors left my rehab doctor came to me and said, did you actually see any change in his assessment or did you just call me because of his oxygen sat (he said this in a stern manner). I simply responded yes. But at this point I was confused because obviously he saw a change in him otherwise he would have cancelled the tests after he saw him, and I had been slightly ticked that he asked me earlier if the oxygen was actually turned on because I felt like it was sort of an insult d/t past experiences with this doctor. So about 30 seconds of pondering why would he be so stern and ask me that like I just base things on numbers and not actually my mind I decided to tell the doctor how I felt. I said you know dr. _________ I was not going to say anything but I think you should know that I feel a bit disrespected that you would ask me that in the manner you did and for that matter I feel like you are implying things about my intelligence by asking questions like well was the oxygen turned on. I said it and felt good that I said it because I didn't want to feel walked all over like I had on repeated instances with this man. He said in response no I am insulted that your insulted by asking you that. Your problem is that you take things way to personally. I bit my lip because I felt like maybe he was right. My question to you all is if you had a doctor that repeatedly said things that you felt made you feel like he thought you were not even stupid but lacking any common sense, would you have told them? If so, how should I have said it. I am just very sad because I feel so belittled all the time by the rehab doctors that I work with that I really felt I needed to stick up for myself. Maybe it was a bad example for the doctor that day of how I feel belittled but there seems like there are so many instances that I had to say something. I don't get questions like that from the other statcare doctors I work with, just the rehab doctors. I know he said that I take things personally, and I know I do at times which I don't know how to fix but I know it wasn't just me that felt disresspected by these doctors. I've had many nurses that I work with meintion that when they worked other med-surg floors their opinion was more valued and on our floor it is like we are treated as just pill pushers with no mind of our own. I guess I just want some advice or maybe someone to say feel better cuz right now I feel like crap. It's days like this I start thinking I am just stupid and I am that nurse has no common sense. It gets to the point where I feel like maybe I should rethink my career...like I should go be a bagger at the local supermarket. It really effects my self esteem and I wish it didn't. Any advice? Also, I know this is probably gonna be asked at some point but I've only been a nurse for two and a half years. Thanks for the vent.
sometimes doctors (and many other professionals) are just jerks. Period. Zero personality or compassion or any other social skill. It's unfortunate. I work with a few. They irk me, but I ignore and move on. Good luck. Don't let it bother you.
I had a patients family member who was a doctor come up to me during my shift and stated that they just came to visit her dad and he is not recognizing anyone. The patient did not have dementia, and about thirty minutes earlier I went in and was having a joking conversation with this alert and oriented man. I was concerned so I came in asked him the usual questions, took vitals on him, and all he could tell me was his name, could not keep a conversation. His o2 sat was 81% on 2.5L which it was 95% earlier, and I cannot remember his exact pressure now but it was in the 90's. I work on a rehab unit so we don't have any monitors or anything like that but the pt had been transferred the day before just an hour after newly diagnosed afib. So I knew the 81% might just be are pulse ox reading incorrectly because of his afib. I called the doctor telling him that I was concerned about him not really able to talk to me or recognize his family. The only change in his assessment I could find was his confusion and vitals. The first thing my rehab doctor said to me was well, is the oxygen turned on? After trying to explain the changes in the pt, the doctor cut me off and said ok I get it. The doctor ordered some tests, I called our statcare docs to let them know and our rehab doctor came up in a few minutes. He spoke with the family and assessed the patient. He didn't cancel any of the tests after his assessment. He called the statcare doctors and he sounded concerned on the phone as well when speaking to them. About ten minutes later those doctors came up and sometime between when the rehab doctor came in and assessed them and when they did, the patient became a little more with it and he was speaking clearly. His ABG's came back and were fine and the statcare doctors basically said he was ok. After those doctors left my rehab doctor came to me and said, did you actually see any change in his assessment or did you just call me because of his oxygen sat (he said this in a stern manner). I simply responded yes. But at this point I was confused because obviously he saw a change in him otherwise he would have cancelled the tests after he saw him, and I had been slightly ticked that he asked me earlier if the oxygen was actually turned on because I felt like it was sort of an insult d/t past experiences with this doctor. So about 30 seconds of pondering why would he be so stern and ask me that like I just base things on numbers and not actually my mind I decided to tell the doctor how I felt. I said you know dr. _________ I was not going to say anything but I think you should know that I feel a bit disrespected that you would ask me that in the manner you did and for that matter I feel like you are implying things about my intelligence by asking questions like well was the oxygen turned on. I said it and felt good that I said it because I didn't want to feel walked all over like I had on repeated instances with this man. He said in response no I am insulted that your insulted by asking you that. Your problem is that you take things way to personally. I bit my lip because I felt like maybe he was right. My question to you all is if you had a doctor that repeatedly said things that you felt made you feel like he thought you were not even stupid but lacking any common sense, would you have told them? If so, how should I have said it. I am just very sad because I feel so belittled all the time by the rehab doctors that I work with that I really felt I needed to stick up for myself. Maybe it was a bad example for the doctor that day of how I feel belittled but there seems like there are so many instances that I had to say something. I don't get questions like that from the other statcare doctors I work with, just the rehab doctors. I know he said that I take things personally, and I know I do at times which I don't know how to fix but I know it wasn't just me that felt disresspected by these doctors. I've had many nurses that I work with meintion that when they worked other med-surg floors their opinion was more valued and on our floor it is like we are treated as just pill pushers with no mind of our own. I guess I just want some advice or maybe someone to say feel better cuz right now I feel like crap. It's days like this I start thinking I am just stupid and I am that nurse has no common sense. It gets to the point where I feel like maybe I should rethink my career...like I should go be a bagger at the local supermarket. It really effects my self esteem and I wish it didn't. Any advice? Also, I know this is probably gonna be asked at some point but I've only been a nurse for two and a half years. Thanks for the vent.
by the way, could've been having a TIA. I would have reported these findings as well. When they resolved, great. Great for the patient, but that doesn't change what you assessed/documented. This other doc witnessed this... great that the patient improved.
2. Anytime O2 sats are low, common sense says you increase some to see if that fixes the sat levels.
3. A temporary swing from 81% to 95% is not earth shattering.
4. Physician had a valid question...before you call the physician you need to make sure that the oxygen is STILL connected at all points and the nares are patent.
well the poster is clearly stating this is an obvious initial treatment - oxygen. My impression was that the poster was offended that the doc would ask such a basic question. A simple act that *most* RN's would indeed implement prior to calling the doc.... but then again, some nurses won't put on oxygen without an order, since it's *technically* a med... I don't work on a floor, but common sense always prevails...
Specializes in Trauma Surgery, Nursing Management.
Rather-you did the right thing. Kudos to you for assessing correctly and for calling the doc. Don't let this jackwagon get your goat.
I had a similar situation-the medical director was working with me while I was charge. He and I round together to make sure the ORs are running on time, and then we conference to make decisions about cases that are running late. It is very loud at the charge desk, and he was turning away from me while talking. I have a slight hearing problem from too many concerts, and I couldn't hear him. I said, "Excuse me, what did you say?" He replied, "Let me say it for you real slow." I was like OMG!!! No you did NOT just say that!!! After steaming for a minute, I went to his office and said, "You know, Dr. X, I was really insulted by what you said. I don't have a comprehension problem, I have a hearing problem. So the next time you feel like insulting me, why don't you use proper English? It's SLOWLY." I turned and walked away, leaving his mouth agape. He hasn't done that to me again!
You can only let someone make you feel like an idiot if you let them. YOU know that you aren't an idiot. You did everything by the book, in my opinion. Consider this: what would have happened if you didn't call the docs? What if your patient had done the whole circling the drain routine? I know that we can go all day with the "what ifs", but in this circumstance, you did EXACTLY the right thing. It isn't your job to diagnose what was going on with this patient, it is your job to report changes in status-which is what you did. How could you possibly think that you are a dummy?
Don't let this guy take away your confidence. It is HIS problem, not yours. Now go and have yourself a Merry Christmas!
Specializes in Trauma Surgery, Nursing Management.
1. I call troll.
2. Anytime O2 sats are low, common sense says you increase some to see if that fixes the sat levels.
3. A temporary swing from 81% to 95% is not earth shattering.
4. Physician had a valid question...before you call the physician you need to make sure that the oxygen is STILL connected at all points and the nares are patent.
My concern with a patient in Afib, is he on Coumadin, because when one is in Afib, you are prone to clots, that can cause a stroke; next, I would be concerned that he DID indeed have a stroke, with change in his mental status.
JMHO and my NY $0.02.
Lindarn, RN, BSN, CCRN
Somewhere in the PACNW
That's what I was concerned about the pt and family declined anticoagulation due to the pt's history of major gi bleed that caused him to be in the hospital for 3 months, which then caused him to come to us for deconditioning.
2. Anytime O2 sats are low, common sense says you increase some to see if that fixes the sat levels.
3. A temporary swing from 81% to 95% is not earth shattering.
4. Physician had a valid question...before you call the physician you need to make sure that the oxygen is STILL connected at all points and the nares are patent.
Perhaps you're not experienced with much afib since you're info says you only have 1 year of experience in NICU and postpartum (Neither being realms with lots of afib). But Lindarn is right. If I didn't see a color change, I would think it likely that in a patient with history of afib, it's not so much a desat as the pulse ox not picking up. And whether the guy's got O2 going or not, the worry is it's a stroke because like Lindarn said, afib folks like to make clots and send them up north to the brain.
I'm not sure where you get "troll" from, but before I'd be calling someone a troll, I'd make sure I understand the pathophysiology of the "trollish" issue in question.
Quick question, can someone explain this? We don't get much cardiac stuff on my floor but I'm curious:
"So I knew the 81% might just be are pulse ox reading incorrectly because of his afib"
Why does afib throw off pulse ox? I understand the basic patho of Afib (ie, atria "quivering" instead of a coordinated contraction sending blood to the ventricles), does it just throw off pulse ox b/c the heart beats come irregularly? And if so, wouldn't it 'resolve' if you just left the pulse ox on and watched it for a minute or so?
To the original question though, I'm surprised a bit all the focus on oxygen, O2 sat, etc - seems to me the number one reason I'd have called the MD is acute change in mental status, that's the most ominous sign to me, or, even in the absence of oxygenation issues a change in mental status in my book would warrant a call to the MD. Just my two cents.
quick question, can someone explain this? we don't get much cardiac stuff on my floor but i'm curious:
"so i knew the 81% might just be are pulse ox reading incorrectly because of his afib"
why does afib throw off pulse ox? i understand the basic patho of afib (ie, atria "quivering" instead of a coordinated contraction sending blood to the ventricles), does it just throw off pulse ox b/c the heart beats come irregularly? and if so, wouldn't it 'resolve' if you just left the pulse ox on and watched it for a minute or so?
to the original question though, i'm surprised a bit all the focus on oxygen, o2 sat, etc - seems to me the number one reason i'd have called the md is acute change in mental status, that's the most ominous sign to me, or, even in the absence of oxygenation issues a change in mental status in my book would warrant a call to the md. just my two cents.
a change in ms is definitely of concern.
combine that with a notable drop in o2, is of more concern....clearly, something is going on.
While I don't blame the OP for being offended, I do think she (?) may have taken the situation a bit too personally. I've had patients in stepdown on continuous pulse oximetry suddenly drop their sats into the 70s and been pretty anxious until I found their probe on the floor. It's possible to overlook something obvious in the heat of the moment, and not such a bad idea to make sure all bases are covered before doing anything drastic. Of course, it is also entirely possible to make sure those bases are covered without a condescending attitude.
I'd be more concerned about questioning whether there really were mental changes when the OP reported them. You need to be sure that the doctor will take your observations seriously, and I think it would be entirely correct to emphasize, "When I said I saw mental changes, it was because I saw mental changes." You might even ask if he didn't see mental changes, and if you really feel snippy, remind him that mental changes that resolve can still be a serious problem. I'm a neuro nurse, so my first thought in the case described would be stroke, although you certainly couldn't rule out more generalized hypoxia. When the symptoms resolved, I'd still be thinking TIA, a major warning sign for increased risk for stroke, and I'd also be wondering about a seizure, which could lead to decreased sats. But most of that would be going on after the doc was paged, which was definitely justified.
In a perfect--or even pretty good--world, the nurse should get some respect simply for being a nurse. In reality, leaving your feelings out of it and focusing your discussion on the patient will get you that respect a lot sooner. I'm not saying that's right--just pragmatic.
MassED, BSN, RN
2,636 Posts
sometimes doctors (and many other professionals) are just jerks. Period. Zero personality or compassion or any other social skill. It's unfortunate. I work with a few. They irk me, but I ignore and move on. Good luck. Don't let it bother you.