Treat the Patient, not the Monitor.....Really?

[jk2185]

This is my least favorite "go-to" that I hear all to often. Why even have monitoring in the first place? I trust the monitors more than my own ability to intuitively know a patient's condition based on my limited assessment skills; and just to ward off evil comments spawning from this notion I want to remind everyone that we all have limited assessment skills, our senses can only do so much. And of course, if your monitor screams asystole or vfib and your patient is smiling at you politely asking for more apple juice, I do hope that we all know to check lead placement or something.

We didn't have numbers 100 years ago and look what kind of healthcare we had...not the greatest.

I just wish we could flush this saying out or maybe change it.

[FolksBtrippin, BSN, RN]

I think the OP is just too experienced for the statement "Treat the patient not the monitor" to apply. You only need to hear it when you're a n00b like me.

And then it's very helpful to remember to delay freak out until you actually see the patient.

[Ruby Vee, BSN]

"Look at the patient, not the monitor" doesn't work for me either. I've seen plenty of patients that look fine chatting away with a CI of 1.8 or an SBP around 200. So...as long as my equipment is calibrated correctly and not being assessed by someone who doesn't know how to properly use the devices, more often than not, I believe what my monitor tells me 100%.

Your story is interesting and it sounds like it made for a terribly stressful day. Seems to me there may have been a failure in protocols. Did anyone check a pulse or responsiveness? Even if a monitor shows a shockable rhythm you still follow the BLS survey first. It also seems odd that the monitor in room A (which was presumably hooked directly up to the patient in room A) would show data from a different room. I'm no IT guy for sure, just seems very odd.

I'd say my point of view only works if you know what you are doing. It doesn't work if you put the wrong size BP cuff on a patient, or if you have bubbles in your pressure lines, or if you don't check your patient's pulse and responsiveness when you have some strange artifact that often does look fib-ish.

I just find this old expression to be only mildly useful. Of course you use your intuition and assessment skills, but the notion that you should treat based on what you see over data drawn from high-tech equipment seems a little over the top.

I think treating the patient and the monitor should be on an equal plane....use all the data you can get.

There was a failure in wiring two adjacent rooms during the construction process. The monitors were on the shared wall, and the wiring got crossed. I'm not an IT person, either, but if you've ever seen some of the mess in the walls you might get how it could happen.

Your point of view sounds to me like the point of view of an inexperienced nurse without fully developed assessment skills. An experienced nurse can walk into the room and engage of less than a minute of chit chat with a patient and walk away knowing respiratory status, rough perfusion status and mental status. If the monitor tells me there's badness going on and the patient looks fine, that means I have time to do a full assessment and figure out the dichotomy. If the patient looks less than fine, it doesn't matter what the monitor shows.

[Ruby Vee, BSN]

Well no duh!!! Of course if your patient looks horrid and the monitor doesn't reflect that you should most definitely perk up and do some investigating.

Im regretting this post!

Your assessment skills can fail you just as badly as a monitor can, we have to use ALL THE DATA at our disposal.

Again, you seem inexperienced. An experienced nurse with good assessment skills will find the monitor's information failing her more often than her own assessment skills. Perhaps your mileage is varying?

[Ruby Vee, BSN]

I think the OP is just too experienced for the statement "Treat the patient not the monitor" to apply. You only need to hear it when you're a n00b like me.

And then it's very helpful to remember to delay freak out until you actually see the patient.

On the contrary; I don't think the OP's assessment skills have matured to the point where he can trust them more than he trusts the tech. It will come. If indeed he has the six years of experience he claims, it's a good start.

[quazar]

In the OP's defense, when I was a new nurse, I relied heavily on the monitors (fetal monitors, bear in mind), as my spidey sense wasn't well honed yet, and 99.9% of our patients were medicated, anesthetized, and on monitors. It wasn't until I moved on to another hospital where monitors were not so heavily used that I learned to actually asses the patient and really take in the bigger picture. Being at a hospital where the culture was very much "monitor, monitor, monitor" sort of stunted the growth of my assessment skills, and they didn't branch out until I got away from that culture.

Now that I'm old and crusty, of course, I function differently, but it took a while to really fine tune those skills and gain that confidence.

[calivianya, BSN, RN]

This actually annoys me, too. The monitor will often give you clues well before the patient does.

The best example I can think of is a sudden widening of the QRS complex. If the patient has been mottled, cyanotic, and totally unresponsive for hours with barely palpable pulses, just looking at the patient isn't going to tell you that the death is going to happen in the next few minutes vs. the next hour. All your spidey senses are going to tell you is that the patient is absolutely going to die, but you don't know when.

The monitor can give you a more precise timeline. I have seen many people widen out their QRS before they code. Once you see that change, you know that is EMERGENT, you can call and get some bicarb, and have fun watching the patient's QRS return to normal, at least while those amps are circulating. That's at least an extra 30 minutes you just bought the patient that you wouldn't have if you hadn't been paying careful attention to the monitor.

[TLSpaz, ASN, RN]

...or maybe change it.

"Treat the monitor AND the patient" is what I was taught. I recently had an 86 year old female with a heart rate of 32. She was sent over from her PCP's office. Her only complaint was "I just feel really tired."

[KatieMI, BSN, MSN, RN]

This actually annoys me, too. The monitor will often give you clues well before the patient does.

The best example I can think of is a sudden widening of the QRS complex. If the patient has been mottled, cyanotic, and totally unresponsive for hours with barely palpable pulses, just looking at the patient isn't going to tell you that the death is going to happen in the next few minutes vs. the next hour. All your spidey senses are going to tell you is that the patient is absolutely going to die, but you don't know when.

The monitor can give you a more precise timeline. I have seen many people widen out their QRS before they code. Once you see that change, you know that is EMERGENT, you can call and get some bicarb, and have fun watching the patient's QRS return to normal, at least while those amps are circulating. That's at least an extra 30 minutes you just bought the patient that you wouldn't have if you hadn't been paying careful attention to the monitor.

Seeing the line is nice, but when patient is already mottled with no peripheral pulses to speak of all hands should be on board already unless he is DNR. The thing is how to catch the coming crisis before he got cold and mottled, if possible, and attempt to buy a few more hours or even days. It sure would be cool to have instant ABGs and lactate readings at any time but I doubt it can be done. Plus, most of patients receive at least some meds which change monitor data, sometimes to the point of the loss of reliability. I'd seen people going to acute shock with no tachycardia, or much less of it than one would expect, due to full b1 blockade. This is leaving alone pacers, which become more and more common, and underlying pathology like cardiomyopathy and past surgeries (often cause "fixed conduction pathways" due to injury to conduction system of the heart; the ECG will look the same till literally the last moment; type of people who die on streets from "sudden" Vfib/Vtach).

One of my last clinical days, I had to practically drag an RN to the room of patient breathing with 90 sec pauses in Chain-Stocks pattern. She pointed on monitor, where there were no changes due to dual-chamber pacer working properly, and BP was at perfect "norm" of 122/73 or so (unregulated hypertension at baseline) and calmly went about her other business saying that she would see the patient in a little. She had a rude awakening in that very little seeing Rapid Responce squad running down there.

[ED_Murse]

The way I see it, the saying is more of a reminder to remember to assess your patient - they're not just a bunch of numbers on a screen, and a manual pulse will give you so much more than the screen will.

[Horseshoe, BSN, RN]

Seeing the line is nice, but when patient is already mottled with no peripheral pulses to speak of all hands should be on board already unless he is DNR. The thing is how to catch the coming crisis before he got cold and mottled, if possible, and attempt to buy a few more hours or even days. It sure would be cool to have instant ABGs and lactate readings at any time but I doubt it can be done. Plus, most of patients receive at least some meds which change monitor data, sometimes to the point of the loss of reliability. I'd seen people going to acute shock with no tachycardia, or much less of it than one would expect, due to full b1 blockade. This is leaving alone pacers, which become more and more common, and underlying pathology like cardiomyopathy and past surgeries (often cause "fixed conduction pathways" due to injury to conduction system of the heart; the ECG will look the same till literally the last moment; type of people who die on streets from "sudden" Vfib/Vtach).

One of my last clinical days, I had to practically drag an RN to the room of patient breathing with 90 sec pauses in Chain-Stocks pattern. She pointed on monitor, where there were no changes due to dual-chamber pacer working properly, and BP was at perfect "norm" of 122/73 or so (unregulated hypertension at baseline) and calmly went about her other business saying that she would see the patient in a little. She had a rude awakening in that very little seeing Rapid Responce squad running down there.

It appears that your auto correct is being really hyper.

It should say "Cheyne-Stokes pattern".

[RunnerNurse09, BSN, RN]

The saying itself truly varies. If someone is having a potentially life-threatening arrhythmia, like sustained vtach, its not something to ignore, not matter how well the patient feels. However if someone throws a couple of PVCs and is asymptomatic, it really isnt anything to get your panties in a wod over. However some people can have PVCs and get very dizzy and lightheaded. So in that case if it really affects their ability to function, then its an issue.

[KatieMI, BSN, MSN, RN]

@ Horseshoe,

.... well, it was a good reason to figure out, at last, how the darn thing can be turned off for good, thanks!