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.

[Sunflowerinsc, ADN, RN]

And not just LOOK at the patient, talk to him, touch him. I've seen nurses look at the monitor and go on with out a glance to the real person. You can tell a lot also just by touching a person's arm . The monitor will tell you a lot but it has to match to how the patient really really feeling. Ask ,don't just look.

[KatieMI, BSN, MSN, RN]

Would you disregard any other piece of information on your patient Just because your assessment showed otherwise? Or would you dig deeper?.

Would you dig deeper if the patient, who is sitting very comfortably, eating Cheerios and playing on his phone casually tells you that he has left-sided chest pain, 100/10, just like he did the night before, and the night before, and then every single day around 8 PM? BP 145/85, HR 91, RR 14, synus rhythm by tele, just came back from long smoking break, known h/o opioid abuse, ETOH and HTN with non-compliance? (you do quick assessment and it is totally negative; meanwhile, the guy asks you for a date while still complaining on 100/10 pain?)

Would you dig deeper on 42 y/o female, BP 89/50 HR 105, RR 16, SaO2 100% on room air, synus tach by tele, comfortably walking and itching all around because she just got non-fatal allergic reaction in a restaurant; reaction did not require EpiPen, she just got her Benadyl, Pepsid and methylprednizolone IV load and now very politely asking you if she could sit there for a little more because she's afraid to drive too soon after Benadryl?

(if you do, please do not jump up with fluids before you know her baseline pressure. It is 90/60, and the last thing she and you both want is fluid overload and edema).

Would you dig deeper on a patient with known COPD, HR 92, BP 150/90, RR 21, SaO2 95% on room air, 100%on 2 L nasal cannula, temp 98.9, a few wheezes here and there, dry cough, feels "great" and walks about; your assessment is the same as it was 6 hours ago; he was started on Solu-Medrol 48 hours ago, now lab is calling you with "critical value" of WBCs of 23.2?

On any of these three guys, "digging deeper" would bring 99% chance it will be useless and only lead to "protective" (read: unnecessary and expensive) care. In the first case, it probably would be inevitable to certain degree; for the last one, it may potentially hurt (if the numbers would be wrongly interpreted as SIRS/sepsis, the patient will get unnecessary wide-spectrum antibiotics).

.

[akulahawkRN, ADN, RN, EMT-P]

...So I think it is important to remember that every patient is in fact very different and all assessments must be taken into consideration when using critical thinking and taking action.

Would you disregard any other piece of information on your patient Just because your assessment showed otherwise? Or would you dig deeper?...

it should instead just say "treat the patient." And leave the treatment plan up to the nurse and her resources.

I'm more of a fan of the saying "Treat the patient, not just the monitor." You have to have both, and know when to apply what weight to each side of the equation when doing patient care. A couple weeks ago I had a patient that was new to the department, came in by ambulance. This patient was a bit tired but otherwise OK. Unknown to me at the time, this patient had some COPD. Every time the patient would nod off, their SpO2 numbers would drop a bit, into the mid 80's from about 91-ish. So I put this patient on a small amount of oxygen, which brought things back up. However when this patient nodded off again, down the sats would go... My mentor then suggested that I should put this patient on a mask. I held off because something was telling me that I shouldn't. I looked at the patient and simply changed out the pillow for a thin folded blanket. This opened the airway a bit and the sats miraculously came up... while I was checking the history. A mask would have increased the FiO2 but wouldn't have changed the volume and this would have made the sats look good while allowing the CO2 levels to rise.

Sometimes you just gotta look at your patient when the monitor is telling you something is wrong. Don't forget that sometimes the monitor can be a late indicator of something wrong...

[Garden,RN, ASN, RN]

First of all as nurses we are expected to use our common sense. So if the patient's O2 sats are 32 and the patient is aaox3, in no acute respiratory distress and pink, then guess which one is the accurate. No acute respiratory distress would mean the respirations are even, not labored, at least 16 for an adult. One hundred years ago we actually did have numbers. Think third world country, do you think that doctors without borders are sitting in a nice air conditioned room listening to beeps? Please. As a patient, I value the professional that does not solely regard on technology, but rather uses it sparingly and when necessary. I go to the doctor for their expertise, not their ability to push buttons and jump when the machine says something is wrong. Technology still has issues. Just ask any nurse that primes a pump 5000 times in one shift. It is our skill level and knowledge that needs to be sharp enough to be able to pick up something when technology goes wrong.

[Garden,RN, ASN, RN]

I agree with the need to treat the patient and think she needs to learn much, but I disagree that she should not ask question because it is too soon. She has every right to question everything, after she does her research, hopefully. That mentality is what keeps nursing from making leaps and bounds into the future as opposed to little steps. That was an awful thing to say.

[Garden,RN, ASN, RN]

Don't regret it, don't ever shut up. I totally did not agree with you on the premise, but don't regret it.

[Garden,RN, ASN, RN]

Your answer was great until you made the mileage comment.

[Garden,RN, ASN, RN]

Great answer.

[Garden,RN, ASN, RN]

Sometimes, the monitors give us information, we have to discern that information, that is why we are licensed. If not any teenager could sit there with an app or something.

[Garden,RN, ASN, RN]

Yes, often nurses that work in hospitals fail to realize that many things happen outside the hospital without the benefit of technology.

[Garden,RN, ASN, RN]

Thank you.

[Garden,RN, ASN, RN]

I notice that clinicians trained in poorer countries have way superior assessment skills than those trained with all the technology. What happens when there is no electricity?