trial by fire...............

[nurseguy74]

well, last night was my first official day as an lpn. i was working the alzheimer's unit as charge. i had previously worked on this unit as a qma but wouldn't you know it, my first night as the nurse and things go bad. i was passing medications in the hallway and started hearing a resident become very congested. i went in to ask how she was feeling and every other word she said was drowned out by the congestion. she was on 2 Liters of oxygen and her oximeter reading was at 84%. there was an order to titrate which i did to 3Liters. her sats gradually came back up but not to the desired level of 92%. i called a nurse from another unit and she suggested calling the md which i did. he told me to send her to the ER. I checked her sats again which now were at 78% to which i increased the oxygen to 4 Liters. The medics arrived and when she left for the hospital her sats were at 70%. I got the call about two hours later saying that she had passed on. So, i guess it's welcome to the nursing world with a bang. I found myself questioning my abilities, but everyone said i did the right thing and that it was commendable that i caught her decline in condition. Definitely a learning experience..................chris

[karenG]

sounds like you did just fine!! well done.

Karen

[Nurse Ratched, RN]

You caught the problem and responded and called in reinforcements when you were unsure - sounds like you did fine.

Unfortunately, I'm sorry to say that you shouldn't have been put in the position of being charge nurse on your first night - I presume this means you got no orientation to the nurse role? Being a QMA and being a nurse are two different things entirely and you deserve a proper orientation to the differences in the roles. I'm sure that won't happen, tho. I'm sorry - it just makes me sad when I see new nurses already being thrown into the deep end of the pool - mgt gets by with it by flattering us and implying we can handle it or they wouldn't do it that way. Please keep your antenna up and call for help or questions if you are the least bit unsure.

[James Huffman]

Chris,

Keep in mind, that's what you're there for. If they didn't have the rough situations, you wouldn't be needed ;-)

Karen was right -- you did the right thing. Just keep doing that. It's never wrong to review what you did in a moment like this, but follow your instincts based on what you know, and you'll probably do the best, both for those under your care, and for yourself.

all the best,

Jim Huffman, RN

http://www.NetworkforNurses.com

[louloubell1]

It's wonderful that you caught her change in condition, and I hope this doesn't sound critical, but with a sat in the 80s I would definitely have hiked that meter up higher than 3L, and if she further declined to the 70s a NRB at 100% would not have been out of order (I'm assuming of course that there are no contraindications to doing so for this patient).

[nowplayingEDRN]

Chris....

You did a fine job. Keep it up and yes, WELCOME to nursing :)

I have to wonder like Ratched, were you oriented to the charge nurse position properly? You responded excellently in a compromised situation. But to reinforce what RNLou said (and not being critical just helping you do better-we all have room for improvement :)) I would have increased the oxygen by more. With a nasal cannula, you can use it with up to 4-5 liters (ACLS protocol states placing the pt on 4L) anything over that, place a simple face mask up to about8-10. However when the sats go in the toliet (ie below 80) bring out that good ol' nonrebreather mask and jack that O2 right up to the top (15L on most meters). Keep your chin up and keep plugging.....you will have the good days, the bad days and then you will have(like your first day) THE UGLY. Always remember...with time comes experience...and never be afraid to dial up the doc.....take time to listen to that 6th sense you have as a nurse.......usually, it is never wrong.

Christie

[Mkue]

Way to go Chris :) That was a difficult decision for your first night as charge, sounds like you handled it well. :)

[atownsendrn]

Chris - we have all experienced situations like yours. Although not usually on the first night. It sounds like you responded like a true professional.

[gwenith, BSN, RN]

Once again Chrs Kudos - you did the right thing - it sounds like it might have been some pulmonary oedema and the others are right - you CAN hike the O2 level up faster but being new it is understandable that you would be hesitant to do so. The only other piece of advice for "next time" is if it is pulmonary oedema and you are able to do so swing the patient around so they are sitting with thier legs dangling. This sometimes allows the fluid to settle to the legs/feet thereby stopping or at least slowing the onset of the oedema. This isn't often done in acute care as usually there is a Doc with a diuretic order standing nearby but it can buy some time in a situation such as yours. Of course you cannot do it if the patient has a decrease LOC or any other contraindications then you just have to try to sit them up as high as possible in the bed.

[Tweety, BSN, RN]

Concur with the above. You assessed, you collaborated, you responded appropriately. Good job!

[angelbear]

You did just great. Always elevate HOB titrate o2 all good. But ya know what in LPN program we were not told all that stuff about titrating and rebreather masks. I didnt even know it had to be 8 to 10 on mask. We all learn by experience and unfortunately at leaste in LTC very rarely get decent orientation. Trial by fire is right. Sounds like you are up to the task.