I've been sitting with one of my clients while he was in the hospital so we could be his advocate and explain to the nurses there what he has, how to do his dressings, etc. Well, he just got a trach on fri. I was with him overnight the other night, and he got this fearful expression on his face and started mouthing "i can't get air, i can't get air" I'm immediatly at the beside trying to get him to calm down. The hospital nurse was in the room and was just standing there. I was like go page respiratory because he can't breathe. and she said: his sats are 97% and then waited another minute before going to page respiratory. I mean come on, how could she just stand there? :angryfire
just makes me mad because I always thought airway was the most important thing to keep open, and he obvisously wasn't able to cough up his secretions (quad in for resp failure d/t mucous plug) and needed sx. am i overreacting?
My mistake, I assume either the LPN who was in the room to begin with or the nurse who came in after this LPN sitter was in the room had already raised the head of the bed.
When I read posts I usually see details left out. The things which were already done, rather like reading PBDS scenarios. I have yet to read any post which complains about some nurse who actually write in detail about what was done as opposed to what they think should be done.
Blarg! PBDS = lame. I'm a nurse in the ICU, so of course I missed all sorts of stupid junk on those things like "hook patient up to telemetry." Well no $&%! That's one of the first things we do, and if they have already been there a few hours, they are already on telemetry... LOL. :angryfire
Blarg! PBDS = lame. I'm a nurse in the ICU, so of course I missed all sorts of stupid junk on those things like "hook patient up to telemetry." Well no $&%! That's one of the first things we do, and if they have already been there a few hours, they are already on telemetry... LOL. :angryfire
I'm helping a friend of mine study for the PBDS...and you're right: it's lame. There are so many things that one does on "automatic pilot" that you don't even have to think about and just don't write down
OP, not having access to that nurse's thoughts at the time, I can only assume she was thinking if his O2 sat was 97% he was moving air, and she may have been further assessing the situation. We simply can't know.
I just think the nurse might not have wanted to suction the pt.
I'm so used to doing all respiratory things where I work. LTCs (except for sub acutes) got rid of RT when PPS started in 1998. We do all of our neb tx, suctioning, trach care, inhalers, insentives etc.
When I was in the hospital for my last baby, I also had a touch of pneumonia/ bronchitis and was ordered neb tx for SOB. They were prn and everything was there in the room, but RT needed paged to give it to me....After waiting for what seemed like forever...I just did it myself...The nurse told me she didn't know "how to work it" yeah, I realize it was an OB floor. My mother works in the same hospital and said she wouldn't know what to do either (yeah, she could figure it out)
On any given day in cold season, I might have 8 neb tx to give qid, a trach to suction all in addition to the 22-26 pts I have...you should hear the machines as i walk down the hall. LOL
I am curious how does this scenario end? what occurred when the nurse walked out of the room to page respiratory. I like full stories before I judge another nurse I do not know, was not witness to etc.
Remember we nurses can be very critical , unless of course it is us in this same scenario, in which case we know what we are thinking we know what we have done we know what we are planning on doing.
I think that the nurse should have assessed the pt not just the monitor. If its a mucus plug issue- suctioned pt, given nebulizer Tx to break up the much plug (no order needed for saline nebs and works great), raised HOB, increased oxygen flow temporarily atleast, and helped calm the pt. Also trach teaching for the pt and caregiver would be indicated. I would never work at a place that makes me call a RT to do any of the above. How shameful to nurses! The fact that she stood there for a minute tell me nothing- ie she may have just been thinking through in her head what to do, who to call...
Being a new trach alone can make you feel like you can't breath. Think about it, you're breathing through a small tube, much smaller than a person is used to. It's like breathing through a straw.
sx means symptoms of suction, its based on the context.
Thanks for all your responses. I know this pt is anxious and scared and does seem to overreact, but i could tell by his facial expressions that he was not getting enough air. After the nurse left, his sats started dropping, then before resp. came in, he became unresponsive. Resp lavaged, and he woke up. He is used to trachs, this is his 3rd one (he had another one about 2 months ago and demanded it be taken out 1 mo after he came home)
This pt couldn't have anything for anxiety because of all the meds he is on, his condition, and his likelyhood to drug-seek it later (if a doc dc's a narcotic, and he wants it, he will do everything possible (ie not eat drink take meds) in order to go to the er to get Iv pain meds) and the doc was trying to do a trial to watch his sats off o2 (he had just gotten taken off that morning) and on the bipap machine while he was sleeping without any drugs to make him sleepy (which didn't happen because he was awake all night)
anyways, maybe i overreacted, but its scary. after rt came in, they said air was not moving well (which the nurse could have atleast checked breath sounds) and sx only to have nothing come up (after a moment she got a scant amt but the mucous was really think). I asked if he could have a prn tx to loosen the secretions up, and the rt snapped back at me "he already had one" (he had had one about 2 hrs back) well, i have many other clients who have multiple orders for prn breathing tx and if one doesn't work within an hour, we do another one.
You all may have misunderstood me about what a nurse can and cannot do at that hospital. I was told a few days back by one of my coworkers that RT was to do the sx, so when he felt like he couldn't breathe, my reaction was to say call the rt. I still think the nurse should have stepped up and told me she could do it, ugh, i would have saved myself some embarrassment.
lpnflorida, LPN
1,304 Posts
My mistake, I assume either the LPN who was in the room to begin with or the nurse who came in after this LPN sitter was in the room had already raised the head of the bed.
When I read posts I usually see details left out. The things which were already done, rather like reading PBDS scenarios. I have yet to read any post which complains about some nurse who actually write in detail about what was done as opposed to what they think should be done.