Was I overreacting?(long)

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Hi all, I am a long time reader but a first time poster but I have a question and would love some advice. I just graduated in May and have been working in a childrens hospital for 4 months now on a heme/onc and med-surg overflow floor. A few nights ago I was taking care of 6 mo old s/p BMT with an Upper Respitory Infection. When I came on the baby was breathing b/w 60-84 bpm, lungs sounded crackly and diminished, he was retracting, nasal flaring and occasionally grunting, HR 145-160, on 1L O2, all other vitals were fine at the moment. Within 30 mins of that first assessment his sats dropped to 85% and he desperatly needed suctioning, after suctioning he would bounce back up to sat at 92%-97%. I called respiritory and the doc and let him know and increased his O2 to 2L. He continued to drop his sats(82-87% at any given moment) about every 30min-1hr and needed suctioning that frequetly also. I again called the doc and let my charge nurse know about the situation and that I needed help with my other 3 pt's b/c this little guy was taking up a huge amount of time. The doc FINALLY came up to assess the pt and ordered a VBG, I can not remember the results but the doc relayed them to me as "crappy" and stated "If he were in charge this baby would be in the ICU but his senior thinks he is fine". After a two more O2 sat dips I called the doc again and he called his senior to come check on the baby. Another VBG was drawn and it came back worse. (by this time I am 3 hours into my shift and very frustrated) I called our STAT/rapid response team to take a look at the kid. He told me that he would keep an eye on him and to let me know if he gets worse but his hands were tied b/c the docs were comfortable with the current situation. They finally ran bicarb on this boy and his VBG improved but he was still breathing 80's and working very hard. I continued to update everyone(doc's, respiritory, stat team, charge nurse) on this situation and nothing was really happening, but I was scared to leave this little guy alone b/c he was doing so horrible, PLUS he was on reverse isolation so everytime you entered the room you had to glove, mask, gown before you could get to him while he was satting 80's. (He ended up in the unit the next afternoon after he almost needed to be intubated on the floor)My questions are...Am I wrong in thinking this was an ICU pt who needed much closer attention and monitoring right at that moment? What would you have done as the nurse who had used up all thier resources? Was it the right decision to leave this little guy on the floor to burn himself out breathing 80's and dropping his sats or should SOMEONE have intervened sooner? OR am I just overreacting??I am so new so all of this is a bit confusing for me. I feel like I could not help this little guy no matter what I did....Advice?Thanks in advance, Kerri

You can't over react when it comes to the well-being of your patient.

I would definitely want you as the nurse for my child.

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This is not my area of expertise but I think is sounds like you were right to be so worried and to keep calling everyone. If it were my child, I would want a diligent nurse like you. It sounds like you did your best to be an advocate for him!! Good job!!:thankya:

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Specializes in ICU, Agency, Travel, Pediatric Home Care, LTAC, Su.

First, I want to say welcome:) You sound like a wonderful nurse. I don't have any children, but if I did you could care for them any day. It sounds like you handled the situation as best as you could and then some. For future reference, like someone else mentioned, I would find out if the Rapid Response Team is able to make the call for the patient to come to the ICU. That would be good to know for future reference. You did great!! What a scary shift for anyone, new nurse or not. Hang in there and welcome to the wonderful world of nursing! BTW I give you and all of the other peds nurses out there a lot of credit, I could not do it. I will stick to my adult ICU patients.

:welcome:Kimberly

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You did a great job.

I would have called the attending directly and requested he respond to the bedside to do his own assessment, and documented the request. Very few docs will refuse if you directly tell them you need them NOW and at the bedside.

I'm not a pediatric RN but I agree with the advise from canoehead - If you don't think you are getting any satisfaction from the residents call the attending yourself. Let them know you're calling the attending (that may make them step it up) also , always call your nursing supervisor to let her know what's going on. You shouldn't be alone handling a situation like this - you did great - but you always need to think..."if this was my kid - what else could I do - have I exhausted every option?" Then you'll probably think of a few more ideas - no matter who's woken up in the middle of the night!

Great Job though - I would've been stressed & frustrated too!

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Specializes in ER, Occupational Health, Cardiology.

I've never worked strictly Peds. If I understood you correctly the child was breathing between 60-80 breaths per minute? I just can't believe that child was not sent to ICU. The poor little guy was wearing himself out! What was his dx, and LOC? Do you know how he subsequently turned out? I think you did a super job for someone as new as you are!

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Specializes in ER, SANE, Home Health, Forensic.

I am an ER nurse, and I have to say that I have been in similar situations with MD's where they do not feel it necessary to place a patient in intensive care when their condition truly dictates the need for them to be there... I find if I continue to "bother" them, stand my ground, and make a bit of a fuss... I get what I need for the patient. The ABG's should have spoken for themselves, besides your call to the MD and notifying of patient's condition. Yes, the rapid response team should have had the authority to transfer patient to PICU, and I have also been known to ask the MD:

1. Would you like me to chart your response word-for-word? or

2. Would you rather I wait to call when the child actually codes, or should I continue to call you with updates as I watch this child's condition deteriorate?

I have also been known on 2 occasions to call the house supervisor and demand the facility Medical Director be called when the patient's condition is not being properly attended to... however the 2 above responses generally get you what you need. The MD does not have to like you in that moment, and they don't have to like you ever, but they will respect you when they find you take top-notch care of their patients. Which it is obvious you had been doing. Thank goodness that child had you in it's corner, and congratulations on keeping an unstable patient in the best condition you could in the poor circumstances you were dealt. That IS an accomplishment!:balloons:

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you did a great job! i don't think you overreacted, however, being a new grad, i can say your preceptor taught you well.

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Specializes in ED, ICU, Heme/Onc.
Hi all, I am a long time reader but a first time poster but I have a question and would love some advice. I just graduated in May and have been working in a childrens hospital for 4 months now on a heme/onc and med-surg overflow floor. A few nights ago I was taking care of 6 mo old s/p BMT with an Upper Respitory Infection. When I came on the baby was breathing b/w 60-84 bpm, lungs sounded crackly and diminished, he was retracting, nasal flaring and occasionally grunting, HR 145-160, on 1L O2, all other vitals were fine at the moment. Within 30 mins of that first assessment his sats dropped to 85% and he desperatly needed suctioning, after suctioning he would bounce back up to sat at 92%-97%. I called respiritory and the doc and let him know and increased his O2 to 2L. He continued to drop his sats(82-87% at any given moment) about every 30min-1hr and needed suctioning that frequetly also. I again called the doc and let my charge nurse know about the situation and that I needed help with my other 3 pt's b/c this little guy was taking up a huge amount of time. The doc FINALLY came up to assess the pt and ordered a VBG, I can not remember the results but the doc relayed them to me as "crappy" and stated "If he were in charge this baby would be in the ICU but his senior thinks he is fine". After a two more O2 sat dips I called the doc again and he called his senior to come check on the baby. Another VBG was drawn and it came back worse. (by this time I am 3 hours into my shift and very frustrated) I called our STAT/rapid response team to take a look at the kid. He told me that he would keep an eye on him and to let me know if he gets worse but his hands were tied b/c the docs were comfortable with the current situation. They finally ran bicarb on this boy and his VBG improved but he was still breathing 80's and working very hard. I continued to update everyone(doc's, respiritory, stat team, charge nurse) on this situation and nothing was really happening, but I was scared to leave this little guy alone b/c he was doing so horrible, PLUS he was on reverse isolation so everytime you entered the room you had to glove, mask, gown before you could get to him while he was satting 80's. (He ended up in the unit the next afternoon after he almost needed to be intubated on the floor)My questions are...Am I wrong in thinking this was an ICU pt who needed much closer attention and monitoring right at that moment? What would you have done as the nurse who had used up all thier resources? Was it the right decision to leave this little guy on the floor to burn himself out breathing 80's and dropping his sats or should SOMEONE have intervened sooner? OR am I just overreacting??I am so new so all of this is a bit confusing for me. I feel like I could not help this little guy no matter what I did....Advice?Thanks in advance, Kerri

I think you did everything right too. I also used to work on a Bone Marrow Transplant Unit and I am shocked that that little baby was on reverse isolation on a general heme-onc/med-surg overflow floor. I do find it hard to believe that no one was overly concerned with this child dropping its sats like that though. Were you talking to the house doc, or the attending who oversaw the transplant? I think that the only think I would have done differently was I would have gotten the senior doc on the phone him or herself to tell me that they were not concerned, and I would have informed the nursing supervisor.

Blee

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