What more could I have done?

[locolorenzo22, BSN, RN]

So, tonight was my first night alone at my new flexi RN LTC job. The night was smooth and uneventful. Through the first 11 hours, that is. dealing with a few confused patients, and then the lights started bombing the aides. I'm standing at the med cart, drawing up some heparin for a PICC, when the CNA comes down the hall and says "Lorenzo, could you come in here?" I say, "sure, give me a minute." Then she says, "H isn't responding to me...." BOOOM! I think I broke the speed of sound booking down that hall.

Walk in to find resident non-verbal...was very verbal earlier in the shift(almost too much)...and has obvious facial paralysis to R side and making "muh-muh-muh" noises....no previous hx of stroke...but that's what I'm thinking. send the CNA out to get the other nurse, other aide, and to call 911. kept reassuring the pt, checked pulse ox (97 on 2L), heart rate in 70s, and lungs sound fine. Heart sounds regular. was diabetic, checked a sugar-87.

Other nurse got papers filled out and copied, I called family and doctor, and pt went to the hospital....but this is the FIRST time I've had something happen to a pt on my shift....and I'm a little freaked. Any advice?

Besides that, then finishing morning med pass acting like nothing was wrong....was kinda tough. I'm hoping the pt is ok.

[NeosynephRN]

Sounds to me like you did everything right!! With the speed that you got things taken care of he may have made to the hospital in time for full treatment! You are a credit to our profession...Great JOB!!!!

[nrsang97, BSN, RN]

You did all the right things. You guys worked great as a team. It always sucks when a pt has problems on our shfit.

[Jolie, BSN]

What the resident needed was a rapid assessment and transfer. That's what he got. You all worked well together to make that happen. Good job!

[smstar1996]

You must be a new nurse. Of course your first life experiences with stuff like this will shake you up. There may be many more situations or even worse cases you may encounter. As a nurse you need to remain calm and focused. Pt care doesn't end with one pt, you have other pts to care for too. It sounds like you handled yourself well and good luck. I remember the first time a responded to a full code and started CPR......I did a good job but my heart was palpitating for like a whole hour after lol. You get used to it.

[BinkieRN, BSN, RN]

You did everything you should have done. I suspect the reason it bothers you to go on and pass meds like nothing happened is because you are a caring human being. That's normal. Don't feel bad about caring about somebody.

Realize that in LTC those patients are at a much higher risk than the general public for a MI or CVA. It is going to happen. It's the nature of working in LTC.

[kmoonshine, RN]

Kudos for checking a blood sugar!

Getting this pt to an ED is the #1 priority, ASAP. Depending on their history, they may qualify for TPA if the symptom onset was within 3 hrs (contraindications include unknown onset, coumadin therapy, extremely high blood pressure, recent surgery, low platelet count, recent GI bleed, hypoglycemia, hyperglycemia, CT showing hemorrhage, and so on). If the pt is DNR, there may need to be a discusion with the family regarding whether or not to proceed with TPA should the pt qualify for it (which isn't your responsibility and would be handled by the ED if needed).

So yeah, quick transport is essential. What we need to see in the ED for quick treatment: advanced directives, documention of the last time pt was seen "acting normal" and the time the pt was found "altered", vitals and blood glucose at the time when the pt was found "altered", medical history, medication list, and a phone number where we can contact the staff should questions arise. We'd also appreciate a phone call once the pt has left so we can get the whole story and ask questions - we have the ability to notify CT prior to arrival and if the pt is a TPA canidate, we can take them to CT right from the ambulance bay.

[jerenemarie]

you did the right thing! some nurses will waste time and call the on-call to get an order to send patients in distress to the er...not good to waste precious minutes when you have someone in obvious distress. so, give yourself a big pat on the back, you definitely did the right thing!!! :bowingpur:redpinkhe

[NursKris82]

Looks like you did everything right. Congratulations!! Also, sounds like you work with a great team- congrats on that, too. You rock!

[NurseKatie08, MSN]

Great job! You couldn't have done anything more.

Just a few weeks ago (on my third or fourth week off orientation) I had to send a patient out to the ED from our rehab unit for chest pain. When the aide ever came and got me and said "Mr. M. needs a nurse, he says its an emergency." In my head I was thinking, "well then why are you looking at me?!!?" But I got help from the supervisor & another nurse, got him sent out, and he turned out to be fine. Like you mention, I was shaking for hours (especially 10 minutes after sending out this man when my one LTC resident that I took care of (with a hx of dementia) came walking on out of his room pointing to his chest and saying "Lady, it's paining me right here."--thankfully it was just indigestion, and a little Mylanta did the trick lol.

[vamedic4, EMT-P]

As others have posted, you did exactly as you should have, lorenzo. Getting your patient to the ER was the only thing that was going to help him any further.

Hope you didn't shatter any eardrums as you broke the speed of sound!!

[Debilpn23]

Hi Lorenzo

You did everything exactly right.Like others have posted you are a credit to the nursing profession