When a patient states "something isnt right..."

Anna Flaxis, BSN, RN · Sep 21, 2012

I think all you really can do is assess the patient, let them know that you're taking their concern seriously, and stay calm. I think it's worth noting if someone tells you this, but if your assessment does not reveal anything not WNL, then all you can do is continue to monitor. If the patient has known anxiety and has a PRN ordered, I might offer that. Otherwise, I might try distracting them with conversation, or find something on the TV they want to watch, or offer to find them a newspaper to read or a cup of herbal tea. Sometimes anxiety is indicative of something physically wrong, and sometimes people just feel anxious outside of their normal environment, and that anxiety can manifest as a feeling of "something not being quite right". The only thing you can do is assess and intervene based upon your assessment. Follow the nursing process.

amoLucia · Sep 21, 2012

Listen to them and watch them like a hawk! And if they tell you 'now it's time to call son in Boston', RUN, do not walk to make the call to Boston.

umcRN, BSN, RN · Sep 21, 2012

This happens a lot in peds where the parents say something isn't right with the child but can't quite put a finger on it. LISTEN TO THEM! Watch them, notify the doc, in peds we heavily rely on the parents when they say something isn't right. It might be just as simple as them not being interested in a favorite TV show, not wanting to eat, breathing slightly faster (but still WNL), etc. Last time I had a parent who told me kiddo didnt look right the kiddo arrested 30 minutes later. And he spent most of the morning sitting up in bed, watching Mickey and telling me about him. I personally thought it looked a little tired, like any child would be in the intensive care unit days after a major surgery, and his parents couldn't quite point out what was wrong except that something was wrong (it was his heart failing, by the way). Even if it's something that seems silly it doesn't hurt to listen to them and pay them a little more attenction

blondy2061h, MSN, RN · Sep 21, 2012

I honestly thought that this "feeling" was basically bull, despite hearing stories about it. Then I had a moment where I just didn't feel right and couldn't describe what was wrong. 5 minutes later I was fully into my first anaphylactic reaction.

Been there,done that, ASN, RN · Sep 21, 2012

I have seen many patients describe "impending doom".

It surely is a reason to take note and re -assess their condition. That's all we can do.

Nine times out of ten... the grim reaper showed up... and my reassessment meant squat.

anotherone, BSN, RN · Sep 21, 2012

Get vitals, focused assessment and head to toe. Look at labs. Maybe alert doctor. Is this a change from his/her personality? CT /xray everything? Draw random labs?

sapphire18 · Sep 21, 2012

Check everything you possibly can, head to toe assessment (at least neuro and heart/lungs) and MONITOR! You know that "sense of impending doom" they tell us about in nursing school? Yeah, that's real.

JMBnurse · Sep 21, 2012

Anytime you hear anyone in a clinical setting say, "Something just isn't right.....", take it very seriously. I have seen patients crash and some die not long after someone uttered that phrase. It can come from a nurse, an aide, a doctor a family member or the patient themselves. As noted by PP, very, very often stated by parents. I worked with several doctors over the years who told me, when a nurse called them and said something just isn't right with a patient, if they knew the nurse, they would immediately take that very seriously and move into action. I have stood there and watched patients crash and die, who were not expected to die that day, after yelling out repeatedly that they were dying. (note: the whole time I wasn't just standing there.)

Of course not all people yell out, "I'm dying", right before they die. Not common at all. And anxiety and panic attacks can cause the same "feeling" in a person, although it's usually always the patient themselves who think something is not right when it comes to anxiety. Others around them don't usually have "the feeling".

So, the moral is, watch closely anytime you hear those words. Assess and monitor and rule everything out.

If you are a nurse in a hospital or LTC long enough, you will witness this rare phenomenon at some point.

jennilynn · Sep 21, 2012

I had a patient the other night that, upon looking at him, I knew something wasn't right. My charge and house supervisor agreed. I kept a pretty close eye on him all night, needed to call for orders, and told the doc of my ominous feeling. I went to hang some fluids on him at about 0430, he was talking and then told me he was scared. Sure enough, we coded him at about 0500 that morning.

I totally trust MY gut and when the patient can tell you that something's off.....listen.

turnforthenurse, MSN, NP · Sep 21, 2012

Thanks for your replies, everything! I'm just trying to see what else I can "do" when a patient says this. I once had a patient tell me something wasn't right but everything was WNL...the hospitalist happened to be on the floor so I notified him. He briefly looked at the patient and just told me to continue to watch her, which I did. Thankfully, nothing happened.

We had another patient, same thing. I was at the desk and the clerk answered the call light phone, but I could HEAR the patient wheezing through the phone from where I was sitting, so I immediately went to check. The primary RN was busy with another patient. Got RT to come do a breathing tx and the patient kept telling me, "something isn't right, and I don't know what. I feel like I'm about to have a heart attack or a stroke or something." :eek: Then they started c/o severe chest pain, but the patient looked calm. Grabbed a 12-lead EKG and it was pretty benign...I updated the primary RN on my findings and stayed with the patient. Had her grab some pain meds because I didn't want to leave the patient alone.

Again, thankfully nothing happened on my shift...but they ended up in CCU the next morning. Not sure what happened afterwards.

Mommy&RN, BSN, RN · Sep 21, 2012

I have had the feeling several times. Usually I'm right.

I had an elderly man who every night would tell me he couldn't breathe, but was yelling. The first 2 nights I was able to calm him and refocus him to slow his breathing.

This night I called for a breathing treatment, and asked a coworker to stay with him while I made a call to the MD. The house supervisor was on the floor and went to check him as well.

During this entire time, he is screaming he could not breathe. RT started the treatment and about 10 seconds into it, he arrested.

We were able to "get him back" and he lived to leave the hospital.

There have been many times that I just can't put my finger on what's wrong, but something usually isn't right. Trust your gut and your pts.