When it's the visitor who needs the ER....

[nerdtonurse?, BSN, RN]

Had family visiting a patient last shift, and when I walked in to do my initial assessment, etc, did a double take at one of the visitors. Before I could even open my mouth, he said, "I don't feel well, can you take my blood pressure? I've got the worst headache I've every had." Guy weighs at least 400 pounds, is sweating, grey in the face, and is just setting off all my "oh crap" alarms. I took his bp and his temp, since he was hot to the touch. Sky high bp, pulse so fast I can't count it, and temp 102.1. EEEEK! I told him to go to the ER, which he did. He was admitted, and I know his weight was over 400 because when they admitted him, he had to be put on an ICU bed in a med surg wing because he was over our equipment's weight limit.

Now, after he wheels down to the ER, my charge nurse tells me I should have never touched the guy, never told him to do anything, just referred him to his family physician. All I could think was, well, it would have looked real good at trial when the wife and patient/father says, "he said he didn't feel well, had a history of hypertension, and that nurse didn't do anything and he died from a stroke on the way home." Not to mention it's not going to help my post-MI patient if his son-in-law codes in his room.

How does your hospital handle this sort of thing? I'm still so new I practically squeak, and I've referred plenty of sore throat/look at this mole requests to "visit you physician of choice," but if you see a visitor who looks like he could be in real trouble, are you still supposed to wait until he hits the ground at your facility?

[JeanineLPN1984]

Don't worry, you did the right thing- he was admitted after all. When he sends you that HUGE box of candy- give one to the charge nurse! Have a great day.:redbeathe

[sjt9721, BSN, RN]

I think you did the right thing. He appeared ill; you got assessment data and referred him to the ED. Offering him a wheelchair and sometime to take him down would have been right-on as well.

About your charge nurse's opinions...would she ignore a visitor that appeared unresponsive? Would she refuse to help someone in labor that came in the 'wrong' entrance and couldn't walk the entire way to L&D? Maybe she expected you to wait until this guy stroked/arrested/collapsed and then help him? (I realize that my examples are extreme!)

Good job!

[SusanKathleen, RN]

Nice catch!

[cardiacRN2006, ADN, RN]

Your charge is only half right. You shouldn't have taken his vitals, but you should have referred him to the ED and told him in a way that ensured that he went.

Mearly telling him to 'take it up with his PCP' isnt' enough.

[RNcDreams]

I work in the ED and had a patient recently that was a spouse of a dying patient up on the floor... the visitor had a near syncopal at the bedside of their dying spouse, and you bet the staff got him to the ED immediately.

I'm new too, but my gut tells me that at the end of the day, you do your best within your scope to help those around you--

patients or otherwise.

Isn't that what this whole nursing thing is all about?!

[racing-mom4, BSN, RN]

I had to send a pts wife to ER once because she fell and cut the crap out of her knee. Blood everywhere. I did put gauze and a bandage on it before the CNA wheeled her down 1) because I am nice and the woman was bleeding 2) because I thought our infection control nurse would stroke out if she saw the blood trail in the hallways.

I was told by another nurse I should not have touched the wifes knee.

My brother in law had to go to ER during the birth of my nephew because he passed out and required 14 stitches!!!! One of the OB nurses had to wheel him down, they saw him stat and she wheeled him right back up. He remained in the wheelchair till it was time to cut the cord and even then the OB nurse held his elbow!!!

I think what you did was 100% appropriate.

[wearingmanyhats, RN]

I too would have assessed the VS.... just telling him to go to the ER may not have been enough... but knowing the VS may have been just the push he needed.... stick with your insticts....

Faye

[Medic/Nurse, BSN, RN]

Hey there nerdtonurse -

Great job!

You were spot on. Kudos to you! You did GOOD! You might have even saved this guy's life! Really. Sounds like he was headed for a bad place - and because you choose to get involved he got the care he was in obvious need of - that is what nursing is about!

I cannot imagine a nurse that would allow a visitor to sit there in obvious distress and not seek to advocate or intervene. Well, I can imagine - but, I can foresee bad stuff in every direction.

I would always rather explain action over inaction to a jury, BON or the "higher power". To sit and observe anyone in distress and fail to act - well, is so wrong on so many levels that I'm not sure where to start.

I think I understand a general concern from your charge nurse - what if you had taken the VS and then he refused to seek care - kinda puts you in the line to share some of the poo if it hits the fan.

In cases where I find something abnormal, I then encourage the "visitor" to become a patient (have called a couple of PCP's in an effort to get them to care) and if necessary ask that they sign a release/AMA and give them written instructions to seek care without delay.

Practice SAFE!

[mianders, RN]

Always do what is best for the patient or in this case almost patient, and you will always be right. It is never wrong to refer a patient to the ER if they are having problems.

[RedhairedNurse, BSN, RN]

I think you did an excellent job in saving this man's life. You did the right thing. If you wouldn't have taken the vitals, he probably wouldn't have deemed it so necessary. GOOD JOB !!

[RN1982]

Tell your manager/charge nurse "whatever". We had a liver transplant patient admitted last week As soon as his wife walked in to the room she was down for the count. We put her in a chair, checked her pulse, her BP, blood glucose, pulse ox. She looked dead. Gave her a nice sternal rub and she came out of it. We took her down to the ER.

You did the right thing!