Will I ever be able to put it all together?

[limabean]

I am a relatively new nurse working on a cardiac floor (with lots of other types of patients also). I have been trying so hard to think critically and be able to process the multiple health issues that my patients have; however, I feel like I will never be able to put IT all together. For example, I had a patient come from the ER to my floor who had a diagnosis of "Mild DKA." Well when he got to my floor he was having multiple episodes of vomiting (dark brown), his blood sugar was in the upper 400's, and he said he felt like he was going to die. He had bilateral iliac stents placed one week ago, and he had been to the hospital two days ago and had been found to have a pseudoaneurysm on the left. He was discharged. On my assessment I found that his groin was very bruised and tender. Also, he was tachycardic in the 130's, potassium was 6.5, and CO2 was 7.4. I did not have much information and I did not get to learn much more about what was going on with him b/c my shift was over a couple of hours after he arrived. My question is ....What was going on with him???? I was trying to process what I had learned about each issue that was wrong with him, but I felt overloaded. I am curious to know if the pseudoaneurysm had anything to do with it, also why would they have discharged him two days ago with it? Also, will I ever be able to think quickly and put everything together? Thanks for any advice.

[RNPATL, DNP, RN]

I am a relatively new nurse working on a cardiac floor (with lots of other types of patients also). I have been trying so hard to think critically and be able to process the multiple health issues that my patients have; however, I feel like I will never be able to put IT all together. For example, I had a patient come from the ER to my floor who had a diagnosis of "Mild DKA." Well when he got to my floor he was having multiple episodes of vomiting (dark brown), his blood sugar was in the upper 400's, and he said he felt like he was going to die. He had bilateral iliac stents placed one week ago, and he had been to the hospital two days ago and had been found to have a pseudoaneurysm on the left. He was discharged. On my assessment I found that his groin was very bruised and tender. Also, he was tachycardic in the 130's, potassium was 6.5, and CO2 was 7.4. I did not have much information and I did not get to learn much more about what was going on with him b/c my shift was over a couple of hours after he arrived. My question is ....What was going on with him???? I was trying to process what I had learned about each issue that was wrong with him, but I felt overloaded. I am curious to know if the pseudoaneurysm had anything to do with it, also why would they have discharged him two days ago with it? Also, will I ever be able to think quickly and put everything together? Thanks for any advice.

First, you need to be patient with yourself. Nursing is a skilled profession that takes time to learn. Yes, you will one day be able to put everything together and recognize all the elements of what is happening to your patient. For now, be sure that your assessment skills are thorough and that you have a resource RN to go to to report and bounce things off of. I know it is tough, but after some additional experience, you will "get it."

As far as your particular patient .... sounds like there was a lot going on with him. Certainly the blood sugar was an issue the vomiting and the stents were another. The groin tenderness was probably related to the cath for the stent placement. The groin site remains bruised and tender for a while.

Try to remember each of the symptoms your patient presented with and when you get home .... look some of them up to determine what your nursing interventions would have been and what treatment the physician might order. Most of all, be patient as you develop your knowledge to care for these patients.

Good luck and come here often for support ... we are good at that! :)