worried

[Ms.RN]

i just came home and now i"m little upset about my work tonight. it happened around 10:30pm my cena told me that my patients blood pressure is 66/40 and patient is not acting right. so i go in and rechecked patients blood pressure, and it went up to 96/50. but i had hard time waking patient up. cena said she usually opens her eyes when her name is being called, but she pened her eyes when i shook her arm. i had given her metoprolol and 150mg of trazadone about half our before. i called my supervisor and she assessed her and she said a reason i have hard time waking her up is because she is in a deep sleep. i gave report to the next shift nurse and documented it in nurses note. but on my way home i thought about it and it upsetted me that i didnt call the doctor. i read so many threads about how nurses lose their license because of small things. now i'm worried that i"m going to lose my license.

[skittlebear]

Were her other V/S wnl? DId you check her blood sugar? If the nursing supervisor came in to assess her as well and didn't see a problem, then I wouldn't worry too much. I hope you charted that as well.

[oslogirl]

It sounds like you did everything you were supposed to have done, but its difficult to say without knowing the pt's hx. You did notify the sup. for assessment, and as stated before, you charted this, right? As you know, Trazadone plus B Blockers can be highly sedating, so yes, she was most likely in a deep sleep.

Try not to stress too much over this; consider a learning experience. I hope everything turns out great for you and the pt.

[SweetTeaRN, BSN, RN]

I'm just thinking...what was her pressure before you gave the meds? Did you have an order to hold the Lopressor for a certain BP? Or to contact the MD if her pressure dropped below a certain level? I'm thinking you did the right things otherwise. I hope everything turns out ok for you.

[Ms.RN]

were her other v/s wnl? did you check her blood sugar? if the nursing supervisor came in to assess her as well and didn't see a problem, then i wouldn't worry too much. i hope you charted that as well.

yes, her other vital signs were fine and her blood sugar was normal. i did chart that a supervisor came and assessed patient but i kept thinking even if supervisor assessed her, maybe i should have notified doctor for change of condition in case she declines more and end up going to the hospital that way i'm protected.

[achot chavi]

Notifying the doctor of every change in your patients condition is always a good idea

I doubt if you will have trouble from this- but we learn from each situation.

I am sure you reported to the oncoming nurse that she needs to monitor this patient more closely as your supervisor says she is in a deep sleep.

I would also check all her meds and see if you need to monitor their levels

I recently had a patient complain that he wasn't getting enough phenobarbital, We explained that the blood levels were WNL and he was seizure-free. the following week he was acting strange, disoriented and confused, loss of bladder control, sexually aggressive to the staff. We had trouble controlling him etc. We sent bloods to the lab and his phenobarb blood levels had jumped sky high !! I found two boxes of the pills in his closet- (hidden in pockets of jackets). Apparently he obtained the pills somehow and was augmenting his dose. We are currently monitoring him much more closely.

The mere fact that you are concerned is good and as you gain experience you will not be second-guessing yourself as much.