Hi, i am a fairly new nurse. ive been working on a rehab floor in a ltc facility. yesterday, while i was passing meds, the aide called me to check on a resident because he was not responding. I went inside the resident's room, called him by his name several times but didnt respond at all, his eyes were just open, he was breathing, he was perspiring and he was a little cold when i touched him. Cant obtain BP. Oxygen sat was at 87%. I put him on oxygen. Called my supervisor for help. I asked her right away if i should call 911 since this might be going on for more than 5 minutes and she said yes. So i called 911. Went back to pt room and tried to get his BP and it was 80/60. When EMT arrived, after 2 mins, the resident started to talk. Eventhough he started responding, we still sent him to er for evaluation.
now, the unit manager and the other staff nurses are questioning me why i sent the man out. I told them the whole story but they keep on talking behind my back and saying that i was wrong. btw, the resident was admitted to the hospital.
Based on your description, you did exactly the right thing. As someone else has already said, there's an awful lot of backbiting and second-guessing from other nurses. Most of the time, they weren't even there but they still spout off about what THEY would or wouldn't have done in the same situation. Bottom line, you WERE there and did what you felt was right based upon your assessment of the situation at that moment in time. Your nursing "gut" told you something wasn't right, and you listened. Imagine what the outcome might have been had you NOT heeded your gut and assessment skills. "Take the hard right over the easy wrong"...a quote from an NCO I served with in the military, and something I've always remembered.
GREAT JOB the only thing I would have added was an accucheck... assuming you're allowed to just do one (I've never worked at a nursing home). Also, please remember..... DNR is NOT DO NOT TREAT!!!!! I don't care if they are a DNR, DNR's are frequently admitted to our unit for sepsis and hydrated, abx and put on pressors..... we simply just don't code them if it's their time to die.
this situation could be very complex... were there recent bp med additions that could have dropped the bp, were they simply dehydrated with poor intake... on and on...
But ya know what? As little as I know about nursing home care... with 80/60... it's not your skill to evaluate, diagnose and treat that.... that's what the ER is for. You're not trained for that and it's not a snub, it's your scope of practice and expertise. I'd never claim to know anything about L&D, simply because I'm a "nurse".
Tell your co-workers that they are welcome to make their own decisions on patient care when they are legally bound to their outcomes, until then stay out of your practice.
Everyone loves hindsight, only then can they be an expert in their practice on your expense.... plug your ears and carry on... you did GREAT:D
I agree that you took the correct actions based on your assessments.
A few years ago, my father was in a rehab facility after a hip replacement. His nurses did not recognize signs that he was acutely ill. My sister had noticed that he seemed a little "off" when she had been to visit that afternoon and called the nurses station that night to check on him. The nurse said to her, "Oh, he's fine. He's sleeping like a baby! He was so tired that I could not even wake him up." My sister, who is an ED nurse, was horrified and said, "That is not 'sleeping like a baby'--that is OBTUNDED or UNRESPONSIVE." The nurse would not call the doctor or 911. By the time my sister got back to the facility, it was 5am. Thanks to her urging, an MD was called in to assess, and my father finally went to the ED a couple of hours later. It turns out that he had viral meningitis. Thank God he recovered.
You sound like the kind of nurse I would want taking care of my father. Don't let your co-workers get you down. They sound like the sorts who would let an obtunded patient continue to "sleep like a baby."
i think i know exactly what they are thinking: $$$$$$!!!!
at our facility don made it clear it is our facility policy to call don first before calling the md when there are change of condition of patient or sending patient out. one time my patient was definitely dying and when i called don( called doc first of course) she told me to give patient "breathing treatment" i was lucky that her physician was in the building to do his rounds and i let him talk to don and ended up sending patient out and patient ended up dying. so dont pay attention to them and do what you have to for the patient. if patient ended up dying, your boss is going to blame you.
The fact that he was admitted to the hospital speaks volumes right there, alot of people feel there are too many BS admission, but it's hard to get a pt from a SNF/LTC admitted without a really good reason these days. Could be they find it easier to question you than to just say you did a good job. Which you did, ignore the doubters and keep on the way you are, never question your gut because of what someone else might say. :heartbeat
the only thing I would have added was an accucheck... assuming you're allowed to just do one (I've never worked at a nursing home). Also, please remember..... DNR is NOT DO NOT TREAT!!!!! I don't care if they are a DNR, DNR's are frequently admitted to our unit for sepsis and hydrated, abx and put on pressors..... we simply just don't code them if it's their time to die.
Tait, MSN, RN
2,142 Posts
You did just fine. Definitely sounds like a strong stroke candidate, and when it comes to strokes there is no time for messing around.
Tait