You Know the patient is going bad when...

heathIam, RN · Apr 25, 2008

When your HR, SBP, PAP, sats, RR and innotrop infusion rates all equal 50 (actually, this is the celestial traige sign; they have already GONE bad!)

When you hear the words ECMO and TRANSPORT in the same sentence from the doc arranging the transport

When the number of IV pumps attached to the patient is greater than the patient's age X number of staff standing at the bedside

When the number of white coats standing around your bedside equals the number of IV pumps coefficient in above calculation

When a senior nurse drops by your bedside to ask you "everything OK? Do you need help with anything?" more than once in the previous 2 hours, then next time by brings the crash cart and says, "I'm just going to bring this here, just in case"

When the blood is dripping through the bed and creating a puddle while you have been pushing blood continuously for the past 12 hours as the CV surgeon INSISTS that cannulas to the IVAD are intact. They weren't. This little guy survived!

When the same CV surgeon pulls your ETT because the patient's sats have dropped - and she can't intubate.

AngelfireRN, MSN, RN, APRN · Apr 25, 2008

I think that would freak me out for awhile!:chair:

Oh, rest assured, it did.

CountyRat · Apr 25, 2008

You know the patient is going bad when you open the door to your unit, and the number of law inforcement professionals exceeds the number of on duty healthcare providers. This gives new meaning to the phrase, "code blue." Best nursing intervention? Curl up into the fetal possition in the nearest unoccupied corner.

CountyRat · Apr 25, 2008

How very short-sighted of whoever was bringing that patient back. From a medico-legal perspective, one could argue that if the pt really did have a rhythm when he left the cath lab, then the leads coming off mid-transport led to a failure to diagnose a possibly salvageable situation.

Of course he had a rhythm! It was the one we in the trade call, "asystole." (Look it up in any text that covers cardiac rhythms. It's right in there!)

Nurse_RaRa · Apr 25, 2008

...they are a frequent flyer, older patient, end stage ________(fill in the blank), mean and verbally abusive to any loved (?) ones still coming to see them/with them - in this case , the wife (poor thing) and they are a frequent AMA (read: know their patient rights well) and are continually demanding the doctor come see them or be notified of results...............he shot himself in the head on the floor 2 hours after shift change while his wife was out of his room. Not a good night. Selfish move by a selfish person.

JustMe · Apr 25, 2008

You've known about an admission for 4 hours, all of a sudden the ED is in a big hurry to get them upstairs.....

Yeah, that! :banghead:

ShayRN · Apr 25, 2008

After almost a year and a half of inpatient hospice work, I have a few to add:

When your unresponsive for 2 years, post MVA in a permanent contracted vegitative state starts tracking things on the ceiling with his eyes. Then two hours later sits in an upright position reaching up with his arms. Chances are good that is the day.

When your sweet but confused respite patient is admitted so that the family can take care of their hospitalized uncle. Then when that uncle dies and his family refused to tell the patient. Next day, patient is angry with EVERYONE. "I know what your not telling me. Do you think I don't know? He told me, he told me, why can't you just be honest?" We made the family tell him his brother died. His response? Well, I know that, he came and said I am not to be scared because we would be together again soon.

Or the woman who saw a beautiful little girl with curly hair playing in her room. When I told this to the daughters, they started crying. Appears their baby sister (who died years ago at age 3) matched that exact description.

The man who always told his daughter that he would die when the country music stopped playing. She would not let us turn his little transitor radio off the whole 3 days he was with us. Played in his ear day and night. On the night he died we had a thunderstorm and lost the power to the building. The music went out and he died just as our generator kicked on. Problem was, it was a battery powered radio. Think the battery went dead? Nope, thing started playing by itself 5 minutes after the time of death.

Then there was the woman who reported seeing a huge white wing at the bottom of her mother's bed. She died that night.

Or the ALS man who came to give his wife a break. Looked out the window into the night, got a HUGE smile on his face....and died.

And the NUMBER 1 and BEST predictor of a person near death? When our medical director's dog-Cody lays on the floor at the bottom of a patient's bed the whole shift.

TabyRN · Apr 25, 2008

working on a medical/oncology unit i have seen a lot, mostly we do get dnr's.

the latest is 4 am a pt states "i need to get up", nurse taking care of pt in other bed states, "it's 4 in the morning, go back to sleep for a little while, we'll get you up in a bit"...........

6:20 lpn out of room, "pt doesn't look to good"........

call night intern, pt continues..."i need to get up"

7:10, pt passed.........

the other was pt on non-rebreather, 89% and normally yelling, resting peacfully and calling nurse honey and sweetheart... i called the family in, not 1 1/2 hrs later the pt passed.......

guess even with only a year in you can develop the intuition right??

:bowingpur:saint:

Warpster · Apr 25, 2008

Another nurse walks by the room and ask, "Who's the Smurf?"

Precious_P · Apr 25, 2008

Too funny!!!!!!

cardiacRN2006, ADN, RN · Apr 25, 2008

Had a sweet old man survive a big surgery. Extubated and doing well. Calls me over after extubation and says, "I just want you to know that I'm going to die tomorrow, and it's not your fault and I don't want you to feel bad." He holds my hand and rubs it, soothing me. How sweet of him to be worried about how I'd feel!

Pt died that next day.

delintfan · Apr 25, 2008

When the patient who has been nonresponsive since she heard her son died (the day before,) tells you "I'm still here honey." she died the next day. :uhoh21: