You Know the patient is going bad when...

Published

You know the patient is going bad when their PA pressure is higher than their blood pressure (Pt quickly coded and died)

Feel free to add and keep the list going!

Specializes in Paediatric Cardic critical care.

just though of one more...

when u come back from break and the theatre team are holding your pt's legs up in the air trying to reestablish a better blood pressure.

Up Vote Up Vote ×
just though of one more...

when u come back from break and the theatre team are holding your pt's legs up in the air trying to reestablish a better blood pressure.

Oh yeah, that reminds me of the liver transfusion method favoured in PICU - another sign things are going badly with your patient

Up Vote Up Vote ×
The patient gasps and goes from a normal Caucasian color to the color of a Smurf.

The patient says "Oh, the angels are singing! Don't you hear the angels singing?"

The patient says "I'm going to die. I'm going to die!" and looks like they mean it.

did that actually happen?

Up Vote Up Vote ×
Specializes in geriatrics and hospice palliative nursin.

when they get that unmistakable look in their eye

Up Vote Up Vote ×
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.

T
he patient gasps and goes from a normal Caucasian color to the color of a Smurf.

The patient says "Oh, the angels are singing! Don't you hear the angels singing?"

The patient says "I'm going to die. I'm going to die!" and looks like they mean it.

did that actually happen?

With the first one, I was working Agency on a telemetry floor. The patient's telemetry started alarming so the charge nurse went with me to check the patient. She'd put the bedpan on the floor and was squatting over it to pee. The charge nurse got one arm, I got the other, and we stood her up. She made a horrible gasping noise, turned that Smurfy blue, and that was pretty much that. Unsuccessful code.

The second one was a friend's mother. Very sweet LOL. Lots of family around when she heard the angels. I think she dozed off and then went in her sleep soon after. (Definitely preferable to kicking and screaming and fighting off things in corners.)

The last one was, I think, the lady sitting bolt upright in bed, eyes popping out, taking deep gasping breaths, blood pressure out the top of the sphygmomanometer. She got to ICU but I don't think lasted 24 hours.

Up Vote Up Vote ×
Specializes in Breast Cancer, Arterial, General Surgery.
they've spent the last week ringing the call bell every five minutes for things like "fluff my pillows". then suddenly they stop calling :uhoh21:

ah ha - i know this one.

patient on the move all night, up/down/up/down.

the night nurse i was on with said finally, "oh look he's gone to sleep".

damn!!! had to put put out a code.

Up Vote Up Vote ×

T
he patient gasps and goes from a normal Caucasian color to the color of a Smurf.

The patient says "Oh, the angels are singing! Don't you hear the angels singing?"

The patient says "I'm going to die. I'm going to die!" and looks like they mean it.

did that actually happen?

With the first one, I was working Agency on a telemetry floor. The patient's telemetry started alarming so the charge nurse went with me to check the patient. She'd put the bedpan on the floor and was squatting over it to pee. The charge nurse got one arm, I got the other, and we stood her up. She made a horrible gasping noise, turned that Smurfy blue, and that was pretty much that. Unsuccessful code.

The second one was a friend's mother. Very sweet LOL. Lots of family around when she heard the angels. I think she dozed off and then went in her sleep soon after. (Definitely preferable to kicking and screaming and fighting off things in corners.)

The last one was, I think, the lady sitting bolt upright in bed, eyes popping out, taking deep gasping breaths, blood pressure out the top of the sphygmomanometer. She got to ICU but I don't think lasted 24 hours.

wow, thank you for sharing

Up Vote Up Vote ×
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.

Wow.. What do you say when a pt tells you that?

btw..i'm a student

Up Vote Up Vote ×
Specializes in aged, palliative care, cardiac, agency,.
Or says something like "I am going to get the car", "I need to get out of here", " I want to go home". All of those can be mistaken for confusion, but if they are talking about going anywhere... watch out.

That would be classic terminal restlessness - phone the family! Another sign is a sudden and inexplicable improvement in condition - usually short lasting and often accompanied by family members and student nurses saying things like "Oh, isnt he looking better? I think he'll be ok."

Up Vote Up Vote ×
Specializes in aged, palliative care, cardiac, agency,.
When the experienced nurse says "this patient is fixin' to go bad" (yes, she's Southern) and the inexperienced doc blows her off...

not only is the patient going bad, it's not going to go well.

couldn't agree more!

Up Vote Up Vote ×
Specializes in aged, palliative care, cardiac, agency,.
The patient insists that he/she HAS to get up to have a BM NOW, and you have a very bad feeling about it, but really cannot see any good reason why not....

Been there, done that very early on in my career. Never forgot that lesson. Especially in a cardiac ward.

Up Vote Up Vote ×
Specializes in aged, palliative care, cardiac, agency,.
when the med student looks at the rhythm and says "are those pvcs?" and they are -- lots and lots of them all in a row!

love it!!

Up Vote Up Vote ×
+ Join the Discussion