You Know the patient is going bad when...

Nurses General Nursing

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!

We once had a post-cath pt with stents placed, recovering nicely in the ICU, who wanted to get up and just walk around the room(bed rest completed hours ago). We got him up, and all of a sudden he got really mad at us, cussing and flailing against our assistance. He yelled, "I'd rather be dead than stay here and put up with this". The other nurse and I looked at him, he was diaphoretic and pale. We both got him back into the bed asap, looked like a nice SR on the monitor, but pt not responding to our voices. I called cards, other nurse felt for pulse...pt in PEA, died a couple minutes later (DNR status).

I take it very seriously when the patient says they'd rather be dead than...(fill in the blank).

Up Vote Up Vote ×

When the patient says "It doesn't hurt anymore"

As a EMT I transported a man to a rehab with the diagnosis of MSF. During the wait for the correct bed, he tells his son, "I'm not in pain anymore". All I could think was, "Please get the bed ready, it would suck so bad to die on a stretcher!!!!" When left and the nexy day, the nurse said, "Hey, you know the guy you dropped off yesterday? He died 20 mins after you left." Go figure.....

Up Vote Up Vote ×
Specializes in Peds/Neo Critical Care Transport.

The Hct, Glucose and Potassium all come back the same number.

Up Vote Up Vote ×

many years ago,I was a brand new CNA,and I was doing homecare.My patient was a 90 plus yr old dying of rectal ca.On my third day there I knock on the door and the husband answers the door and says to me " I dont think Anna wants a bath today,she has her' monthly.' even as a newbie green CNA,I knew 90 yr olds dont get monthlies .but they do bleed out. Very calmly I access the situation,she was no longer alive,so i called the appropiate people.....I have never seen so much blood or poo in my life.....:barf01:

Up Vote Up Vote ×
Specializes in neuro, ICU/CCU, tropical medicine.
I have never seen so much blood or poo in my life.

I learned to recognize signs of hemorrhagic shock when I was a relatively new nurse. I had a patient with expressive aphasia from a new stroke. He was restless and anxious, but couldn't tell me what was wrong. Towards the end of my shift I figured he must be uncomfortable, so I decided to help him reposition himself in bed. I reached between his legs and felt a large, warm puddle. I pulled my (ungloved) hand out and saw it covered with blood.

Then the whole picture made sense: tachycardica + pale + restless = hemorrhaginc shock. I have never forgotten that, and have lost count of the number of people, nurses and docs, who have argued with me since then when I tell them that a patient is bleeding out.

Unfortunately for the patient, I have always been right.

Up Vote Up Vote ×
Specializes in ICU, telemetry, LTAC.
I learned to recognize signs of hemorrhagic shock when I was a relatively new nurse. I had a patient with expressive aphasia from a new stroke. He was restless and anxious, but couldn't tell me what was wrong. Towards the end of my shift I figured he must be uncomfortable, so I decided to help him reposition himself in bed. I reached between his legs and felt a large, warm puddle. I pulled my (ungloved) hand out and saw it covered with blood.

Then the whole picture made sense: tachycardica + pale + restless = hemorrhaginc shock. I have never forgotten that, and have lost count of the number of people, nurses and docs, who have argued with me since then when I tell them that a patient is bleeding out.

Unfortunately for the patient, I have always been right.

Yup, you hit the nail on the head. Post-cath patients can't tell you when they're having a retroperitoneal bleed, but their vitals and a sharp eye on their behavior can help. RP bleeds make me very, very nervous. Usually they have my hair wanting to stand on end before I know, or suspect, what is wrong. Add "personality change" to the pale, tachy, restless part too- some I've seen have completely flipped their personality right before they shat two thirds of their blood supply into the bedside commode.

Up Vote Up Vote ×
Specializes in Utilization Management.

If you're ever taking a patient to surgery and the patient suddenly asks, "Am I gonna die?" turn that stretcher around and cancel surgery, because the patient will die on the table.

It was actually policy in one of the hospitals I worked to do this, so there had to be a pretty strong correlation.

Up Vote Up Vote ×
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
If you're ever taking a patient to surgery and the patient suddenly asks, "Am I gonna die?" turn that stretcher around and cancel surgery, because the patient will die on the table.

It was actually policy in one of the hospitals I worked to do this, so there had to be a pretty strong correlation.

I've known anesthesiologists and surgeons who, if the patient told you "I'm not going to make it off the table," you'd better call. They would absolutely, positively not take that patient to surgery.

You really, really don't want to be the person who ignored the patient and let them operate unawares.

And, for what it's worth, I believe it, too. If the patient says they're not going to make it off the table, they won't. I don't care how healthy the patient, nor how minor the surgery.

When I've been the patient myself, I've taken a moment, before the point of no return, to ask myself how I felt about being put to sleep. Each time, the answer has been that I've had absolute confidence that I was going to wake up just fine. I suppose if I'm ever mistaken, then I'll have gone peacefully, while asleep (I hope! everyone else in the OR might be pretty perturbed, but hopefully not me) and I can't ask better than that.

Up Vote Up Vote ×
Specializes in cardiac.

When a pt says, " I feel really good today!" And their lips are a purplish/blue color!

Up Vote Up Vote ×
Specializes in Critical Care.

When the patient, whose in for her nightly post-meal epigastric pain, turns to her son (rhythm on the monitor a nice NSR @ 80 BPM) and says, "I'm tired now." In the next second, the monitor goes flat.

Talk about a freaky feeling!!:no:

Up Vote Up Vote ×
Specializes in Critical Care.
Yup, you hit the nail on the head. Post-cath patients can't tell you when they're having a retroperitoneal bleed, but their vitals and a sharp eye on their behavior can help. RP bleeds make me very, very nervous. Usually they have my hair wanting to stand on end before I know, or suspect, what is wrong. Add "personality change" to the pale, tachy, restless part too- some I've seen have completely flipped their personality right before they shat two thirds of their blood supply into the bedside commode.

I have learned NOT to doubt my gut feelings. This actually caused me to get written up once. I worked on an ICU and right next door was the step-down unit. The post-cath patients went there for overnight OBS. I was on a 12 hour 7P-7A and scheduled as charge for the last 8 hours of it. At about 8:30P one of the step-down nurses stopped over with a rhythm strip and asked me to take a look at it. Said the patient had fallen and complained of pain in his back after hitting the bedside table. The strip looked good, NSR, and the nurse said there was no bruising on the patient's back.

At 2AM, I get a frantic call from the step-down unit that they were bringing a patient over with a BP of 40/0 and unresponsive. We get the patient settled in and have a BP of 80/20 now and as I get report the light flashes in my mind. It was the fall guy and he was post-cath that day.

For some reason I decided to turn the patient, low and behold HUGE bruise from the mid-back to mid-thigh on one side. I called the doctor who declined to order an H&H. After talking with the house supervisor and informing her of the patient's retro bleed and my decision, I got an H&H. Sure enough he needed 2 untis of blood. I called the doc back with the results and got he order for blood. He gave it along with the fact that he was going to write me up. Go ahead doc, at least my patient will get what he needs.

The next morning they ordered a STAT ct on him and he had a huge retro bleed (DUH). My nurse manager took the write up and attached a note congratulating me on a great save.

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

I called the doctor who declined to order an H&H. After talking with the house supervisor and informing her of the patient's retro bleed and my decision, I got an H&H. Sure enough he needed 2 untis of blood. I called the doc back with the results and got he order for blood. He gave it along with the fact that he was going to write me up. Go ahead doc, at least my patient will get what he needs.

The next morning they ordered a STAT ct on him and he had a huge retro bleed (DUH). My nurse manager took the write up and attached a note congratulating me on a great save.

Wonder why the doctor chose to highlight the fact that he was an idiot. He should've been the one congratulating you.

Up Vote Up Vote ×
+ Add a Comment