Last week I had to go to a patient deterioration class. In this class we discussed identifying patients who are at risk for deterioration and how to spot early signs and symptoms…now one might ask…why is it so important to recognize early signs and symptoms…well to avoid placing yourself in the middle of a Code Blue situation of course.
All during this class all I could do was think about work the night before. I had a patient who was in the hospital for a GI bleed. Now while I was getting report on this patient, a nursing care tech came in and told us that the patient was acting “funny”…the pt was sleeping and not waking up when there was someone in the room like normal. The day nurse just continued to give me report like she wasn’t concerned at all…I looked at her “um…is this normal for the patient?” “Well they never sleep so they are probably just tired”. Uh…huh…
After getting report, I decided the first thing I should do is go in and check out this patient. As I was about to enter the room, I noticed there was a dr in there with the pt…I figured the best thing would be to wait until the dr finished.
About five minutes later, the dr came into the nurses station. “Has the pt been acting like this for awhile now…is this normal…because I was here the last two nights and when I saw the patient they weren’t like this at all?” Ummm….why are you asking me when you answered your own question…is what I wanted to say. But I told her “Actually I have never had this patient before, but the tech who was here earlier said that it’s abnormal.” My fellow nurse spoke up… “I had the patient before and this is not normal…they are never like this…they usually are talking from the moment you walk in the door until you leave”. The dr looked at us and said “Well, I’m sure it’s just because they’re tired…keep monitoring, I’m sure there’s nothing to worry about”
Off on a little side note here…WTH does it mean when a dr tells you “keep monitoring the pt” What exactly does that mean!!!! What do you think I have been doing since I got here and the last 8 hours!!!???? Ok back on point.
I continued monitoring the patient…who slept for the next 6 hours but would wake up when I was in the room. Throughout the night, I kept in contact with the dr…but got the same message… “Oh it’s fine…” Well that’s what I heard until I checked the morning labs and saw the hemoglobin was 4.5 and the hematocrit was 18.3%,... which means nothing until you consider the last labs from yesterday showed a hemoglobin of 11.2 and a hematocrit of 29.2%...
Don’t you love how it was no big deal…oh yeah…except the patient was actively bleeding out!
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