What in the World is Going on With This Patient?

Sometimes one of the hardest things about nursing is knowing what is actually going on with a patient…especially in the middle of a patient decline.  During a decline, it is the responsibility of the nurse to inform other members of the healthcare team (doctors, rapid response, and respiratory therapists, etc.) what is happening with the patient.  The information obtained from the nurse helps set the treatment plan. 

However, many times when a patient is declining, there are a million reasons why the patient may not be doing well.  In fact many times, it is impossible to tell right away because so many different declines may have similar signs and symptoms, which may prolong diagnosis and treatment.

 
The other night was a regular, ordinary night with not much action occurring.  In fact we had all gotten into the mindset that this was going to be a good night, and this was our mistake number 1 (Never ever as a nurse or healthcare professional even entertain this idea, because as soon as you do, you will have jinxed yourself 
every time).

 As we were basking in our quiet night, one of the nursing techs came and informed us that one of the patients was acting a “little funny”.  She was definitely more confused and more agitated then she had been for the last few nights we had been there.  We went and checked on her, but found nothing to be alarmed about, our mistake number 2 (Never assume just because some patients get confused over night in the hospital, that this is normal for all patients).

 Twenty minutes after checking on this patient, I was giving some medications to another patient, when I heard patient number 1, start yelling at the top of her lungs.  “Help!!! Help me!!! I need you to help me right now!!!”  I went running into the room with the other nurse and we found the patient laying in the bed with a crazed look in her eyes and tossing herself all over the bed while still screaming at the top of her lungs.  Her next words got us springing into action.  “I think I am having another stroke!!! Help, Help me please.  I don’t want to die!!!”

 We quickly asked the tech to get a set of vital signs (temperature, heart rate, blood pressure, respiration and oxygen saturation).  While he was doing this, I quickly did a stroke assessment trying to ascertain whether she really was having a stroke.  My assessment came up inconclusive because there were some signs and symptoms of a stroke, but not enough to warrant a stroke alert.  The tech informed me he was not able to get a temperature on the patient.  I asked him if he would mind getting a blood glucose level.  Sometimes when a patient’s glucose level is low they tend to have signs and symptoms of a stroke.  As soon as the tech informed me of the glucose level of 15, I knew we had found the reason the patient was declining.

 I quickly ran out of the room to grab some D50, which is a concentrated form of sugar that is pushed into a patient’s IV to raise the glucose level in the blood.  However, as I ran back into the room with the D50, the other nurse, the patient’s nurse, informed me, “Oh shoot she doesn’t even have an IV.”

 Because of the no IV access, the treatment options had become very limited.  I quickly grabbed a glucose gel tube and some glucagon.  As the other nurse put the glucose gel under the patient’s tongue, hoping the sugar would absorb into her blood, I quickly mixed up the glucagon and administered it as a shot in her leg.  When we rechecked her glucose level again, it was 14.  Our mistake number 3.  (When you arrive for your shift and you learn that one of your patients does not have an IV, it may be a good idea to ensure an IV is placed BEFORE the patient actually begins to decline and every minute counts).

 While we were starting the IV and administering meds to help the patient, the patient was yelling the whole time.  She was saying she was dying, she knew it.  She was having a stroke and we needed to help her.  Finally I grabbed her hand and was able to calm her down with a quiet voice.  Within seconds of placing an IV we were able to administer the D50, and within minutes she was more responsive and aware of her surroundings.  Thankfully all the pieces of the puzzle fell into piece relatively easily for this particular patient decline and we were able to quickly provide treatment with no harm to the patient.