Well, if you remember, a few days ago I wrote a sarcastic – and completely true – post about what it’s like to be a nurse. You can check it out here. I thought it was pretty funny.. but now I’ve had two terrible, terrible nights at work. Both nights I transferred one of my patients to the ICU. So today I’m going to tell you about what happened last night – because this REALLY, TRULY, SERIOUSLY is what it’s like to be a nurse.
The patient is 44 years old. He was admitted to the hospital with nausea and vomiting. Medical history includes AIDS, ESRD (end stage renal disease), and high blood pressure. He’s not a diabetic, but they’d been having trouble stabilizing his blood sugars all day because he hadn’t been eating, so he had IV fluids with dextrose running.
When I had checked on him in the beginning of the shift (about 7:45pm), he was sleeping – no distress noted. The tech took his vitals about an hour later (about 8:30pm) – no distress noted. When she took his blood sugar at 9:40pm, it was only 51. When I entered the room, the patient was lethargic, difficult to arouse, but did not appear to be in any type of distress (which is normal for a patient with low blood sugar). I immediately gave him concentrated dextrose through his IV. Then when I went to re-position him, while I waited to recheck his blood sugar, I noticed a thick, brown liquid coming out of his nose. At this time I noticed he had become diaphoretic (aka sweaty) and his breathing was very labored. He would open his eyes only if I shook him and shouted his name, but would not keep them open and would not talk. I immediately placed him on oxygen and notified the MD and the rapid response team. When I rechecked his blood sugar, he had come up to 99.
Everything happened very quickly after that – we suctioned him, we assisted his breathing with an ambu bag, we attached the AED pads (which thankfully, we didn’t have to use), we inserted a nasal airway, and we immediately transferred him to the ICU. While there the doctor attempted to place a subclavian central line (in his chest), but was unable to due to poor vascular access. Eventually, they placed a central line in his femoral vein (in the groin), and then intubated him. They suctioned his lungs and his stomach – and both contained a thick, brown liquid.. meaning he most likely vomited and then aspirated on it.
It’s crazy to me because it all happened so quickly. This patient is known for sleeping while curled up in a little ball. The way he had his arm positioned was blocking my view of the vomit, which is why I initially only noted it coming out of his nose and didn’t see it on the sheets. I initially thought he was lethargic from the low blood sugar, but I quickly realized that was not the case. He must’ve vomited like 2 seconds before I walked into the room – which is quite lucky for him.
So what did we learn from this?
1. Never assume anything when you first walk into a patient’s room. If I hadn’t continued to assess him, or even if I hadn’t stayed in the room while waiting to recheck his sugar – we might’ve found him too late.
2. Don’t be afraid to ask for help. I immediately notified the charge nurse, the doctor, the rapid response team, and the other nurses working down my hall that something was wrong and that I’d be needing assistance. Shouting for help is also very effective.
3. Don’t feel bad if you don’t know what’s happening. I didn’t know exactly what was wrong with him, but I knew his symptoms meant something was very, very wrong. The important part is just knowing that something is wrong.
4. Trust your instincts. I notified the doctor and the rapid response team before I even checked his vitals, before I even thoroughly completed my assessment. I was checking his pupils while on the phone. I knew that things were progressing rapidly and I knew I needed them there ASAP.
I’m sure there are things I could’ve done differently, but I feel very pleased with the way I handled the situation. I knew my patient. I knew something was wrong. I knew to ask for help. I knew exactly what to do before I was told what to do. It’s a
good great AWESOME feeling to feel like you really know what you’re doing in your career.
I am proud of myself.