Saturday, July 07, 2007
what I learned today
If the medication record says that your elderly patient is supposed to be wearing a nitroglycerin patch from 8:00 pm until 12:00 noon, you should go in and look for the patch at the start of the shift instead of waiting until nearly noon, at which point you will go into the room to remove the patch and instead find that your patient has not had a patch on all night and is now having angina (chest pain, for the laypeople in the audience). Because then you have to take some vital signs and get even more concerned when your patient's heart rate is in the 130s and he's saying, "It hurts here" and pointing to his jaw and chest. And then you'll have to go find the doctor and give your first-ever report to a real live doctor in an urgent situation. And the doctor will look alarmed and say "get a nitro patch on him stat and call for a stat EKG" and then you'll start to wonder if Something Bad is going to happen. And then the guy comes in with the EKG machine and says "Hmm, sinus tachycardia, oops, there's some a-fib" [translation: his heart is being really fast and sometimes it's not beating right]. Criminy.
The outcome was all right by the end of my shift - the patient was in a tele bed [translation: he was hooked up to a machine to monitor his heart rate and blood pressure automatically] and got some medications and was doing fine.
You can bet that if I see another order for a patch of any kind on a patient, I'm going to go look for that patch with a flashlight and a hunting dog, if necessary.
The outcome was all right by the end of my shift - the patient was in a tele bed [translation: he was hooked up to a machine to monitor his heart rate and blood pressure automatically] and got some medications and was doing fine.
You can bet that if I see another order for a patch of any kind on a patient, I'm going to go look for that patch with a flashlight and a hunting dog, if necessary.
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Additionally, it sounds like you learned you can trust your instincts, and talk calmly and intelligently to a doctor in an urgent situation, and handle what must have been a very scary situation for both you and your patient! Way to go, Em!
# posted by 
: July 08, 2007 9:38 AM
: July 08, 2007 9:38 AM
You did fine. I'm w/you, though; I'll hereby check my patients for patches at the start of the shift..especially nitro and fentyl patches. I wouldn't want to find either missing w/o being charted after an order was given to remove them.
# posted by : July 08, 2007 7:29 PM
: July 08, 2007 7:29 PM 
Wow, scary stuff. Sounds like you handled it well. I guess you have to learn some stuff the hard way!
good piece of advice. I'll remember that with my patients. I haven't had anything more than a nicotine patch on a patient but I'm sure as my nursing program goes on I will. I'm only first semester so I'm sure it will come.
Since the summer began I get to see all kinds of patches on people and wait for the right opportunity (sometimes it never comes) to ask what it's all about. But heck, if someone displays something so prominently, is it wrong to ask about it?
In my field the answer is, Well. . .it all depends.. .
In my field the answer is, Well. . .it all depends.. .
Yeah, that happens, unfortunately. I've also done my little head-to-toe morning assessment thing and found three or four old patches on a patient, none dated nor initialed.
I always date/time/initial patches, but then again I'm an improperly medicated OC freak.
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I always date/time/initial patches, but then again I'm an improperly medicated OC freak.
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