But, yeah, I totally saved my patient last night....hahah not.
Anyway, she had major abdominal surgery; was completely necrosed inside/ major sepsis from a perforated bowel from extreme IBS and narcotic use for the pain. So, yesterday she had some serious blood pressure issues. They couldn't keep her MAP about 65, etc. and received like four 250ml bolus'. When I came on, she was holding steady, but then at like 1 in the morning, her pressure started to drop. 99/50 to 88 to 78.. I'm like...c'mon dude! So I bolus her once. I know it sounds insignificant and I will laugh about this later in life, but I felt proud that I just went ahead and did something rather than ask someone; mostly because this was only my second night off orientation and usually I have someone looking over my shoulder and when something goes wrong, they know about it, ask me what I would do, or tell me what to do.
Also, I am still getting used to the extreme autonomy I have as a nurse in the unit. I would never be able to just give someone fluids without talking to the MD first on the floor. Granted, we have standing orders/early goal direct therapy, but still...
So the point...I'm bolusing her, blablabla, still not coming up. And then I woke her up while fiddling with her lines (effing DUH) and her pressure went right back to 120-140!!!
I'm like...ok, note to self: whenever someone starts dropping their pressure, freakin' wake them up. Nursing 101 people, i have mastered it. For the rest of the night, whenever she started to look like she might drop her pressure, I just went in there and like slammed something or called her name and her pressure would shoot right back up, ahhahaha. I crack myself up.
I guess I didn't think to wake her up because she was in such intense pain and everytime she was awake she would moan out. I figured, sleeping and not moaning=no pain=happy patient and happy nurse.
I'm a total hero and genius, I know...hold your applause!
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4 comments:
ohhhh IBS is a scary thing... and hearing that story made me a little nervous... since I have IBS.
but then, I guess I manage mine fairly well and don't use narcotics for the pain... that's pretty terrible for her. :(
It's great that you figured out how to keep her pressure down. although, I'm sure she didn't like getting woken up, I wonder if simply explaining the situation to her would be alright...
but then I guess that would just be my preference- knowing what was going on... unless of course I was incoherent... hah.
congrats on the autonomy :)
oh i told her what was happening, but she was also on a fentanyl drip, so not completely coherent, that and totally septic...may not survive.
They drilled it into us in nursing school...what do you when the monitor looks like v. fib?? Go check the patient! And then find out they're brushing their teeth. Obviously.
well, it still isn't normal to drop your pressure that low when you sleep, but for documentation purposes, it helped to wake her up lol. she was extremely septic, not expected to probably live
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