gut feelings

Last night I had one if those feelings that something wasn't right with my patient. I remember the last time I felt this way, something really wasn't right and my patient ended up coding and died. So when I felt the kick in my stomach again, I was like "oh! I can't ignore it this time." Just glancing at my patient at start of shift, he looked fine. Blood pressure, alright. Oxygen level, good. A little swollen yes, but he was getting dialysis first thing in the morning. He's talking, actually getting up to the bathroom and inask him how he feels he says "I'm okay jus feeling a little weak." (kick,kickin in my stomach)

3 hrs later, knocked out, snoring. Vital signs all the same. Wake him up a lil cuz I'm
scared haha, And I ask him if he's ok cuz he's snoring louder than usual. He says " yea, kinda having a hard time breathing, can put my head up?" so I do, his oxygen levels perfect but I'm happy cuz I've been looking for a reason to call the doctor!!! it's sucks when you don't know exactly what your gonna say to the doctor in the middle of the night. This is the one of the reasons I don't like night shift--you have to hesitate before calling the doctor. But I call him anyways, tell him the pt is having a hard time breathing. He asks what the o2 sat was, I say 99 (haha), he doesn't think there's a problem (kick kick in my stomach) dammit.

I ask my coworkers to look at him, but nobody really thinks he looks to bad. So I'm like ok, fine--let it go. Then 2 hrs later his BP drops to the 80s. I turn off all the drips that affect his BP...wait an hour to see if it will come up but it never does. Pt still looks the same, jus a lower bp but he feels fine still jus a lil short of breath. i do an EKG--looks the same In comparison. So I calls the dr again. He dismisses my call "oh no that bp is fine, he's been in that range before" he's getting kinda irritated I keep calling him, and I am getting more and more nervous-jus overwhelmed with the feeling that it wasn't right.

Coworkers still think he looks okay, there's sicker patients on the floor. So finally 2 hrs later he's like I'm sorry to bother you but I am just feeling really weak, like I can drink a whole carton of lemon Gatorade & he laughs. His breathing seems more labored but still ok oxygen levels & his lungs sounding a lil noisy. I can't put my finger on what's wrong, but i wanna call the doctor again! hah, for about 20 minutes I was like should I call him? Or no?he was one of those docs who are just asses bc they are. Most cardiologists there are. But i decided fuuuck it, if he yells at me fuuuuck it...gotta cover my ass tho. haha so I call him--with no real point to make to him but just telling him everything I am seeing and assessing with the patient. The doctor decides he's gonna come in--3 am.

Now I'm scared, lol. What if the patients okay and I made the doctor come this early, he's gonna kill me!!!! I started a drip the dr orders to get my patients heart pumpin, his blood pressure went up & he said he could breathe better. I'm like ohhh shit, and the doctors coming! Almost like I wanted him to tell me he felt bad, lol. The doctor came and the patient looks fine!! so I bustbout my charts and show him the vital signs before the drip was started, so te doctor takes him for a study while he's there. Lo and and behold!!!--- the patients previous heart attack had extended all over the inferior part of his heart...!

He came back to my unit with like 8 drips to sustain his bp, a mask to push oxygen, a new dialysis catheter for crrt, a balloon pu
p in his heart. Pretty much so sick, that they had to send another nurse to come help take over because I have not been trained with all those machines he was connected to. The doctor went up to me and grabbed my name badge and said "maricel, you did a good job. Thank you for being persistent in calling me" & began showing me what happened.......finally, the feeling in my stomach went away.

Sorry for the nurse talk...but aside, I came home thinking where the hell do we get those gut feelings from? Who tells us something isn't right..who puts that idea in our heads?! Not just at work it happens, but in life. so my lesson for the day us to trust that gut feeling, cuz most of the time it's right.