Rapid Response

My last day on Women's Speciality turned out to be a very exciting one...it began with my mentor trying to set me up with a 4 foot 11 chubby doctor...sorry, but no. But that wasn't the exciting part. The beginning of the day was really slow with a low patient number so L sent me down to the CVICU (Cardiovascular Intensive Care Unit) to see some "cool" (this word is relative to your desire to see chest tubes, blood and other bodily fluids) things. A very nice nurse showed me around the unit and was so patient explaining everything to me. She had just come on the shift so she showed me what an ICU nurse does and how they prioritize patient care. Just being in the ICU setting was very intense and I don't know if I could do that kind of nursing! The patients had a least 10 IV fluids running, wires and tubes coming from all kinds of places and they just looked really sick. I was able to watch her take out a chest tube which was really interesting but looked painful for the patient. By the end of my hour with her I felt more comfortable but I think I'll stick to the pregnant people and babies.

The real exciting part of my day came at the very end. L and I had gotten a new admission around 4:30 and she had just had GYN surgery. She had a medication ordered for her and the ordered range was 1-3 mg. They had given her 1 mg and it wasn't having any effect so L decided to try the 3 mg. She was hesitant because she had never given this much before but the patient said she could handle it and the doctor had ordered it so L thought it should be fine. Fifteen minutes after administering the medication via her IV we heard beeping from her room and I went in to check on her. Her pulse was 147, her skin was blue and her eyes were fluttering. Her daughter was at the bedside and said all of a sudden her mom started acting funny and that was when the machine started peeping to indicate her high pulse. I went to get L and we hurried back into the room. At this point the daughter was crying so I did what I was taught to do and calmly took her outside the room and told her we were going to do everything to make sure she would be OK. L called 2 other nurses in the room and a "Rapid Response". Rapid Response is a step below from calling a full code but basically it is designed to help a nurse with a patient in critical condition. A RR will send 2 ICU nurses and a Respiratory Therapist immediately to the floor to help you out. While we waited for them we put the patient on oxygen, moved everything out of the way in case of a code, put cold washcloths on her face and chest and pushed Narcan which is a narcotic drug reversal agent. By the time RR got there she was doing a lot better but was still having trouble keeping her eyes open. We stayed with her for a while until the Narcan kicked in. Fortunately Narcan works very well to reverse the effects of the drug but it also makes all of the pain come back. Our poor patient was so confused what had happened, was all of a sudden in a lot of pain but was afraid to take any medication. We monitored her for the next hour and then before the end of the shift we convinced her to take a 0.5 mg dose to take the edge off.

It was a scary moment and I truly felt bad for the patient and her daughter but it was also a really educational experience for me. I learned to trust your instinct if you sense something is off, even if the doctor ordered it. With pain medication it is important to keep the pain at bay but also to ease the patient up with dosages, especially with narcotic drugs. Also, I learned to not hesitate to call a Rapid Response. This patient obviously needed help even though she was much better by the time she arrived. It is better to be safe than sorry!

Tomorrow I get to go to Labor and Delivery for one more day so I am very excited. Hopefully it will be less exciting than today though!