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Da-dum-dum

The other night I took care of a man who was hypoxic and needed oxygen in the form of an oxygen mask. Most people tolerate the mask fine, but there are a few that just can’t handle having something on their face.

My patient was one of those few.

Even though the little nasal prongs were doing the trick, the pulmonologist wanted us to use a mask because “he will probably take a turn for the worse eventually.” (Side rant: This is also the same pulmonologist, who upon walking onto the unit unable to find this patient’s chart, came up to me and said, “Geena, when you have a critically ill patient, wouldn’t it be at the forefront of your mind to have the chart available?” To which I replied, “Dr. B, the very fact that I have a critically ill patient who is hypoxemic and trying to climb out of bed actually explains why I don’t have the faintest idea where the chart is.”)

Anyway, due to other circumstances, I didn’t immediately connect that the patient became severly agitated when we applied the oxygen mask. I had to give him an antipsychotic shot and spent as much time as I could at his bedside to avoid having to restrain his arms (which I correctly assumed would make him worse and wouldn’t work anyway… when another nurse watching him for me went ahead and restrained him, he just bent over and put his face to his hand to take the mask off). While I was there trying to chat with him about other things to help take his mind off the bothersome mask, he finally stopped struggling against the restraints and laid back on the pillow.

After a few moments, he looked at me. He asked, “How long have you been working here?”
“Three years,” I replied.
“So before that, did you get your Bachelor’s, or your Master’s….”
Before I could answer him, he finished, “IN TORTURE???”

I’m sure it is not good nursing etiquette, but I laughed quite hard at that. Which made him laugh. I eventually decided that the amount of energy he was exerting to remove the mask was far outweighing the benefit of it, so I switched him to the nasal prongs again. After a few minutes of low oxygen sats, he calmed down considerably and actually drifted off to sleep. His O2 sats came up perfectly and the rest of the night was fabulous.

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Comments

Which is a dynamite example of “treat the patient, not the numbers.”

And “be in the moment, not the future.”

And “do your utmost to keep from committing critical care on a patient unless absolutely necessary.”

Good story, Geena.

Excellent work. And a perfect example of how nurses can tell docs what their patients need.

Good story, wish my students would read more medical/nursing blogs.

I once had a 50/50 patient in the ED. The doctor said put a mask on him. I discussed my concerns that the man would stop breathing because of high levels of O2.

That’s nothing to be concerned with, the doc responded. I put the O2 mask on the patient and set up the intubation equipment. Twenty minutes later I asked the doc to come in and intubate the patient. His C02 had risen to 92 from 50.

Yea, don’t listen to the nurse, we don’t know what we’re doiong.

GOOD READING MATERIAL!!

I just found these blogs and have enjoyed reading them. I’m an RN supv at a rehab center.



So, what brought you to the hospital today?

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  • profileI am Gina. I have been a nurse for 15 years, first in med/surg, then CVICU, inpatient dialysis, CCU and now hospice. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!

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