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What to do? A real life scenario – Updates Complete!

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All right nurses, here is a scenario for you. You walk into the room. The patient seems a bit “off” but he’s sick, (DM, HTN, etc.) and a bit older at 74 y/o.  The second time you head into the room, his wife and adult daughter are there.  They tell you he’s NEVER like this.  What’s the first thing you do?

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Thanks for the responses!  Melzie said to check vitals, blood glucose, and neuro status.  I love that she included to do a neuro check. You don’t want to spend a long-time doing this. I’d stick to orientation questions only (who are you, where are you, what date it is). Maybe ask them the name of the family in the room with him.  You want to be sure to do this neuro check because you want objective data.  How confused is he?  How will we know when he’s better?  It’s important to listen to the family’s feeling about the patient, but it’s just as important to convert that information from a statement of opinion to objective medical data we can do something with.

Sheila also said to consider the possibility that the patient has a UTI.  This is a great point, especially since the patient is 74. The older the patient, the more confusion a UTI could cause, even without a fever present.  Of course, a root cause like this is a secondary concern for now.

So, I’d get the vitals and blood glucose and neuro check as quickly as possible.   The patient is oriented only to self.  He has no clue where he is, the date, or who is President.  His vital signs are within normal limits except for his blood pressure which is 74/50.  A quick glance at his charge reveals he is on blood pressure medicine and his BP is usually closer to 140/80, even when on meds.

You page the doc.

What do you do while you wait?

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Wow.  See TaraRRT’s comment below.  I’m guessing she’s a Rapid Response nurse (based on her username) and did an amazing job of saying what she’d do next!  Here’s what I did:

I put the patient in trendelenberg and started running saline at 150 ml/hr.  The docs called me back immediately and arrived immediately so I did not, in this instance, call the rapid response team.  However, a call to the Rapid Response Team was definitely warranted given the situation.

The patient’s vitals recovered quickly.  The family was really grateful for my help–they felt very listened to and cared for.  This situation was actually a really good one for me as it was really early in my career and I felt like I made some good, quick decisions.

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