For me, it was the result of the nurse faculty who challenged me in the simulation and skills lab, with thought-provoking didactic classes, and most importantly, prepared me for clinical rotations. This “gut feeling” we call clinical judgment that results in sound clinical decision-making is not something we graduate with from nursing school. Not one of us took credit for that day-we simply said, “you are welcome.”
The surgery went well the patient survived and later returned to the unit with treats and a “heartfelt” thank you. She was not convinced of the urgency, to which I responded, “they need to be here now, trust me.” Reluctantly, she made the call. I looked at the resident requesting an ultrasound and that the cardiothoracic team be called. My gut told me this patient needed surgery now. I’d read about it, heard about it during a Laura Gasparis lead conference, but never heard it in real-time-but there was no doubt. I immediately assessed heart sounds, and there it was, the “whoosh, whoosh, whoosh,” the classic washing machine sound of a blown mitral valve. As the arterial line was placed, I half-joked with the CRNA, “are you sure this is an ART line, not a SWAN?” as the reading was that low. The CRNA on call happened to be on the floor, and I let the resident know that I’d like an arterial line and signaled the CRNA.
As other nurses assisted me in placing his ECG leads, the BP cycled a second time. He was pale, and his altered level of consciousness communicated in the report was obvious. The elderly gentleman was wheeled into the ICU just as I was getting off the phone with a report from the nurse on the step-down unit. I remember the patient presentation like it was yesterday it has been 20+ years.
0 kommentar(er)
