September 2014
Nanci
Corrigan
,
RN
PACU
Legacy Emanuel Medical Center
Portland
,
OR
United States
... Yesterday I worked with Nanci Corrigan on a lovely 3 year old girl. "Ana" had been in the hospital on the 8th floor of RCH for about a week to evaluate a fever of unknown origin. After significant work-up, she was found to have a large, 9 cm liver abscess, which was drained in Interventional Radiology yesterday. I provided the anesthesia for her and brought her to the PACU afterwards on oxygen/face mask. The child has a moderately complicated medical history (not unusual for our patients), and Nanci had already reviewed the patient's chart prior to our arrival and was aware of the patient's issues.
During the patient's PACU stay, she continued to need a bit of oxygen to maintain adequate saturations. In addition, she had labile temperatures and was just not waking up to the level expected. Nanci and I discussed the proper monitoring location for this patient and she strongly encouraged me to move her to the PICU. I had discussed it with the radiologist and the infectious disease physician in the CT suite, and we were all impressed with how awake and alert and stable Ana had been pre-procedure on the floor. However, Nanci and I were concerned that placing this abscess drain had possibly resulted in spillage and systemic uptake of this infectious process. Though the patient's BP was stable (SBP ~ 100), and her heart rate corresponded with her increased temp, Nanci said she "had a feeling."
When an experienced nurse tells me she has a feeling, I have to have very good reason not to follow his or her recommendation. I think she encouraged me to follow through on the earlier thoughts of ICU level care. I discussed it with both the ID attending and the PICU attending and all were in agreement, though none felt strongly that it was necessary.
However, Nanci was right. The child was placed on a dopamine drip in the PICU overnight. Thanks to Nanci's gentle nudging, this patient had the proper monitoring and care before it became more serious.
Your nurses do an excellent job on a daily basis, but I wanted to let you know this wisdom and experience of a seasoned nurse is invaluable and much appreciated.
And as an added bonus, Nanci set up her personal iPad with the movie Frozen for the patient to watch while we monitored her and made the PICU transfer arrangements. A sign of a truly caring, thoughtful, and resourceful nurse.
During the patient's PACU stay, she continued to need a bit of oxygen to maintain adequate saturations. In addition, she had labile temperatures and was just not waking up to the level expected. Nanci and I discussed the proper monitoring location for this patient and she strongly encouraged me to move her to the PICU. I had discussed it with the radiologist and the infectious disease physician in the CT suite, and we were all impressed with how awake and alert and stable Ana had been pre-procedure on the floor. However, Nanci and I were concerned that placing this abscess drain had possibly resulted in spillage and systemic uptake of this infectious process. Though the patient's BP was stable (SBP ~ 100), and her heart rate corresponded with her increased temp, Nanci said she "had a feeling."
When an experienced nurse tells me she has a feeling, I have to have very good reason not to follow his or her recommendation. I think she encouraged me to follow through on the earlier thoughts of ICU level care. I discussed it with both the ID attending and the PICU attending and all were in agreement, though none felt strongly that it was necessary.
However, Nanci was right. The child was placed on a dopamine drip in the PICU overnight. Thanks to Nanci's gentle nudging, this patient had the proper monitoring and care before it became more serious.
Your nurses do an excellent job on a daily basis, but I wanted to let you know this wisdom and experience of a seasoned nurse is invaluable and much appreciated.
And as an added bonus, Nanci set up her personal iPad with the movie Frozen for the patient to watch while we monitored her and made the PICU transfer arrangements. A sign of a truly caring, thoughtful, and resourceful nurse.