Tanya Perez is an outstanding nurse for her hard work and exemplary dedication to patient care. Tanya was the primary nurse for the patient, a lady whom I had admitted a few nights prior for sepsis and who was receiving dual antibiotics, also had a clotting disorder on Coumadin. Her initial INR was sub-therapeutic so had received higher initial Coumadin doses, but had to eventually hold the anticoagulants due to continually escalating INR.

On the night shift, the patient had an episode of confusion and altered mental status early in the shift. Tanya paged me to evaluate the patient. Definitely, the patient was not at her baseline, and was a concern for a bleed or opiate toxicity as the patient had received morphine earlier. We gave Narcan without much change. Tanya also pointed out a change in the patient’s abdominal infection with more redness, heat, and new bullae forming. We obtained a CT brain and dry CT chest, abdomen, and pelvis. CT pelvis showed concern for necrotizing fasciitis. Tanya immediately notified me of the result and I was able to contact our general surgeon for stat consultation. It was deemed patient needed OR immediately and we had to reverse the anticoagulation ASAP.

This was a very long process that took many hours, constant infusions of different medications as well as mixing the K-Centra in large volumes due to high INR and patient size. Tanya remained calm, even-tempered, and always had a professional demeanor through this entire process. We had difficulty obtaining the needed medication and it was a new medication for many of the staff, the pharmacy was no longer in-house, so was difficult to rapidly administer this. The pharmacy was eventually able to come in for medication verification but Tanya still needed to draw up and mix the medication without pharmacy assistance as well as administer it to the patient. The entire shift was consumed by caring for this very sick patient, and Tanya was instrumental in us being able to recognize there was a new very serious clinical issue with her patient and to intervene repeatedly on patient laboratory and hemodynamic issues throughout the shift.

By the end of the shift, we had successfully reversed the elevated INR and the patient is now stable for OR this morning. None of this would have happened without Tanya’s astute clinical assessments and dedication to outstanding clinical nursing care. She is one of our best nurses and is a role model for exemplary patient care. She played a major role in saving this patient’s life this past shift.