Renee was caring for a sixty-year-old female who was a patient on the ICCU. That morning, Renee noticed that this patient appeared to be more confused than the day before and that her blood pressure was running lower than usual. Renee notified the attending physician and the cardiologist of the patient's hypotension and change in mentation. The patient was scheduled to be discharged that day and the attending did not feel like the increased confusion was a reason to delay the discharge since the patient's baseline was occasional confusion. Renee continued to advocate for her patient despite the fact that the physicians did not share her concern. Renee checked the patient's blood pressure frequently and saw that it continued to trend downward to an unsafe level. Renee initiated a rapid response to expedite treatment of the patient's severe hypotension. The patient's mentation worsened despite fluids being given to raise her blood pressure. After fluids were given, the rapid response team left, feeling that the patient had been stabilized. Renee again followed her instincts that something was still wrong with her patient. She noticed during her assessment that the patient's abdomen was round and hard and that the patient was unable to tolerate food. Although the patient had a history of ascites, Renee felt that her abdominal swelling was greater than the day before. She again contacted the attending and obtained an order for a CT abdomen. The CT revealed a small bowel obstruction. Renee notified the physician and obtained an order to place an NG tube and to transfer to ICU since the blood pressure had once again dropped below 70 systolic. During the placement of the NG tube, the patient stopped breathing and became unresponsive. Renee quickly initiated a code blue. Because of her quick response to an emergency situation, the patient was resuscitated and regained consciousness. The patient was then transferred off the unit to ICU.
This patient survived because of Renee's unwavering commitment to advocate for her patient. Despite orders to discharge the patient, Renee continued to advocate, following her instincts that something was not right with her patient. Many of the clinical findings could have been caused by the patient's known medical conditions, but Renee knew something more was at play. I am so thankful that Renee was taking care of her that day. If the patient had been discharged that morning, the story could have had a very different ending. Renee's questioning attitude, excellent assessment skills, and confidence in her feeling that something was not right saved her patient's life. I can only hope that if I am ever in the hospital that I have a nurse that advocates as hard for me as Renee did for her patient.