One of those weird caregiving things

Have you ever cared for a patient who’s on the verge of instability? You know…type of stable, but not a lot that you simply’re too optimistic that they will not crash? In the intensive care unit where I worked, I remember many situations where we had this one habit that helped us get through the shift and supply stability for the patient. It sounds silly, almost superstitious, however it has worked sometimes… and I’m wondering if any of you have got similar quirks or traditions that you simply use in your personal practice.

What is that this? Here are some examples:

We admit the patient and get him into his room – we activate the EKG monitor, take vital signs, set alarms, establish intravenous access, take a history and perform a physical assessment. He appears to be fairly stable, but once you leave the room, an alarm goes off indicating that his systolic blood pressure is 90 mm Hg. His initial blood pressure was 116/78. Your friend asks, “Do you want some intravenous fluids?” to which you reply, “Yeah, I’ll just keep it in the room.”

Another patient who had been on the ward for several weeks and had resolved ARDS (acute respiratory distress syndrome) was extubated 2 days ago and was respiration on her own. However, because the change progresses, her need for oxygen increases and respiration becomes increasingly difficult. The respiratory therapist asks, “Do you think she will be reintubated?” and also you respond, “Please bring a respirator to her room just in case.”

I can consider many patient scenarios like this where we brought IV catheters, vasopressors, or other medications, even urinary catheters, into the room, but then didn’t should use them. I do know a few of that is within the pipeline and an “out of the box” treatment or intervention is something we do on a regular basis as nurses. However, sometimes it seemed that just bringing something into the patient’s room was enough to offer stability. Just a coincidence? Probably. But if it really works…