WHEN I WAS IN nursing school, my professors always stressed that, above all, you should listen to your patients. I recently had an experience that reminded me how important this is.
Mr. D, 82, arrived in the ED with shortness of breath and pleuritic chest pain. His health history included coronary artery disease, coronary artery bypass graft surgery, left-ventricular (LV) systolic dysfunction (LV ejection fraction, 20% [normal, >=55%])1, prostate cancer, and chronic obstructive pulmonary disease. His chest X-ray showed a complete white-out (opacification) of the right hemithorax which, along with other objective and subjective data, indicated pneumonia of the entire right lung. Mr. D was admitted to the hospital and management included endotracheal intubation, mechanical ventilation, and I.V. antimicrobial therapy.
Improved clinical status, more demands
After several days, Mr. D's clinical status gradually improved and he was weaned from mechanical ventilation and extubated. He was hemodynamically stable and awake, alert, and oriented.
The next day, Mr. D was assigned to my care. When I introduced myself, he seemed pleasant and talkative. I assessed him, made him comfortable, and ensured that all his needs were met. He had a nonproductive cough and was complaining of a "slight discomfort" in his right lower quadrant, describing his pain as a dull ache and 2/10 on a 0-10 numeric pain rating scale. After evaluating him, his healthcare provider found no abnormalities and reassured Mr. D that "all was well."
Throughout the rest of the day, Mr. D verbalized multiple complaints: I'm cold, can you cover me with my blanket? (He had full muscle strength of his upper and lower extremities.) I need a swab for my mouth right now! (He was in the middle of a bath.) My stomach hurts. I'm anxious, can you give me something? I have this little cut right here that the doctor needs to know about. By the end of the day, nurses and UAP had been in and out of his room many times and were feeling frustrated with him.
About a half-hour before change of shift, Mr. D. complained of excruciating sharp pain with a rating of 10/10. He was notably anxious.
Even though his vital signs were stable and there were no new physical assessment findings, I immediately called the physician, who said he'd come in right away and ordered a stat computed tomography scan of the abdomen and pelvis. By the time Mr. D returned to his room, his respiratory status had deteriorated, requiring reintubation and mechanical ventilation.
Mr. D's clinical status continued to deteriorate despite all interventions and he passed away from an internal hemorrhage with his family at his side.
Listening is critical
As busy nurses, we may get frustrated with patients who seem very needy and who are frequently "on the light," and be tempted to ignore them. I'm here to say, don't! It may be all you have to go on. Even though Mr. D's outcome was tragic, we fulfilled our ethical and professional obligations to him and his family by listening to him without judgment and intervening without delay.
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