1. Johnston, Dana L. MSN, RN, CLNC

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When I was in nursing school, my professors always stressed that above all, nurses should listen to their 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, heart failure with reduced ejection fraction (EF) (left ventricular EF, 20% [normal, 55% or higher]), prostate cancer, and chronic obstructive pulmonary disease.1 His chest X-ray showed complete opacification of the right hemithorax that, along with other objective and subjective data, indicated pneumonia. Mr. D was admitted to the hospital and management included endotracheal intubation, mechanical ventilation, and I.V. antimicrobial therapy.


A demanding patient

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 complained of discomfort in his right lower quadrant, describing his pain as a "dull ache," with an intensity rating of 2/0-10. After evaluation, 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, I had been in and out of his room many times and was feeling frustrated.


About a half hour before change of shift, Mr. D. complained of excruciating, sharp abdominal pain with an intensity rating of 10/0-10. He was notably anxious. Even though his vital signs were stable and there were no new physical assessment findings, I immediately called his healthcare provider, 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 after the scan, 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." I am here to say, do not ignore them! Their discomfort may be all you have to go on. Mr. D's outcome was tragic, but I will never forget the patience he taught me.




1. Colucci WS. Screening for asymptomatic left ventricular dysfunction. UpToDate. 2016.[Context Link]