Hahn also consulted with an intern. The intern told Hahn to give the patient a drug called Lopressor, a beta-blocker that controls blood pressure and heart rate. But Hahn knew this was the wrong call. Aside from having had an aneurysm, the man also had chronic obstructive pulmonary disease (COPD), that is, lung disease. Lopressor is dangerous for anyone with COPD. If this patient took Lopressor, he might end up in the intensive care unit with serious breathing problems. Hahn explained all this to the inexperienced doctor and suggested he prescribe another drug, called diltiazem, which could safely deal with the patient’s elevated heart rate without aggravating his COPD. She also suggested that they use Lasix, a diuretic. During surgery, patients are often given a great deal of fluid. Sometimes it takes days for the body to eliminate this extra load. The patient had put on weight, which indicated that he might be “fluid overloaded.”
The intern followed her advice. When the medication began to have an effect on the patient’s heart rate and blood pressure, the online lpn programs decided he could be discharged. Hahn, however, recognized that the patient was still unstable. Even though he seemed to be awash in his own bodily fluids, inside his circulatory system there was actually not enough fluid. The edema, or swelling, he was experiencing was a result of fluid collecting outside of his bloodstream in tissues and between cells. As the medication helped his body eliminate all the excess fluids, it could put him at risk for low blood pressure, shock, or low blood supply to the heart, which could cause a heart attack. Even though his heart rate was steadier, Hahn knew he could still have a potentially fatal blood clot. If any of this happened at home, the patient could die. She wanted the patient to stay in the hospital, where his changing condition could be closely monitored and cardiologists could consult on his care.
With little experience handling this kind of patient, the intern, Hahn knew, was dealing in snapshots. In his sporadic contacts with the patient, he saw a man whose condition was improving, whereas Hahn anticipated a more complex trajectory of recovery that included not only highs but many potential lows. Finally, after she had discussed the matter with the intern, he concurred. The patient stayed in the hospital. When the cardiologist finally came to check his status, he agreed with Hahn. In order to be safe, the patient needed close monitoring.
As they listened to their colleague recount this experience later, nurses in the lecture hall nodded knowingly. When I suggested that Hahn’s story illustrates how nurses routinely diagnose problems, making lifesaving prescription and treatment recommendations and helping physicians avoid potentially fatal mistakes, Hahn agreed. “Yes, that’s true. We do that every day. But why,” she asked, her voice dropping in sadness rather than