What Should I Report to the Provider?

As a new nurse, you should be asking a lot of questions especially if something is abnormal with our patient. It is so important that you collaborate with providers and others on the interdisciplinary team. The more collaboration you have is the better chance for the patient to recover or improve their condition.

Never feel that you are asking a dumb question. If you are unsure of something you observe or do not understand you should make it a priority to get clarity. This can result in a positive outcome for a patient.

Below is a list of some common conditions that you will experience in the critical care environment and even in other parts of the healthcare system, potential causes, and reportable conditions.

INFECTION

Potential Causes:

  • Invasive devices (tubes, drains, intravascular devices)

  • Immunocompromise

  • Debilitated patient condition

  • Aspiration

  • Prolonged immobility

  • Wounds (traumatic, surgical, pressure ulcer)

  • Redness, swelling, foul odor, and/or exudates from catheter insertion site or wound

  • Decreased tissue perfusion

  • Diabetes mellitus

Reportable Conditions

  • Fever

  • Redness, swelling, foul odor, and/or exudates from catheter insertion site or wound

  • Increased or decreased white blood cell count

  • Results of cultures (blood, urine, sputum, wound)


HYPOXEMIA

Potential Causes:

  • Low cardiac output state (hypovolemia, cardiogenic shock, cardiac tamponade)

  • Hypoventilation (central nervous system depression, thoracic surgery, pneumothorax)

  • Intrapulmonary shunting (pneumonia, pulmonary edema, atrial or ventricular septal defects)

  • Ventilation/perfusion mismatch (pulmonary embolus, increased secretions, bronchospasm)

  • Diffusion defects (thickened alveolar capillary membrane, increased fluid in interstitial space)


Reportable Conditions

  • Dyspnea

  • Tachypnea

  • Tachycardia

  • Dysrhythmias

  • Chest pain

  • Hypertension with increased heart rate

  • Hypotension with decreased heart rate

  • Anxiety, restlessness

  • Coma

  • Pallor

  • Cool, dry skin

  • Cyanosis

  • Diaphoresis (late)

BLEEDING

Potential Causes:

  • External and internal fluid losses (hemorrhage, third spacing)

  • Expanding hematoma


Reportable Conditions

  • Hypotension

  • Tachycardia

  • Tachypnea

  • Oliguria

  • Cool, pale skin

  • Decreased hemoglobin/hematocrit

  • Frank bleeding

  • Anxiety decreased level of consciousness


DYSRHYTHMIAS

Potential Causes:

  • Electrolyte imbalances

  • Hypoxia

  • Hypothermia

  • Hyperparathyroidism

  • Digitalis toxicity

  • Myocardial ischemia, injury, infarction

  • Acid-base imbalances

  • Medications

Reportable Conditions

  • Change in heart rate or rhythm

  • Palpitations

  • Syncope

  • Hypotension

  • Abnormal electrolyte values

  • ST-segment changes

  • Abnormal cardiac enzymes

  • Chest pain

References:

uptodate.com, clinicalkey nursing, merck manual professional

CherylAssessment, icu