You work on the frontlines with the patients. It’s often the Nursing Assistants who spend the most time with patients. After all, assisting with toileting, taking vitals and helping with meals brings us into close intimate contact with the patients we are working with. Because of all the time spent interacting with the patients, a Nursing Assistant can play a vital role in the identification of potential problems. Early warning signs of a problem often go unnoticed by others, which can lead to life-threatening problems for the patient.

There are several red flags you can keep in mind when caring for the patients including:

Change in level of consciousness: If you notice a change, such as your patient is hard to wake up or seems confused when they had been alert, it’s a good idea to alert your RN. A change in level of consciousness can indicate a wide variety of conditions including a reaction to medication, increased carbon dioxide or sepsis.

Decreases oxygen saturations: Your patient’s oxygen saturations may not stay exactly the same throughout your shift. Small variations may be normal. But greater changes are worth mentioning to the RN. For example, if your patient was maintaining an oxygen saturation of 98 percent all shift and has decreased to 90 percent suddenly, it is a significant change in status.

A significant change in respiratory rate, heart rate or blood pressure: Although heart rate, BP, and respiratory rate vary, if it is significantly outside of normal limits, let the respiratory therapist or nurse know. Respiratory rates, heart rate or BP that is higher or lower than normal may be early warning signs of a change in the patient’s condition. For example, increased respiratory rate can be caused by pain, fever or anxiety.

Decreased urine output: In some cases, decreased urine output may also be a concern and should prompt you to tell the nurse.

Increased pain: Throughout your shift, you probably ask your patients if they have pain. If there is an increase in the patient’s pain level, notify your nurse.

Signs of decreased circulation: If your patient shows signs of decreased circulation, it is also a red flag that something may be going on. Signs of decreased circulation include bluish skin, muscle cramps and numbness and tingling.

Considerations When Assisting Your Patients

It is helpful is to have a good understanding of your patient’s baseline. Know what is normal for your patients. For example, if a particular patient tends to get confused every evening, it may not be a cause for concern if he does so on your shift. Getting a thorough patient report at the start of your shift is essential.

Keep in mind, automatic blood pressure machines, which measure BP, oxygen saturation and heart rate may not always be accurate, especially in patients who have a-fib. If you get a BP or heart rate, which is abnormal, consider taking it manually. If oxygen readings are low, try another finger.

Also, trust your gut. You may feel something just seems off with your patient. It may not be anything that shows on the monitors or can be immediately identified. For example, maybe your patient suddenly looks worse even though vital signs remain stable. Some nurses will tell you to treat the patient, not the machine and will appreciate what you are seeing and report to them.

Lastly, it’s always better to err on the side of caution than ignore something that may be wrong. Don’t hesitate to notify the nurse if you have a concern. At the very least, the patient should be reassessed in a timely manner.

Let us know your questions and what you alert your RN to immediately.  Also, let us know if there are any topics you would like to hear about in our blog, maybe we will include it in an upcoming post.

Posted in Southwestern Association of Certified Nursing Assistants