Dizzy, Confused, and Asking to Walk Alone
Mr. T is 70 and started a new blood pressure medication yesterday. At 2:00 p.m. he is alert but "not himself," asking the same question repeatedly. Vital signs: lying 88/54, pulse 112 and irregular, respirations 22, temperature 98.6°F. When you sit him at the edge of the bed he says he feels dizzy; sitting BP is 80/50. His skin is cool and damp, and his urine output for the shift is 90 mL. Two hours ago he was oriented with a BP of 128/76. He now wants to walk to the bathroom alone and pushes the covers back.
1. Before you leave the room or call for help, what do you do and why?
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Reasoning: this is a falling, possibly crashing resident. The order of actions is stay, stabilize, summon - not fetch someone and hope he waits.
- Stay with him and keep him seated or lying. Do not let him stand to walk alone; with a sitting BP of 80/50 and dizziness, a fall is the most likely immediate harm.
- Use the call light or your radio from the bedside to get the nurse now, and say the number: "Mr. T, BP 80 over 50 sitting, pulse 112 irregular, new confusion, dizzy - please come."
- Offer the urinal or bedpan so the need to toilet - a common reason residents stand up - is met without walking.
- Lower the bed, raise the side rail on the side he is not exiting from per facility policy, and keep the call light in his hand.
- Recheck and record pulse, respirations, and how he responds, with times.
Do not leave him alone to find the nurse, and do not walk him to the bathroom 'just this once' because he is insistent.
2. What exactly do you report to the nurse, in what order, and how do you convey urgency?
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Reasoning: report the change and the trend, not your theory. The nurse can act on numbers and times; 'he seems off' gets lost.
Lead with the change: "Mr. T is newly confused and dizzy. Two hours ago he was oriented and 128/76. Now lying 88/54, sitting 80/50, pulse 112 and irregular, respirations 22, temp 98.6, skin cool and damp, urine output 90 mL this shift. New BP medication started yesterday."
Then the immediate risk: he wants to walk to the bathroom alone and is unsteady; he is asking the same question repeatedly.
Then what you have already done: stayed with him, kept him seated, offered urinal, call light in reach, times recorded.
Why this order: the nurse needs to know this is a change with a downward trend and a fall risk right now, not a routine end-of-shift report. Ask directly: "Do you want me to stay or get the BP cuff and recheck in five minutes?" Write down what you were told.
3. What is outside your scope here, and what should you not do or chart?
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Reasoning: your value is accurate observation and safe immediate action. Guessing at causes and treating them is how residents get harmed.
Do not:
- Decide he is "dehydrated," "over-medicated," or "having a reaction" in the chart. Those are conclusions for the nurse and provider.
- Hold, change, or give a medication, or push fluids against a restriction without an order.
- Ambulate him alone to "see if he's better."
- Wait to see if it passes before telling the nurse.
Do chart: objective findings with times - the BP and pulse readings in both positions, the irregular rhythm as you counted it, skin temperature and moisture, urine output, exactly what he said ("I feel dizzy"), what you did, and who you notified and when.
Do say to the nurse anything you noticed that doesn't fit the numbers, such as the repeated question or a change in speech. That observation is in your scope and may be the detail that matters.