Part II: The Overnight Presentation – Recognizing Hidden Danger Early

Some symptoms appear so frequently at night that they can become easy to dismiss. But behind the wall, common isn’t always simple. Subtle presentations may reveal serious conditions underneath. Overnight nursing demands pattern recognition, especially when complaints are vague. Here are the presentations correctional nurses should never underestimate on night shift:

Nausea and Vomiting

This is one of the most common overnight complaints—and one of the most misleading. Vomiting may be related to:

• Withdrawal
• Cardiac ischemia
• DKA or severe hyperglycemia
• Infection or sepsis
• Gastrointestinal emergencies
• Toxic ingestion or medication effect

If vomiting is persistent, accompanied by diaphoresis, chest discomfort, tachycardia, or abnormal vitals—it is no longer “GI upset.” It’s a red flag.

Chest Pain or “Indigestion”

Patients may describe chest pain as:

• Pressure
• Burning
• Indigestion
• “Tightness”
• Pain that comes with nausea or shortness of breath

Women, older adults, and people with diabetes frequently present atypically. Overnight, these subtle descriptions deserve rapid hands-on assessment and timely provider notification.

Shortness of Breath or Restlessness

Tachypnea is one of the earliest signs of deterioration, yet it is often underestimated. Watch for:

• Breathing faster than normal
• Difficulty speaking in full sentences
• Unusual agitation or anxiety
• Low oxygen saturation

Even mild respiratory changes can precede sudden decline.

Dizziness, Weakness, or “Not Feeling Right”

Vague neurologic complaints can reflect:

• Hypoglycemia
• Stroke
• Sepsis
• Dehydration
• Arrhythmia
• Medication effects

These symptoms require physical assessment, not reassurance.

Abdominal Pain at Night

Abdominal pain is another common overnight issue. Pain accompanied by guarding, vomiting, fever, tenderness, or abnormal vital signs requires escalation. Don’t assume it is merely constipation or indigestion.

Overnight Pattern Recognition Pearls

• Persistence matters more than severity. If symptoms haven’t improved, they deserve evaluation.
• Officer calls are clinical data. Repeated calls should prompt immediate assessment.
• Vital signs tell the story first. RR and HR are often the earliest warning signs.
• Symptoms rarely present cleanly. Nausea + chest discomfort + diaphoresis? Think cardiac until proven otherwise.

Next in the series: how correctional nurses can strengthen their overnight clinical judgment—and protect themselves in high-risk moments.