:angryfire

The cause of my "happy mood"

Last week one of my alzheimer's patients had a seizure. She was perfectly fine at med pass. About 2 minutes after I gave her her morning meds I heard some make a loud groaning noise and then a crash. Immediately 2 CNA's began to yell that she fell. The next second one of them called out to me as I was running toward them "She's having a SZ". Not 2 seconds later I had made it to the area. The patient was obviously having a tonic-clonic sz. She was non-responsive and thrashing wildly. I immediated began to support her head. Upon touching her head I noted that she had a large amount of bleeding from a laceration to the back of her scalp and already had a huge hematoma.

When the sz subsided I place her in the recovery position and took VS. She has HTN and her BP was elevated, no doubt due to the sz. After initial post-icthal period, pt aroused easily and returned to her baseline LOC.

She vomited x1 after the SZ. As the pt is confused and didn't want to sit. I kept her at the nursing station for 1:1 obs while making calls for transfer.

She does NOT have SZ d/o. However as a nurse I have had numerous experiences with seizures. I am not afraid to say that I am well versed on the subject.

I gave report to the ED, POA, MD, and EMS. I charted thouroghly and I sent all documentation with her to the ED.

The pt was readmitted to my floor after hospital stay. As I read what had been transcribed in her HX and phys from the hospital I was completely flabbergasted and increasingly angry with each sentence.

The doc wrot that it was reported that the pt was seen "shaking and fell" What I reported was that she had a freaking sz. It says the family says she "shakes" normally due to anxiety and therefore she may not have been seizing. It says her BP was elevated and it is unclear whether she was receiving her BP meds or not. I thought that was why I sent the MAR. It says that it was not clear if the fall was witnessed. I reported to the RN that she was witnessed to have a sz by 4 staff members. It say that EMS reports pt. found "shaking". EMS didn't see the event. I did. If I cant identify a sz after seeing as many as I have then I have got problems. Also if they checked their records.....EMS was called for due to pt having tonic clonic SZ and has no hx of sz d/o. The doc says that the family may not be comfortable with her returning to our facility. Why not? Sure as crap doesn't have anything to do with the care she received on the morning of the SZ.

The family refuses to believe she had a SZ because she never has had one before. HEY, there's a 1st time for everything.

Anyway I believe that this documentation makes it look like her care is just incompetant. And i can't help but feel that It reflects poorly on the facility and ESPECIALLY on MY NURSING CAPABILITIES!

Look I appreciate anyone reading this long long post.

I have decided to contact this hospital and voice my displeasure with what this record says. I am sure it won't do much good, but her TX was ideal in my opinion. My report and documentation was meticulous. I just cant believe what I read. Complete BS.

BTW this is the same ER that I sent a pt to about a month ago that DC'd my pt back and the record says he was in a MVA......that patient fell and obviously isn't able to drive D/T advanced alzheimer's.

Any advice would be greatly appreciated. Thanks all.

Dang that is long. Sorry. Verbal diarrhea.

I can understand your frustration, but I would not contact the hospital without first discussing this with your nursing supervisor and your house MD. By directly contacting the hospital and confronting the MD involved you could be opening an another whole can of worms. Get your nursing supervisor involved. Have the other people who witnessed the seizure to also verify your documentation to the DON.

In my personal experience some doctors don't believe you when you tell them someone had a seizure. A tonic-clonic seizure is pretty darn easy to spot in my book. I have had a couple of docs tell me "They didn't have a seizure." I want to respond, how the heck do you know? Were you there to witness it yourself? In the past 2 years 2 people I know with no known seizure history have had tonic-clonic seizures....it does happen.

Make sure you document everything very well.....including your discussions with your supervisor. Best wishes....

I can understand why you are so upset. Sometimes I think the doctors dont listen. I actually had a doctor change the wording in MY charting. It was after I had called in and told her that the pt. was having problems, and I documented her response (which was basically that she didn't feel the need to do anything). Then something ended up happening, so when she finally did respond and read the chart, she put in her own two cents on my entry!

"I would not contact the hospital without first discussing this with your nursing supervisor and your house MD."

Right, unless you are the official liaison with this hospital.

I agree with the above posts. Does this resident have a GP who knows her and her history? You need to get your DOC/DON involved. Nice to see someone was paying attention there...jeez.

I might consider writing an incident report on this including your witness statements...but clear it with your DON first.

At the very least, write this up for yourself including witness statements, and keep it for your own record of what REALLY happened.

This stuff sucks but I know it happens out there and it is not fun. Good luck and hang in there...you did exactly the right thing.

Good lord are you a total idiot! How could you ever presume to know anything. You are just a fri&&n nurse.

I share your frustration. Nurses are idiots, we don't know a dam%% thing. Why did we bother to go to school pass boards etc etc. everybody including the janitor knows more than we do. GRR.

Always start with your immediate supervisor first, and if no resolution there, then move on up. Don't give up on it though. I agree that it's worth the time and headache that is bound to follow your complaints. Goodluck. Hang in there.

In defense of the ER nurse and doc.....after many, many "wolf cries"......be sure you talk the the ER nurse yourself, describing what you saw yourself, to be sure the episode is heard "from the horse's mouth", so to speak. We get MANY unnecessary ER visits from our local NH with things like low glucometer reading (we gave the pt a glass of OJ in ER to resolve), abd. pain (you guessed it....constipation! Mg+ Citrate resolved).

I am not negating what you saw at all! I would just appreciate a verbal report, and will relay that accurately! Do not count on EMS to report anything that they didn't see. Also, send all written doc along, and welcome questioning follow-up phone calls.

Sorry about doubt by your local ER doc. Probably just many a wolf-cry ahead of you. (was there a full moon?)