[ragingmomster]

Let me stick to the basics...

My orientee and I had a pt yesterday that was 23weeks and came to our triage/unit 3 times in 4 days for PTL. Each time she was treated with IV fluids and the ctx decreased. When she was in on the weekend, she was admitted and the nurses believed she was faking some of the ctx. We all know what the pattern looks like, tombstones or a sharp incline at the beginning of the ctx.

Please don't start the flaming here, I know that ctx can graph in many patterns.

Yesterday we caught her at it though. We were in the room for 1/2 hour and she had one gently rising gently falling curve of a ctx. We left the room and immediately we see ctx q 3-5 minutes with the sudden up, sudden down pattern.

I sent the orientee back into the room on some bogus errand and she stayed about 20 minutes. While the RN was in the room the pt had 2 of these sharp UP/Down ctx and the RN marked the strip and asked the pt to take her arm off her abdomen and toco.

MD is aware what is going on, but the group is a family practice group that manages labors as only part of their residency and we are dealing with the first year residents at this time.

Mind you, her boyfriend/finance does not leave her side, to the point where he hasn't eaten in 2 days and the pt asks us to feed him anything we have in the unit fridge. We got him a box lunch (we're not completely heartless).

He left the unit for some reason and went outside the hospital to the front sidewalk. Our police were in the lobby so I explained to the officer that we had some suspicion of abuse and could he let us know when he came back in.

While he was out the orientee and I went into the room to have a frank talk with the pt.

Explained that we were concerned about her and her baby's safety and that 3 admissions in 4 days was certainly out of the ordinary. Was there a reason that she preferred to be in the hospital, was there something we could get her help for? We also explained that the pattern and timing of her ctx did not appear to be something that was happening from inside and may have been caused by something outside her body.

Pt immediately denies abuse, accuses us of calling her a liar and bursts into hysterical tears. We stayed in the room and tried to reassure her that we were only concerned for her safety and wanted to be sure that we were getting the whole story to make sure she got the care she needed.

Knock on the door, another RN lets us know that the boyfriend is on his way back. We let the pt know that we spoke to her privately because often women are afraid to speak about violence in the home in front of their s/o and asked her if she would like to tell us anything before he came back.

Hysterical crying continues along with threats to leave AMA immediately. We try to reassure her and ask if she could just stay until 1400 as we would like to recheck her K+ and blood sugar as they were low and high earlier.

Pt agrees to stay and we leave the room just before the s/o returns. As we are calling the md to update him, the police officer arrives in our unit as we are expecting trouble. Not 5 seconds later the s/o comes blazing out of the room, sees the officer sitting next to us and immediately does an about face and goes back into the room and closes the door.

Call light goes on and the two of us go in to find the pt on the phone, hands it to me and says "my mother wants to talk to you". The mother and I do the HIPPA dance on the phone and all she gets from me is "Your daughter's and grandchild's health and safety are paramount to us here at ACME hospital" Mother threatens to come pick up her child and deliver her to another hospital. "Well I wish you wouldn't but I understand you are concerned about your child, so are we"

End of story - the attending arrives, pours oil on the water and pt agrees to wait for labs and then d/c, and will f/u in the clinic on Monday. Pt leaves unit still bawling and curled up under the arm of the s/o.

I had a sick feeling in my stomach all day yesterday and am definitely off my feed today over this whole incident. You can believe I spent more than an hour charting all this info so that I can explain it clearly when I get called to sit in the 'splainin chair, but I still feel bad.

[Mulan]

Don't work OB so don't know what to say about it all. I would have said "here are the AMA papers, go ahead and sign them". Is this another case of waste of health care resources on the tax payers dime?

Hope all works out okay for you. It sounds like a case of damned if you do and damned if you don't.

Keep us updated.

[May_baby]

I know this situation has really stressed you out.

So here it is:
You did the right thing!

Something was wrong, is still wrong.
And you stepped up to the plate.

You made your pt's safety (and that of her infant) a priority.
It is not wrong or offensive to ask someone if they are safe in their relationship or home.

[flytern]

Gut reaction - you did the right thing. It's not always pretty to be the bad guy. But how would you feel if you see her/baby obituary in the paper next week and didn't feel you did something? Maybe you opened the door for this girl to start thinking about her life, maybe next time she sees you or her MD she'll open up. You can bet your life that IF something goes wrong, her family or s/o will be first in line to sue you, the hospital, the MD.....

We don't want to think about anybody hurting a pregnant woman, I can sympathize with her mother being angry, after all isn't that how a mama lion would protect her cub?

[ragingmomster]

Thanks for your support, I will be sure to add more info when I get called on the carpet.

[tryingtomakeit]

I don't she why you should be called on the carpet. I have seen patients do the same thing - nurse in the room, no ctx - out of the room, ctx appear again. As far as asking her about abuse, this is part of our screening on both admissions and triages. I think you handled the situation very well.

[HappyNurse2005]

We have abuse questions as part of our admission paperwork. if they are alone we ask them, otherwise, we hand them a piece of paper with the questions about being hit, kicked, slapped, etc doyou feel safe, do you need counseling along with have you had any std's do you use any illicit drugs so they can look and answer them without thsoe in itne room knowing what's going on.

maybe asking your manager to incorporate these types of abuse screening questions into the admissions process would help this type of situation in the future. then, they won't get all offended when you ask, b/c its a routine question that everyone gets asked

[SmilingBluEyes]

Do not beat yourself up. you did the right thing.

[Ruby Vee]

I know nothing about OB, but I do know about domestic violence from first hand experience. You did the right thing in asking her. She may be in denial right now, but you've certainly given her something to think about, and perhaps you've chipped away a little bit at her denial. I know it was a terribly difficult thing you did, and you should be proud of yourself for having the courage to do it!

[babyktchr]

Oh I couldn't agree more....you did the right thing. I, too, would've suspected some kind of abuse in this situation, and would've done the same exact thing. Hopefully your sick feeling will be replaced by some sigh of reliief if she shows up again wanting help because of what you did.