Did I mess up badly?

[amzyRN]

Today I had a patient with hyponatremia. I got floated to another floor. Sodium holding steady at 127. They were on Q 4hr BMPs. I missed sending the urine CR. I was extremely busy. I just overlooked the order somehow. The patient was also on a full liquid diet; no fluid restriction. The patient was a DNR. They were A/O x4. The patient lost IV access so couldn't get their NS infusion because they were refusing a new IV. The MD was aware and would come and see the patient ASAP. When the next nurse came on were super annoyed I missed the urine and also that the patient wasn't on a different diet, or that they weren't on a fluid restriction.

The patient had been on this diet for a while.

In retrospect, I think I probably could have asked for some oral sodium tabs and asked about the diet. I just don't get hyponatremia that much unless it's as a result of CHF. I feel bad because the urine was delayed by 4 hours and they are probably trying to rule out renal causes. The serum CR had been low.

[jadelpn, LPN, EMT-B]

It is up to the MD what diet and/or restrictions that this patient has or doesn't have. Not your call. Nor is restricting fluids. Yes, you did miss the urine. And if it was timed, the only thing you can do is learn from it.

Sounds like the patient needs a complete case review. That would be what I would suggest to the oncoming nurse taking report. Otherwise, you can't make a patient do or not do one thing they don't want to do. Nor what an MD doesn't order.....

[amzyRN]

The urine wasn't timed. I still feel like I delayed the process. I will just be more careful in the future not to miss things. Your right about a case review. The patient has been there since 8/1 and the sodium has stayed where it is. Thanks for the input.

[TakeTwoAspirin, MSN, RN, APRN]

While there are aspects of this that should be a "learning experience" I really do think sometimes people (us nursing-type people) get caught up in the numbers. One of the first things I learned fresh out of school is to look at the patient and treat the patient, not the numbers. If this person was AAO, and had no changes in LOC, and grossly asymptomatic, then missing the urine was not the end of the world. Sure, it was a mistake, but it's not like this was a symptomatic patient with acute changes. It is likely they "run low" chronically and this is may well be their baseline - they have been their for at least 4 days that you are aware with no acute changes.