I feel really bad about HH case....

  1. Last night, got a call from HH family..stating client not feeling well..(mom thought chx pox)..Today, cl. had appt w/ ped doc..come to find out she was dehydrated...I feel really bad...
    Clients fontanels were not sunken, she had moist mucus membranes, and her skin turgor was good....WHAT DID I MISS?????????????????????
    Her lips were chapped..but that was the ONLY thing out pf ordinary w/her at the time...I feel soooo bad....What did I look over????
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  2. 11 Comments

  3. by   redwinggirlie
    I'm sorry you feel bad. I wish I could say more, but if you feel your assessment was complete, it's hard to think of what else you could have done. Hoping you're feeling better.
  4. by   CraftyLPN
    I guess that's the prob w/ getting "attached"...The question.."WHAT DID I MISS??" goe sthru your mind constantly after they go into the hospital
  5. by   kids
    How long since she had last voided? (shouldn't be >8 hrs)
    Did she have tears when she cried? (should be yes)

    Those are usually the flags for us if everything else is OK.
  6. by   CraftyLPN
    she voided 2x in 6hr shift.. and cried "real tears"... she was just wanting cuddled all day today...she was fine fri night...no mention of vomiting or anything...Another thing is going thu my mind... she was on 6.5 oz per g-t feed ..they reduced her down to 5oz because we were trying to feed p.o.
    And then another, I kinda wonder if she gets all her feeds or if mom gives her extra H2o....during the weekends...
  7. by   Karina212
    She may not have been dehydrated (or maybe very mildly) when you assessed her but could've worsened by the time she went to her PMD's office as kids can quickly become dry. Maybe she had an underlying infectious process that made her feel ill and then led to dehydration as a result of not drinking, diarrhea, fever,etc. I'm sure you did just fine with your assessment. You seem to be very conscientious!
  8. by   hogan4736
    You may have missed nothing...

    Sometimes IV fluids are given to kids for no other reason than to either appease the parents, or, are more of a reflection of the insecurities (or "practice style") of the attending doc...

    I've worked ER for 8 years, and have started IVs on kids peeing and crying (tears)...

    AHH, the inconsistency of modern medicine...A puking kid at one office gets Tigan suppositories and p.o. fluids in 30 min...At another office, gets a spinal tap and IV hydration...
  9. by   Tweety
    Things happen fast, so don't feel bad. She might not have been dehydrated when you saw her. Give yourself a break.
  10. by   CraftyLPN
    I know..The mom called melast nite to give me an "Update"...she had changed from stable condition to a worsening state in just 30 min time...ex: she was dusky and turning blue when they got to docs office..sats were 87...I hear what you are saying...and I thank you for it..but yet..that ole' nagging question lingers....
  11. by   Tweety
    Originally posted by CraftyLPN
    I know..The mom called melast nite to give me an "Update"...she had changed from stable condition to a worsening state in just 30 min time...ex: she was dusky and turning blue when they got to docs office..sats were 87...I hear what you are saying...and I thank you for it..but yet..that ole' nagging question lingers....
    I know. I torture myself too whenver a bad outcome happens on someone I've taken care of. Also, family, md's, and administration are always looking to the nurse for blame. But sometimes things happen.
  12. by   purplemania
    You did not state age of pt but I assume very young. Kids dehydrate FAST, in a matter of hours, and faster with fever, vomiting, poor appetite, etc. When I took call for pedi clinic I used to tell parents what to look for (amt. they should drink or pee or whatever) to give parent guidelines. Still comes down to parent. Can't treat anyone over phone. I always closed with"You know your child best. Take him to ER if you are anxious". Remember, you are GUESSING from a distance without seeing or even talking to the patient. I think you did fine and child would have had same outcome if you had not been involved.
  13. by   CraftyLPN
    15 months old

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