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- by LuxCalidaRN Oct 13, '10Please share some of your stories about near misses, accurate assessments, and care provided that made you as a nurse shine to the whole team!
This week on our cardiac surgical ICU, I caught a 3/6 systolic friction rub in a heart transplant (post-op day 15) patient that 2 *residents* had missed. It totally changed the course of treatment, and was lauded...imagine that, a nurse got credit from the attending!
Let's hear your *POSITIVE* stories about how nurses know their stuff!
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- Oct 13, '10 by wound warrierThis happened quite a few years ago. Took care of a patient who just did not look right. Called the resident who ripped me a new one because I told him she did not look right. Her VSS, he did give her some IV fluids. That night she coded and died. The next morning I saw the resident, gave him the raspberries, and said "I told you she did not look right!!"
- Oct 13, '10 by kloneA few months ago, there was a baby who was not nursing well. He would nurse fine on one side, but when switched to the other, he would cry and refuse to latch. I asked about his delivery, if it was traumatic, if there was a shoulder dystocia or anything. The other nurse said yes, there was a shoulder dystocia. So I looked at the little guy and felt crepitus over his clavicle (just as I suspected!). Turns out he had a broken clavicle from the birth that nobody else (including the ped) had caught, and it was causing him a lot of pain when he would lie on that side.
- Oct 13, '10 by cecilsgirlA women of about 55 ws dying of cancer, came to the facility a hospice patient, was there only 3 days when we all knew the end was coming sooner than later, she had come to the facility with a quilt her Great grandma had made her when she was born. That day she asked for it, we couldn't find it, Laundry had gone home ( small facility) I went to the "basement" found it in the ditry laundry, I got off work at 10:30pm, went home washed it dryed it , took it back to the facility at about 12:30 a.m, she reached for it, and embraced it, she passed away at 3 a.m. . I went to the funeral, her quilt was in the casket with her, it was burried with her. Her family thanked me, and I left,.. not a big medical save or anything.. just something I knew I had to do. In LTC, I think there are a lot of these stories,.......
- Oct 13, '10 by LaurenBoogA year or so ago I took care of someone who was admitted the night before with rapid a-fib to a telemetry cardiac floor. Since her main problem was cardiac, I guess everybody missed the ABG with respiratory acidosis that was drawn in the ED.
After I got report and looked at her ABG I thought there must have been some respiratory intervention I didn't know about because she looked fine, the RT had already been in and hadn't sad anything about low sats, she was A&O, etc." Several hours later I thought to double check with the RT that something has been done the night before. Sure enough, nothing had been done. The RT drew another ABG, pH was 7.11, and we rushed that patient to the unit for some BiPAP!
The funny thing was that the patient really didn't look all that "bad" for having such bad numbers. If I hadn't kept investigating the situation I'm not sure when her respiratory issue would have been addressed. I felt pretty good about my nursing care that day!
(It is nice to brag on myself when most of the times I am criticizing myself for mistakes that I make!)
- Oct 13, '10 by mskateI had a patient s/p CABG that was on Nipride, high doses - for days. He was extubated earlier that day and was down to 2l NC. His sats were poor when I got there, and I kept having to go up and up on his o2 and was drawing gases with each rise in the o2. His Pa02 was in the 50s. He was slightly cyanotic, but didnt LOOK like he was in any distress other than slightly hyperventilating. But no matter how much o2 he was on, the Pa02 didn't change at all!
I kept telling the resident it was the Nipride causing a intrapulmonary shunt and that we needed to switch pressors. I went through the resident, fellow, attending and pharmacist. NO ONE believed me and the PHARMACIST even told me that it was not a side effect of Nipride. I kept pushing the issue, no one would change the drug, no one would intubate him because he didnt LOOK bad. He was just hypoxic (soooo great for his cardiac status.... *rolls eyes*)
It wasn't until I saw the critical care medical director stroll through the unit that I told him what was happening and what I thought was causing it. He agreed, wrote the order to switch pressors and contacted everyone that I had been speaking to all night and told them "You need to listen to these nurses!! They know what they are talking about!"
- Oct 13, '10 by ElvishUncomfortable antepartum that residents had been sitting on for several hours, blowing off her sx, saying 'the toco isn't picking anything up' (which means nothing, but try telling these particular individuals that). They checked her, saying no cervical change in spite of regular uncomfortable contractions and increased show. Attending comes, checks behind the resident...Bam! Dilating, needs to go to L&D. She delivered shortly thereafter.
- Oct 13, '10 by cherrybreezeHad a young patient, in his 20's. In for a lap chole, but they were waiting for his labs to get a little better before taking him to surgery. I had called the hospitalist a couple of times during the night, because the guy just didn't look good....I had nothing concrete to say WHAT was off, other than he was slightly more tachycardic than he had previously been. I knew the hospitalist was busy that night, but all he would do was order a couple of fluid boluses. I think he was annoyed at me for calling, when I had nothing new to report, other than a gut feeling.
Next day, after I had gone home, guy was transferred to ICU with necrotizing pancreatitis. Spent at least a month in the unit. I feel bad that nothing I did had gotten him there sooner (not that it maybe would have mattered?) but proud of myself for at least having the instinct to see something, and the guts to pester the MD despite how busy he was (and his lack of further intervention).