What's your best catch?

[beekee]

I was reading another post called what was your worst mistake? I find reading about mistakes very informative and educational, but we never get kudos for all the good stuff we do. We just get lambasted (sometimes by others, often by ourselves). So, I want hear about your best "I rock" stories!

I don't have any great stories, but I'll share one recent encounter. I had a CHF patient who became fluid overloaded and went into respiratory distress. Doctor ordered P.O. lasix instead of IV. I took the time to double check that the doctor had indeed wanted PO (he didn't). I was a little hesitant to bother the doctor again, but he had a reputation of belittling staff. But, I did it anyway and he thanked me for calling (and changed the order).

[Rocknurse, MSN, APRN, NP]

This is another one from me, but it's the worst one I've ever seen and unfortunately there wasn't a good outcome.

We had a young Mexican illegal immigrant woman in the ICU. She had come in with dehydration and exposure after trying to make it to the US across the desert. I came in one night and was taking report and I noticed her alarm was going off rather a lot during report. I glanced at the monitor and there was no SP02, a very rapid tachycardia and the BP cuff was unreadable. I interrupted report to go in and look at her. She was intubated and not moving so I figured I'd just finish up report and try to fix the monitor, but as I passed the pump I glanced at it. She was on a vasopressin drip, only it was programmed wrong....it was programed at 0.1 units instead of 0.01. Immediately I knew what was going on and called the MD in right away. She was so clamped down that we couldn't get a blood pressure or an SP02. He threw in an arterial line and her blood pressure was 260 systolic. She had a massive stroke and she ended up being hyperthermic with temperatures at 108. It was heartbreaking to me because she had young kids and a young husband and they spoke no English and obviously had no idea what was going on. I tried...I really tried. I noticed the mistake but it was too late. She died a week later. The worst part was the hospital didn't want to accept any blame and tried to transfer her back to Mexico so they didn't have to pay for her care. I had just arrived in the country myself so I didn't really know how it all worked. I still think about her a lot. It still haunts me to this day. I did do an incident report but I don't know what happened to the nurse who started the drip. Since then I've always checked my drip rates as soon as I take a patient over, and I never ignore an alarm.

[AceOfHearts<3]

I'm reflecting on the irony that I posted yesterday before going into work and according to my charge I had a really great catch during my shift. Not going to go into specifics since it could be too identifying.

[Leader25, ASN, BSN, RN]

Ummm...what does a "normal" scrotum sound like and what does a incarcerated wall scrotal hernia sound like?"

lets do it lets do it'

"set me free why dont you babe"

[UrbanHealthRN, BSN, RN]

This was when I worked inpatient pedi as a new grad. There was a little baby admitted who had a congenital cardiac defect in need of repair. It was a non-emergent defect, so the decision was made to admit him as a feed-and-grow before surgery. He had several issues at the start of his admission- was gaining weight slower than expected, even with an NG tube placed, and needed a lot of careful positioning or else he would have weird sx like increased respiratory rate and coughing. His team was wondering if the sx were cardiac, GI, or ENT related.

My first time caring for the baby, I checked his NG tube placement at start of shift, which at the time was through auscultation. I heard air, but it sounded very faint and muffled. Pulled the tube, pushed formula through, and discovered a pinhole-sized crack in the tube right where it would have been in his pharynx. All feeding problems with the baby immediately resolved after a new tube was placed. Mom was also thrilled to learn that her concerns about the NG tube were true, which she had already been voicing for several days when I took him on for my shift.

Other catch: one of my boyfriends had a hx of seizure disorder. When I reached the neuro section of Med-Surg in nursing school, I realized that several of his health complaints at the time were related to breakthrough partial seizures. He followed up with his neurologist, who confirmed my suspicions and immediately increased the dose of his seizure med.

[BSN16]

back when i worked Neuro ICU, ED nurse brought up a pt that had fell and hit her head...she had a very swollen eye and that was painful to open...pt is drowsy but responsive....ask ED RN to do a bedside neuro with me. she tells me she hasnt been looking at that one eye because it's very painful for the pt. I peel it open to check...it was blown and un reactive.

off to the OR we go. i think one of the biggest "catches" i have ever had

[tiggertiffany, ADN, RN]

I caught new neuro changes (very subtle if you're with the pt less than 5 minutes they could be overlooked) I knew something wasn't right, called the dr multiple times, who refused to do anything. I narrowed s/s down to mini stroke or absent seizures. Ended up calling a rapid, the resident on the team ordered a neuro consult (whom I called immediately..yes during the rapid) thankfully neuro listened and ordered a stat ct of the brain. Critical results returned pt was having both mini strokes & absent seizures. At the end of the day I will always follow my instincts.

[CherylBishop]

My new grad was about to give a patient 80 units of regular insulin in lieu of the ordered Lantus. She thought that since we were out of Lantus, that she could substitute regular instead. Luckily, she came to see me for the double-check first.

Sad to say this.. I had a 20 yr RN start to give a patient Regular insulin instead of Lantus. Luckily the patient was with it. He knew what the color of his insulin pens were. He told me about it the day after it happened. Told me "he was happy as hell I was back from my night off"

[beckysue920]

I've had a few 'good catches' in my multiple nursing years:

The first was when I was a STUDENT, of all things, and answered a call light on a lady who was not my patient. She related she had had a procedure done that day that involved a cath being inserted in her femoral artery. I checked her pedal pulse...it was non-existent!! (That's the day the RN instructor wanted me to enlist in her program...NOT!)

Another incident was an HIV diagnosed patient just wasn't exhibiting the usual symptoms of a long standing diagnosis of HIV. For some reason, I decided to do another HIV on the patient. The State Lab called me after they received the sample, asking many questions. HUH! what's the issue? For some reason they sent the spec to the CDC. After that I was inundated with questions from the CDC. As it turned out, the patient has HIV 2. It was the first case diagnosed in our state. The HIV state program never forgot my instincts to retest the patient. That feels good.

Moral of the story? Trust your intuition.

[ccharlonne, ADN, BSN, RN]

A couple of my catches that remind me why it is important to always follow basic nursing processes: 20 something I admitted with Crohn's flare, NPO and on IV fluids. Gave him urinal, explained we measure what goes in and what comes out and to please use the urinal. He used urinal on my time. Had weekend off, came in after weekend and got him back as a patient. Nurse reporting off said patient was independent to bathroom. She was a recent grad, off orientation a couple of months. I asked why he wasn't using the urinal since he was receiving IV fluids the response was "he's a young guy, he is voiding fine." I asked him to use the urinal if he voided, checked in a couple of times overnight and nothing in the urinal. Asked him if he was getting up and using the toilet, he said he hadn't. I asked the last time he had voided, he reported he wasn't voiding much and his back felt "swollen." I checked his I/Os for the day, nothing had been documented. Bladder scanned patient (minimal) and called MD. Stat labs drawn, sodium elevated, IV fluids changed and patient started voiding.

Second catch was med related. Night meds were ordered at 2100 for BIDs and 2200 for HS meds. Patient transferred to my unit in afternoon, getting ready to give his night meds noticed he had 300mg gabapentin scheduled at 2100 and 600mg at 2200. Asked patient about how he took his gabapentin at home, he took 300mg in the morning and afternoon and 600mg at night. Reviewed admitting med rec, data entered correctly. Physician ordered gabapentin 300mg BID and 600mg at HS, pharmacy processed the orders and scheduled the meds at 2100 and 2200, admitting nurse signed of the orders, several nurses gave patient 900mg of gabapentin at night. Notified supervisor, pharmacist, and house officer. Meds rescheduled. Why didn't anyone question it before me?

[Lulu Belle, RN, EMT-B]

As a student: I happened to answer a call light at clinical and the patient told me to tell her nurse she needed her pain meds. I started chatting with the patient, and something told me to take a look at her abdomen. I found her bladder felt pretty distended. I asked her when she had last peed. Turns out it was over 14 hours ago. I did a bladder scan and straight cathed her with my instructor, got over 1000 mls. The night CNA had charted that she was voiding all night because she had repeatedly asked for the bed pan, but she never actually went. I'm sure the nurse would have caught it when she came in to do her assessment, but it felt good to be able to help the patient out and relieve what must have been awful discomfort.

[nursej22, MSN, RN]

My mom was in ED for hypotension, which turned out to be sepsis, with a white count of 1. The ED nurse hung dopamine, programed the pump, then turned it off to get another nurse to double check, and never came back. I checked it and turned it on, as the nurse was coding another person 1 curtain over.

My dad was admitted for near syncope, tachycardia. I filled his med set at home weekly so I was familiar with his meds, yet no one asked me to review. He was on my floor, so I asked the pharmacist if there were any questions about his home regimen. She suggested we review them together. The nurse who had entered his home meds had included a diuretic (ethacrynic acid) and the admitting doc had ordered. Dad had stopped that med 6 months prior. The record showed the nurse had verified the meds with a family member, which would have been me. Well why wouldn't you diurese and old guy with a bp of 80? Derp.

[T-ROD, LPN]

Group home for fragile children.

I have a kiddo that because of a displaced stomach had to have a foley placed for a J-tube.

One evening I came in following a temp nurse. This kiddo was brought up to me vomiting and acting lethargic. VS were horrible and she sounded like she was drowning. I called our in house doctor. I explained what was happening. My words were "it is like shes got a blockage somewhere", before I could finish i noticed the balloon port was uncovered. I grabbed a syringe and pulled out 12 mls of tylenol. She was sent to ER and was fine. Bowel obstruction!

The bad part it happened again a few months later. Same symptoms. Having dealt with the first time I walked the nurse through what to do. Sure enough blocked.

Doc changed her tubes after that!!!