Ok I have to confess; I may be an experienced nurse but nearly missed something HUGE last night. It was a busier-than H@ll night last night; you know the kind. When you feel badly cause NONE of your patients gets your best cause you are too busy running around, putting out fires all over the place. It has been raining labor patients where I work this week. The floor looked like a tornado had blown through.... Anywhoooo...
I had a patient who had had a dense labor epidural (gosh I hate that). She had a foley cath which the OB insisted be pulled for the last stage of pushing (I understand why). Anyhow, I had turned off the epidural by this point and once the placenta was delivered, and I was sure she was firm and not bleeding, I turned down her IV rate to 75cc/hr, knowing her bladder would get full fairly soon. I was hoping the epidural would wear off and she could void at some point! In vain. I tried EVERYTHING to make this happen. Her peri swelled horribly and no amt of ice would bring this down. I continually assessed her bladder and uterine tones and bleeding to ensure she did not become distended. (I thought)....
Well, about 3 hours later, she began to have HORRIBLE pain. I KNEW this is not normal for a routine uncomplicated primip vag delivery, so I assessed for all the usual things, uterine tone, rule out infection, check bladder tone, etc. The bladder was non palpable, uterus altho 2 fingerbreadths above U, was midline. So, I got my charge nurse and asked her to 2nd my opinion before I called the doctor. I brought a foley incase cath was needed.
Well, she agreed with me, although the bladder was non- palpable and ute midline and firm, it might be a full bladder, so with MUCH effort, and two sets of hands, we cath'd her. Guess how much urine drained? 1900 cc! I have NEVER seen anything like it. I felt HORRIBLE. What kind of nurse am I to have missed something so basic? Duh. Well predictably, after suffering the discomfort of cathing her (which I truly had wanted to avoid), she reported immediate relief (duh). NEVER again will I overlook the obvious in looking for something more complicated. And never again will I make assumptions based on basic assessments; each patient is indeed unique. Fortunately, no damage was done. Her uterus was firm, we could massage no clots out and her bladder tone was ok. She was a happy camper after this. GRRRRRRRRRRRRRRRR.......Has ANYone else ever felt this badly? I feel terrible about this oversight! Lesson learned, fortunately with no harm to the patient.:imbar
