I made my patient cry (long) - page 2

Let me stick to the basics... My orientee and I had a pt yesterday that was 23weeks and came to our triage/unit 3 times in 4 days for PTL. Each time she was treated with IV fluids and the ctx... Read More

  1. by   Lisa CCU RN
    What are PTL, ctx, and toco? OB/PEDS is not till next semester and I get the abuse part, but I wasn't following this story at all in the beginning.:spin:
  2. by   HappyNurse2005
    What are PTL, ctx, and toco? OB/PEDS is not till next semester and I get the abuse part, but I wasn't following this story at all in the beginning.:spin:
    PTL is pre term labor
    ctx is contractions
    toco is the monitor placed on the abdomen that picks up contractions.
    when mom is having a contraction, as her abdomen tightens, it picks up and the monitor transmits it to paper/computer screen and it looks like a hill, a gradual curve up, a peak and a gradual curve down. since it picks up pressure, if you push down on the monitor with your hands, it picks it up. pt's may think it looks like a contraction, but when you push down and let up, it has more of a sharp up/sharp down instead of the gradual curve, which is how you can tell the difference
  3. by   smk1
    I remember that when I was pregnant, I was asked the abuse questions each time I had a doctors visit. Standard care, and I wasn't offended at all. I think you were being a caring, concerned nurse.
  4. by   Lisa CCU RN
    Quote from HappyNurse2005
    PTL is pre term labor
    ctx is contractions
    toco is the monitor placed on the abdomen that picks up contractions.
    when mom is having a contraction, as her abdomen tightens, it picks up and the monitor transmits it to paper/computer screen and it looks like a hill, a gradual curve up, a peak and a gradual curve down. since it picks up pressure, if you push down on the monitor with your hands, it picks it up. pt's may think it looks like a contraction, but when you push down and let up, it has more of a sharp up/sharp down instead of the gradual curve, which is how you can tell the difference
    Thanks!
    I am over here smaking my head. :smackingf
    Last edit by Lisa CCU RN on Nov 17, '06
  5. by   magz53
    Yes, you did the right thing to ask the patient the questions we also have on our admission forms. Ours says something like ......free from apparent abuse.....now that leaves a big window. Are they talking black eyes, broken bones or the kind of hovering over the patient....not leaving etc. that says they don't dare leave her lest she say something about them. I have seen it many times . I have also seen nurses get in trouble when patients complain no matter what the situation is. The hospital and Press Ganey don't want details and don't care that we are doing our job........as long as the patient and family are happy with their "service" in the hospital. Nursing is not what it used to be. Sadly.
  6. by   charebec65
    You did the right thing. As another poster said, she may have been in denial at the moment but you gave her something to think about. I think many of the hospitals around here have abuse/safety questions as part as the ER or admit process. I was in the ER back in Feb. My husband was standing there when they asked me if I were abused or if I felt afraid living in my home. Through severe pain, I laughed and told him no, not really thinking about why he was asking at the moment. I'm not abused in any way but am glad they do ask though. There are those people that are abused by their s/o's or even other family members.
  7. by   rn/writer
    When you are confronted with a situation that makes your "gut alarm" go off, the one thing you can't do is nothing.

    The right thing isn't always the easy thing. And it doesn't always look or feel nice on the surface. Sometimes it's messy and awkward, but it's still right.

    Any number of factors could be in play with this patient. Maybe she's feeling frightened and insecure for reasons that have nothing to do with abuse. Could be she's afraid of losing the baby and just wants to be in an environment that feels safer and more controlled. BUT, when in doubt, you HAVE to consider worst case and start from there.

    If anyone gives you a hard time about the way you handled the situation, ask them what they would have done differently.

    I'm just glad you had the police so readily available. Do keep Nice2MeetU's advice in mind and watch your back for a while. Have security walk you to your car if you can't go with a group.

    You did well. Now rest in quiet confidence that you gave your best.
  8. by   foxyhill21
    did pt return a couple days later or did u never she her again
  9. by   ragingmomster
    Thank you all for the support.

    Our admissions paperwork does have a screening for abuse, but we don't directly ask if the pt is not alone.

    I am amazed I have not been called on the carpet for this event, but have taken copious notes and kept them for myself along with the ones that were in the chart.

    Having worked in a jail for few years and then worked in areas that many of our clients came from has made me almost paranoid about my surroundings. Thanks for the reminder, it never hit me that the s/o could be feeling vengeful.

    We have not seen the pt in the hospital again recently. I am thinking I may have gotten through to her that the nurses and doc's aren't stupid and she is keeping to the straight and narrow. She has her next prenatal visit the week after Thanksgiving and I will be sure to check with the doc's from the clinic to see if she made it in, or changed providers.

    Thanks again everyone.

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