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Discussion

2 out of 3 ain't bad.

I am stressing. I had a patient today who was pre-op for a D+C. While she was in my care, she passed a 6cm x 8cm, dark red, gelatinous mass while trying to void. Assuming it was a clot, I immediately called the surgeon to ask her if she wanted me to send it to the lab. The surgeon asked me if it looked like a clot or a fibroid. I said, "It is gelatinous like a clot. What do you think?"

She told me that it probably was nothing to worry about. So I disposed of it in the garbage and documented the incident. Then... I get a call tonight from the night nurse. She asked me how I disposed of the "matter" because the surgeon would like to know. Obviously it was a fibroid? I guess I did the right thing by obviously calling and documenting... but I made the wrong choice and I am thinking about it even though there is nothing I can do now?! Ahh! I guess I should have known the difference more clearly. Now I just feel stupid. :(

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Next time take a tongue blade and see if you can cut the "clot". If you can't it ain't a clot!

  • Author

Thanks. I knew there had to be more technical way than just "squishing it around" a bit.

One thing I would suggest is "document document document!"...make sure that in your care notes you include your call to the MD, what was said (I find quotes very helpful)...and really describe the mass. This way if someone is to question your reasons, you have it documented and a lot less troublesome than word against word outloud.

I had a similar deal with a large mass passed after bowel surgery, and I described it so well that the doc almost paniced (helps to know your docs too when you can...that comes with time...pretty soon you will learn what to say and what not to say to get action out of them ;) ). Sure enough it came back as a cancerous mass freed from surgery they didn't notice before...well at all for that matter, the client was post stab wound and lost a bit of intestine r/t it. Cancer never came up, but for some reason my internal 'red flags' flew when I saw it, and I made sure action was taken...better safe than sorry is my motto :).

Go with your gut instincts, and if it isn't going well or in the way you feel it should, you can try to talk with your nursing manager and see if they can help. Plus, it involves them at that point, so they become part of the responsible people involved too (hint hint).

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