Epidural block

[spicychap]

Hello,

I had a patient who was feeling very sick, vomitting, cold and shivering. I had this patient in PACU for about half an hour, out of which 25 mins was used to manage his feeling of sickness. I couldnt check his epidural block levels because he was shivering so much and I'll feel bad to be spraying any cold spray on his body. I documented this and all other care given.

After patient was transferred to ITU, the nurse was very mad that I have'nt checked the epidural block levels, I tried to explain but she wouldnt listen. Anyway, I always try to be a good nurse and look after my patient as I'll like to be looked after. However, this nurse made things so difficult for me that I started wondering if I've done the right thing? And what would happen in this instance, in the court of law.

I believe I wasnt negligent because I knew to check it but just didnt think a cold spray on a very cold and shivering patient is right. A colleague said the question is, should it have been done? Yes. Did I do it? No! Which means Im wrong.

Please what do you think and whats my stand in the court of law?

Thanks

[Esme12, ASN, BSN, RN]

Hello,

I had a patient who was feeling very sick, vomiting, cold and shivering. I had this patient in PACU for about half an hour, out of which 25 mins was used to manage his feeling of sickness. I couldn't check his epidural block levels because he was shivering so much and I'll feel bad to be spraying any cold spray on his body. I documented this and all other care given.

After patient was transferred to ITU, the nurse was very mad that I haven't checked the epidural block levels, I tried to explain but she wouldn't listen. Anyway, I always try to be a good nurse and look after my patient as I'll like to be looked after. However, this nurse made things so difficult for me that I started wondering if I've done the right thing? And what would happen in this instance, in the court of law.

I believe I wasn't negligent because I knew to check it but just didn't think a cold spray on a very cold and shivering patient is right. A colleague said the question is, should it have been done? Yes. Did I do it? No! Which means I'm wrong.

Please what do you think and whats my stand in the court of law?

Thanks

We can't give legal advice here so what they would think in a court of law, I have no idea. I do however know that if the patient would suffer complications from the epidural and you did not perform the "standard of care that another reasonable and prudent nurse would" you are libel and that you didn't check because they were cold isn't an excuse for not doing the require assessment. Shivering is a common side effect of epidural anesthesia

http://www.painfreebirthing.com/english/complications.htm

Shivering: Shivering may occur and is a common reaction. Sometimes it happens during labor and delivery, even if you have not received any anesthetic medications. Keeping warm often helps it subside.

Decreased blood pressure: You will receive intravenous fluids and your blood pressure will be carefully monitored and treated. Decreases in blood pressure are expeditiously corrected.

Mild itching: This is a result of narcotics used in the epidural/spinal medications.

Breathing problems: On rare occasions, the anesthetic medication may affect the chest muscles and make it harder to breathe. Oxygen can be given to relieve this and help the breathing.

Injection into veins: There is a risk that the anesthetic medication could be injected into one of them. To help avoid unusual reactions stemming from this, your anesthesiologist will first administer a test dose of medication and you may be asked if you notice any dizziness, a funny taste, numbness of ears, dizziness or rapid heart beat.

It the nurses responsibility to correctly follow standards of care and if not followed will be held liable and responsible for their actions. IN this case "the patient is cold" I believe will not release you from responsibility

Here is a link.....I hope it helps.

http://www.nursingceu.com/courses/249/index_nceu.html

[Biffbradford]

I'm certainly no expert on epidurals, but we had some in the ICU.

Safety over comfort. Sometimes, you just do what you have to do.

Tell the patient what you have to do, and get it done right the first time.

Live and learn! :)

[nurse2033, MSN, RN]

Surely a cold spray is not the only way to assess? What if a displaced epidural was causing the symptoms? Your first job is patient safety, not patient comfort. Sorry but I agree with the ICU nurse.

[Isabelle49]

Anesthesiologist probably needed to assess the patient.

[traumaRUs, MSN, APRN]

Closing as we can't provide legal advice.