Feeling a little discourage

[kurisutein]

So here is my situation that I want to get out of my chest. So basically, I'm relatively new to the ICu unit with 3.5 years experience in the ED. This would be my 10th month in the ICU setting.

Anyway, I just got off work last night and felt a little discourage since I missed to do an ABG. So basically I received this pt at the beginning of my pm shift who was vented recently after many days on bipap with no improvement to his respiratory status. This pt has been in the ICU for 2 weeks so this is my first time taking care of this pt. Apparently this pt. caught a bad pneumonia bug from a business trip overseas. From report, the day RN reported to me he had some agonal breathing going on since 2pm despite being vented and his SaO2 are between 88-95% on fio2 of 98%. Not sure if she reported it to the md but apparently he has been in several times that day. With movement, pt would drop down too and is very sensitive.

So I start my shift and my RT placed him on Fio2 100%. His sats. were still not good, between 89%-90%. He was breathing over the vent rate of 24 so it's reading between 25-30s. With breathing treatment, his SaO2 would go up but would only last long. Pt. Was also on propofol at 60 mcg and did not do much with his decreasing breathing rate. So I used Ativan for the first hour to see then morphine and it did help a little with his breathing. Still agonal though. Called the MD on call in regards to of status and states to continue to monitor him. No new orders other than what the primary md placed. There is abg ordered prn and I did speak with the RT but doesn't seem like he had any issue and didn't do an Abg. There was an Abg drawn that early morning and it definitely looked pretty crappy but the primary MD was there the time it was drawn. Otherwise there is nothing I else I can do other than monitor him, give morphine and Ativan prn, and titration propofol if needed. Last cxr was that early morning too before my shift and it was stable compared to last time.

So I did what I can and passed it on to the same day shift nurse and asked if I did an Abg on him which I didnt. I was thinking about it but forgot in the midst of treating a pt that came in for bleeding. The RN was good about it but I felt like I should of caught it. Not only that, it's one of the Rts during day shift that i have a bad impression over and feel like she'll write anyone up. I mean, I felt like I should of done things differently but then I felt like I did take the steps to inform the MD about what's going on. I even spoke withe cardiologist who came and noted right away his fio2 level and states he will eventually be trached. So overall, I feel bad and I feel discouraging after missing that simple test. What do you think? Should I approached things differently?

[browneyes3000]

You tried your best to take care that patient. The patient is still alive when you left. Do not beat yourself up.

[IsabelK]

The patient was alive. If the powers that be do approach you, be honest. You won't make that mistake again. You'll just find others. It's part and parcel of being human. The write up process in a lot of places is meant as a learning tool. When I've been written up, it became a learning experience. Now, I just take good notes and keep track of my own tasks and check them off as I do them. It helps..

And you'll beat yourself up more than the powers that be can...try to take a deep breath and relax.

[hybr1d]

You learned from this and as the others have said the patient is alive. Some colleagues do come off that way but try to shrug it off, I bet they have made mistakes or misses themselves, we all do at some point. You've talked to the doctors and done your best. Try to see what you've done right too, I'm sure it's most things.