I recently (4 months ago) accepted a position for a home health nurse for one child.
This child has a low profile g/t and has neurodegenerative disease, proximal hypotonia.
With the exception of a few uri's since i have been this child's nurse there have been a few incidents in which there has been significant lower extremity edema. the mother has assured me the M.D is aware and just states its part of the disease process.
More recently the child seems to go 4 days with no b.m and urination is not spontaneous but i have to resort to straight cath. even though there is more than adequate fluid intake.
I was very frustrated with the pcp last week when I tried the PRN's ordered for constipation which was M.O.M in 3 10 cc doses and no luck. he ordered a ped. fleet enema and still no luck.
Bowel sounds have always been active in all 4 quads, however on this day they were active in am and upper quads during course of day became sluggish and abd. got very distended and hard. Bilat. feet were taught shiny and enormous!
I alerted the mother and we were ordered to take the child for labs and then to M.D and then rushed to e.r where child is now in ICU.
Is there something else I could have detected before it got to this point?
This child's M.D is over 1 hr away from childs home and therefore M.D does like to treat remotely if possible, on this day the mother insisted and I agreed that the child should be seen.
I have lost sleep overnight wandering if my nursing skills have failed me.
Is this something I am at fault for.
It has not been required as of yet to take child b/p and pulse was normal and regular , also temp was 97.8.
PLEASE, anyone who can help me clear my consious or am I a terrible nurse for not catching something I could not see?
Jan 13, '07
Doesn't sound like it, except maybe suggest the child be seen sooner. You were keeping in touch with the MD, so you weren't ignoring anything. Is there any way to transfer his care to an MD closer to where you are?
Jan 13, '07
I don't think you did anything wrong either. Always go with your gut instinct and next time you need to call a doctor and you really feel strongly the patient needs to be seen, express that to them over and over if you need to and most of the time the will agree with you.