I try as hard as I can to be a good nurse to my patient's and part of being a good nurse is being an advocate for the patient.
I had a couplet on Sunday and the baby had some things that were just not right about her. First off, she had very large fontanels. The anterior fontanel could be felt all the way to almost the top of her nose and laterally to almost her ears. It was not flat or bulging, just large. She had a very shrill cry. Sometimes her cry sounded typical, but sometimes it was very shrill. Her hands folded kind of towards her wrists, looked like a "V" shape. She also had reduced tone. She was pale and had sort of transulcent skin. Ped had seen her and just noted that she was breasfeeding well, had large fontanels and ordered a TSH and T4. TSH was mildly elevated. Baby wasn't breastfeeding real well and by day 3, she had lost 11% of her birthweight. Mom was pumping and had lots of milk, was supplementing with breastmilk after feeds and using a syringe. VS were all within normal limits, she had no problems maintaining her temps and she was small 5#13 at birth.
Anyway, my dilemma came in when she became my patient the 2nd night. I had seen and heard her the first night I worked, but then she was mine on my 2nd night. Mom is a nurse as well. I don't think that mom had even noticed that she was a little different and I really felt like I should tell her something. Who knows, maybe the baby is fine, but I felt like I should have told her something. Being new, I discussed it with 2 other nurses who said I shouldn't. It was the doctor's job to talk to her about anything like that. I felt like the doctor wasn't being aggressive enough to at least evaluate the head and make sure things were okay. All the nurses on both days and nights felt like something was not right with her, but nothing seemed to be being done except the blood tests. Of note, her first child had hypothyroidism, but was no longer considered hypothyroid. Which is why ped had told her he ordered TSH/T4. I know that hypothyroidism babies can have large fontanels, so I hope that is what it is if anything, since it can be treated.
I was frustrated all night. She was the sweetest little thing, but I can see how the nursery was frustrated because she would just cry and cry sometimes and it was very high pitched. Even being held. Then sometimes she would be fine and sleep peacefully. My frustration was that I couldn't tell if she was in pain or it was just the way she cried.
Also that I felt like I had bonded with her mother, yet I didn't have the courage to at least say to her "I am not sure if you have noticed, but XXX's fontanels are a bit large. You might want to ask her pediatrician about that and see what he thinks." I didn't want to alarm her, but I felt like no one had told her anything.
So, what would you have done?
*To my patient and her daughter~I hope that all turns out okay and I am sorry I wasn't a better advocate for you guys. You are in my thoughts and prayers. *
Bluesky-I was using XXX as a name, instead of putting a name there. I wasn't talking about Trisomy X. I would never tell a patient/patient's parent they had a specific illness because that is the doctor's job, especially with no proof. I merely wish that I had told her that her daughter's fontanels were a bit large and that she might want to follow up with her pediatrician.
Ooooops! Ha ha ha, can you tell I'm not a peds nurse! Sorry I misunderstood. :rotfl:
That's okay. I was really confused at first, thinking "I was just saying she has large fontanels." Then it hit me that you were thinking I was diagnosing her with XXX. No problem at all.:chuckle
bluesky, BSN, RN
864 Posts
Ooooops! Ha ha ha, can you tell I'm not a peds nurse! Sorry I misunderstood. :rotfl: