I feel so stupid. What should I have done?

[arelle68]

A CNA came to me and told me that one of my residents was walking fine yesterday, but couldn't walk today. I went to assess her, and had the CNA's lay her down. She was screaming and sobbing. I felt of her hip, and tried moving it around. She was in obvious extreme and unusual pain, and I didn't know what was wrong with her. She is in a very advanced stage of Alzheimer's, and was especially confused today. She really is not capable on any day of telling us where she hurts. She is very delusional. Anyway, I called the Dr, and had her sent out to the ED to be evaluated for her pain. Her son met her there. She came back with antibiotics and pyridium. Dx:severe UTI. The son was upset, and didn't understand why we didn't just give her a PRN pain med. He also thought we should have known about the UTI without sending her out. They had given her pyridium in the ED, and I get her back feeling a lot better. I feel bad that he was annoyed. I feel dumb that I thought it was a hip. What should I have done? How could I have done better?

[Neveranurseagain, RN]

Just tell the son you didn't bring your Superman Xray Vision Googles to work that day so you weren't sure if it was her hip or not!

[coffee4metech]

You were in the right , sent her to the ED to get evualated you can't diagnos her because thats not in your scope of practice ..... sometimes the patients family are clueless on how everything works and demand things that are out of our control in many situations !!! don't feel bad or stupid everything you could have done you did .

[wee_oneRN]

Sounds like you did the right thing, UTI's in elderly can be so tricky! I am a new grad, so I don't have much nursing experience to share with you, but my first degree is in psychology and this is where I can add my 2 pennies!

You can actually use one of those textbook phrases on the son; "It must be so difficult for you to see your mother in so much pain."

Unless this is his everyday attitude, the son isn't a jerk nor does he really think it is 'all your fault'. He's scared and angry that his mother is deteriorating and he has zero control over it. He feels powerless and is projecting that fear and anger onto the closest person, you.

Try the above phrase and see if he is able to open up. We meet people in the most vulnerable states and often take the brunt of outbursts. You did a great job at critical thinking, don't let the incident take that from you.

[pednursedeb]

I agree with everyone else. You did the right thing. Who knows she could have been having flank pain that felt like hip pain. I have found with the elderly that for some reason UTI's lead to confusion or more confusion in pt. As said before they can become septic very quickly. The right thing to do is send them to the ED, which you do. Also do thank you CNA for catching something. She will be more likely to come to you with things.

[caliotter3]

I also think you did the right thing.

[Otessa, BSN, RN]

Better safe than sorry.

Every patient experience provides us a learning opportunity-we learn and grow and may do the same or different next time.

otessa