I feel terrible...

[vccm]

Hello all, I am a home health nurse, licensed since last May, first job as a home health nurse since June. Currently, I care for a 20 month old girl with Down's Syndrome, GERD, & PDA 12 hrs/day 2 days/ week. A few days ago, a nurse I work with informed me that the child had a non-productive "cough" and had been eating less, but was afebrile, no other s/s present. I saw her Thursday, upon doing my assessment I ausculated rhonchi, upper airway, not lungs, and a mild fever of 99.3, O2 high 90's, HR 120. We went to her pediatrician who said it was a viral upper resp. inf. Prescribed albuterol 2.5 mg q6h via neb, budesonide BID, and acetaminophen 160 mg q4h. Throughout the day, she did not eat much, I attempted to give as much fluid as possible but the pt consumed no more than 270 ml that day, and about 8 oz of baby food during the day. I instructed mother to encourage fluid intake as patient is at risk for dehydration. The next day, (yesterday) I see she appears the same as the day before, she still has a fever (highest 100.3), and a productive cough, her pulse had increased to 130's mainly after given albuterol, and O2 was at 96% I attempted to give her fluids, I bought Pedialyte for the pt, during the day she had consumed about 8-10 oz of fluids, and 12 oz of baby food b/c she refused to eat. She falls asleep aroudn 3 pm and while she is asleep I take her vitals again and her O2 sat was at 87%, I administered o2 via N/C but to no avail, O2 remained at 91%, RR had increased to almost 30/min. Knowing her, I knew this wasn't normal for her, I notified her PCP and called 911, by the time EMS arrived the pt was awake, alert responsive. She was playing as she normally does, and her O2 increased to 96%, v/s stable. I felt she needed to be seen in the E.R. and perhaps get a chest x-ray, but the paramedics said that it would take a long time for her to be seen as she is "stable" and appears content, that it would probably be best to observe. Mother was present at the time and she agreed that it would be best to observe. I told them that she hasn't been eating, or having adequate fluid intake and was afraid she would become dehydrated. They looked at me as if I knew nothing, and I felt dumb. Ultimately, the mother agreed to keep an eye on her and give her fluids. I reported to the other nurse what had occurred, and the next morning she said the patient had been asleep for a prolonged period of time, vitals were not normal, h.r in the 140's, RR in the 30's, elevated temp, low O2 Sat., she also administered O2 via n/c with no difference in o2. She then attempted to wake the pt up at around 11 am, but said she was falling right back asleep, obviously the patient was lethargic. She called 911 and the pt was admitted to PICU for RSV pneumonia and dehydration. All I can think about is that this is my fault and I have never felt so terrible as I do now. It makes me question whether I am fit to be a nurse

[OrganizedChaos, LVN]

First off, PDN is a terrible place for a new grad. Especially with such a young baby.

But don't beat yourself up. If the paramedics & mom didn't want to bring her to the ER there was nothing you could do.

[LadyFree28, BSN, LPN, RN]

First off, PDN is a terrible place for a new grad. Especially with such a young baby.

But don't beat yourself up. If the paramedics & mom didn't want to bring her to the ER there was nothing you could do.

Agree.

Also, as long as you documented your findings during the whole visit, you did what was right; also, you have to remember that the parent also makes the choice to send their child out. In hindsight, if you were worried, you can always reach out to your supervisors on the case.

[Farawyn]

Do NOT beat yourself up. You did everything right.

[Double-Helix, BSN, RN]

RSV pneumonia is a tough illness. It sounds like you recognized the symptoms in the early stages and tried to get the patient help. It also appears that she was clinically stable at the time of EMS's evaluation and you did all you could advocating for her. Since RSV is a virus with no antiviral treatment, management of the disease focuses on treating the symptoms throughout the progression of the illness. Once RSV has taken root, there isn't much that can be done to stop progression of symptoms. Even if your patient had gone to the ER the day before, even if they had been in the PICU, she still would have continued to deteriorate and require the support she is requiring now. That's the nature of RSV. We often have to tell parents in the PICU that their baby with RSV may get even worse before they get better. We suction, give O2, ensure adequate fluid intake (IV or PO) and administer meds to help increase respiratory performance, but there is nothing we can do about the RSV until it runs it's course. It was great that you were vigilant and sought care for your patient. But the fact that she didn't go to the ER on your shift didn't make any difference in her condition right now. Furthermore, absolutely nothing in your post suggests you did something wrong or shouldn't be a nurse. You can stop beating yourself up.

[budgie16]

Sounds like you were spot on and really couldn't have done anything differently. People (in this case parents) have the right to make their own decisions, regardless of if we agree, and you did all you could to educate and advocate for your patient. Just make sure that everything you did was documented, although EMS hopefully documented the call as well. You did good- You have no reason to beat yourself up or feel guilty.

[jdonovan151]

I think everyone has already expressed that you did nothing wrong.. and I agree. My question to you is... what do you think you should have done differently and why?

You did everything right... Have faith in yourself and your abilities... do NOT fall into that typical nurse thing of putting yourself down and ruining your self esteem... That doesn't help you, your patients or our profession.

-JD

[njpawarn]

You need to be truthful and tell yourself you did a very good job. You are not responsible for what happened, in fact, you made the best effort to have her seen by a physician early on. RSV will progress despite the appropriate treatment.