Holy cow! What a night. I'm a newer nurse working in OB. I earned my RN license last October and have learned a lot since then, but I work in a small hospital so even in the time I've been there have not seen what many see in only a few weeks in larger hospitals. Anyway, last night I take report on a new mommy and babe just about 4 hours old. Beautiful story of an ideal labor and delivery with this wonderful babe who nursed within an hour, like a champ I might add. So we are all in awe of this mom who delivered a nine pound baby quickly, no intrathecal, (no side effects) and this baby who is a dream to feed. I was told in report he did have some facial bruising from coming down so fast so not to be alarmed when I see him. I go to retrieve this baby from mommy, notice that he does indeed look bruised, and proceed to the nursery to assess him. I immediately notice his little feet are pale, he has acrocyanosis of hands, and I think, "okay well I don't see this a lot, but he's only a few hours old so acrocyanosis is WNL for his age." I take his temp and he is 98.8 axillary. I then think, "no, babe's I've cared for who are still having acrocyanosis are not usually this warm. Something is not right." I do a pulse ox and get 66%. I about $%#@. I pulled aside the other nurse working with me and said, "That number better be wrong." She said that it HAD to be. He looked totally relaxed, breathing normally with NO signs of respiratory distress. I changed probe location several times, changed probes, change oximetry machines, and promptly placed blow by to his nares. He pinked up (in his "bruised" face) and hands very slowly and his pulse ox rose VERY slowly. I then placed him under oxyhood since oxygen was what he apparently needed. I was not impressed with the slow response to O2, and the fact that he never got in high 90's like most babies. I called his doctor, informed him of the situation which he had a difficult time believing. He gave orders for a chest x-ray and said he'd be in. It turns out this kid has cyanotic heart disease and was shipped by transport team to a children's hospital to see a specialist. I got a call later in the shift from the transport nurse saying that if I had not detected the problem, acted when I did, that baby would have died in our nursery. She said that when he was declining when she and her team were there it was due to his ductous arteriosis (ductous venosis?), I can't even keep my terminology straight at this point, closing. This was the only way his lungs were getting any oxygenated blood so if it had closed he would have died. Since the transport team was there and had time to confer with the neonatologist they had determined what the suspected diagnosis was, had a drug available to open that back up, and had placed the UVC and UAC. They pushed the drug, which slowly worked, stabilized him and transported him. I was the hero of the unit with all singing my praises. I was flattered and appreciated the recognition. I even felt a surge in confidence that I met the challenge and made the right call with a baby that needed more than routine care. So, now that it has all sunk in, why do I feel so bad. By the time I had been patted on the back for what seemed like the hundredth time I wanted to scream, "what the &%#$ does it matter, the kid may die anyway!" I didn't feel like I saved his life, if anyone did him any favors it was his doctor who doesn't have one of those big egos that make them decide that they are going to keep the kid here and provide care themselves, or "watch them" for awhile. It was the transport nurse who was a pro at what she does. She was so calm, methodical, and reassuring to the parents. She's the hero. The call we got back says this kids heart is a piece of junk. He's got multiple defects that make it a very complex case. If they can save him he will have to survive at least 2 or 3 surgeries which are risky at best. So, everything that was done may be worth nothing. I'm sorry, I know I did my job and I have nothing to feel guilty about if he doesn't survive, but my efforts are worthless to his parents if that boy dies. They aren't going to be comforted by the fact that "that nurse made a good call, she caught on early on that something was not right. " Woopee, I really don't care how good I did. If he doesn't live what value did my actions have?
If it had been me, and my baby, I would have been very greatful to you. You bought them some time. Each moment is precious. Dont beat yourself up looking at the negatives. Things happen for a reason, you were the nurse on duty for a reason, to give this baby and family a chance, that they would not have had if you hadn't been there:icon_hug:
Way to go Sweetcheekers. As other posters have said, even with a more than even probability of a negative outcome, I can't possibly emphasize enough the importance of giving your patient's family that thread of hope!
Specializes in PICU, Nurse Educator, Clinical Research.
You did an amazing job! I worked in a PICU at a hospital that does a lot of complex pediatric heart surgeries, so I took care of a LOT of babies with multiple cardiac issues requiring several surgeries- yes, some didn't make it, but with excellent specialized care, many do. more than I would've thought, in fact. Getting that baby the care he needed, WHEN he needed it, was the ONLY chance he had- and you gave him that chance!
I'm so impressed by what you did. Never forget that your judgment and actions gave that whole family a priceless gift.
Specializes in FNP, Peds, Epilepsy, Mgt., Occ. Ed.
You did an amazing job! I worked in a PICU at a hospital that does a lot of complex pediatric heart surgeries, so I took care of a LOT of babies with multiple cardiac issues requiring several surgeries- yes, some didn't make it, but with excellent specialized care, many do. more than I would've thought, in fact. Getting that baby the care he needed, WHEN he needed it, was the ONLY chance he had- and you gave him that chance!
I'm so impressed by what you did. Never forget that your judgment and actions gave that whole family a priceless gift.
GREAT NEWS! The baby in my post had open heart surgery yesterday and did well. He may only need one more surgery instead of two more like they originally were thinking and he goes home this coming week if all goes well. (To wait for his next procedure.) I am sooo thrilled. Thanks for all your support.
Thank you so much for posting again!
As a NICU nurse, I can say that I am tremendously proud of your care of this baby, and would be privileged to have you care for my own girls. You have demonstrated good instincts, maturity, and poise, and you will make a fabulous nurse.
The story you wrote the other night could have been the story of my neighbor's delivery. Her son had an undiagnosed heart defect, and likewise would have died if not for the attentiveness of a nurse who questioned very minor symptoms early on. His surgical course was rough, but he is now a healthy, robust 7 year old (who my daughter has a crush on). He would never have had a chance if not for that nurse, and your little patient would never have had a chance if not for you. Be proud of yourself!
Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Please take the compliments when offered; you did an excellent job. You cannot hold yourself in any way responsible for those multiple cardiac defects and problems; you will learn, cardiac defects can be undetected for up to 12-24 hours after birth! YOU DID SO WELL, you are to be praised. YOU SAW the SUBTLE CHANGES AND DID SOMETHING ABOUT THEM EARLY-ON. Don't change; you are an excellent nurse. I feel horribly about that poor kid, but don't take it so hard. You did your part and did brilliantly! Hat is off to you.
Woopee, I really don't care how good I did. If he doesn't live what value did my actions have?
The value you provided, Nurse, was that you advocated for your patient to the best of your ability and saved his/her life THAT NIGHT! The value you provided was to allow the opportunity to live that he/she would have had NO OTHER WAY.
You did not give that kid a bad ticker, and you have no control over Life and Death. God decides the course we all follow - and you were His instrument for some (as yet unknown to you) purpose.
God bless and keep you. You have done that to which we all aspire.
" Woopee, I really don't care how good I did. If he doesn't live what value did my actions have?
Thanks for being honest about your feelings. I've had the same thoughts time and time again. We get a lot of really sick people in the BICU, and some of them die...I often wonder what I could have done better. I've come to a conclusion: I'm glad I was there to make any moment they are there better; sometimes that's all I can really do. Sometimes it's little things: just smile, talk to them (even though they are under sedation), and keep their sheets and dressings smooth. I figure that's what nurses do...no matter what the outcome may be (we never know what will happen), we provide professional and compassionate care and hope for the best. There are so many things outside of our control. I've felt many times that my work has been futile, especially if a patient dies after really aggressive treatment, but I've got to believe all my actions have value. I would think most nurses would have to believe this...or there would probably be no nurses. I hope that you come to really feel good about what you've done, like many before have said, you've given this family their little baby for however long he will be here...how wonderful! Keep up the good work, and again thanks for voicing your feelings...it helped me focus mine.
The value you provided, Nurse, was that you advocated for your patient to the best of your ability and saved his/her life THAT NIGHT! The value you provided was to allow the opportunity to live that he/she would have had NO OTHER WAY.
You did not give that kid a bad ticker, and you have no control over Life and Death. God decides the course we all follow - and you were His instrument for some (as yet unknown to you) purpose.
God bless and keep you. You have done that to which we all aspire.
Well said, and it is close to what I would have said also.
You did great, sweetcheekers. More than that, you have no control over.
It's so hard to accept the things we can not change. But, this story looks like it may have a happy ending. I am happy for you as well.
:icon_hug: how would you have felt if you didn't listen to your gut feelings and the infant died on you? There have been many times that I have taken a "very bruised baby" to the nursery and placed them on pulse ox JUST TO MAKE SURE! that its the bruising and not hypoxia. I have been ridiculed by the NICU nurses and co-workers for doing this. Been accused of trying to "break babies" and cause more work for the NICU. I just know that I would not be able to live with myself if I didn't check and there really was something wrong. Keep doing what you are doing. I would work with you anytime.
GREAT NEWS! The baby in my post had open heart surgery yesterday and did well. He may only need one more surgery instead of two more like they originally were thinking and he goes home this coming week if all goes well. (To wait for his next procedure.) I am sooo thrilled. Thanks for all your support.
Now I'll say it. "Great Call." I want you on my team.
moongirl
699 Posts
If it had been me, and my baby, I would have been very greatful to you. You bought them some time. Each moment is precious. Dont beat yourself up looking at the negatives. Things happen for a reason, you were the nurse on duty for a reason, to give this baby and family a chance, that they would not have had if you hadn't been there:icon_hug: