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?
