I made my patient cry (long)

Specialties Ob/Gyn

Published

Let me stick to the basics...

My orientee and I had a pt yesterday that was 23weeks and came to our triage/unit 3 times in 4 days for PTL. Each time she was treated with IV fluids and the ctx decreased. When she was in on the weekend, she was admitted and the nurses believed she was faking some of the ctx. We all know what the pattern looks like, tombstones or a sharp incline at the beginning of the ctx.

Please don't start the flaming here, I know that ctx can graph in many patterns.

Yesterday we caught her at it though. We were in the room for 1/2 hour and she had one gently rising gently falling curve of a ctx. We left the room and immediately we see ctx q 3-5 minutes with the sudden up, sudden down pattern.

I sent the orientee back into the room on some bogus errand and she stayed about 20 minutes. While the RN was in the room the pt had 2 of these sharp UP/Down ctx and the RN marked the strip and asked the pt to take her arm off her abdomen and toco.

MD is aware what is going on, but the group is a family practice group that manages labors as only part of their residency and we are dealing with the first year residents at this time.

Mind you, her boyfriend/finance does not leave her side, to the point where he hasn't eaten in 2 days and the pt asks us to feed him anything we have in the unit fridge. We got him a box lunch (we're not completely heartless).

He left the unit for some reason and went outside the hospital to the front sidewalk. Our police were in the lobby so I explained to the officer that we had some suspicion of abuse and could he let us know when he came back in.

While he was out the orientee and I went into the room to have a frank talk with the pt.

Explained that we were concerned about her and her baby's safety and that 3 admissions in 4 days was certainly out of the ordinary. Was there a reason that she preferred to be in the hospital, was there something we could get her help for? We also explained that the pattern and timing of her ctx did not appear to be something that was happening from inside and may have been caused by something outside her body.

Pt immediately denies abuse, accuses us of calling her a liar and bursts into hysterical tears. We stayed in the room and tried to reassure her that we were only concerned for her safety and wanted to be sure that we were getting the whole story to make sure she got the care she needed.

Knock on the door, another RN lets us know that the boyfriend is on his way back. We let the pt know that we spoke to her privately because often women are afraid to speak about violence in the home in front of their s/o and asked her if she would like to tell us anything before he came back.

Hysterical crying continues along with threats to leave AMA immediately. We try to reassure her and ask if she could just stay until 1400 as we would like to recheck her K+ and blood sugar as they were low and high earlier.

Pt agrees to stay and we leave the room just before the s/o returns. As we are calling the md to update him, the police officer arrives in our unit as we are expecting trouble. Not 5 seconds later the s/o comes blazing out of the room, sees the officer sitting next to us and immediately does an about face and goes back into the room and closes the door.

Call light goes on and the two of us go in to find the pt on the phone, hands it to me and says "my mother wants to talk to you". The mother and I do the HIPPA dance on the phone and all she gets from me is "Your daughter's and grandchild's health and safety are paramount to us here at ACME hospital" Mother threatens to come pick up her child and deliver her to another hospital. "Well I wish you wouldn't but I understand you are concerned about your child, so are we"

End of story - the attending arrives, pours oil on the water and pt agrees to wait for labs and then d/c, and will f/u in the clinic on Monday. Pt leaves unit still bawling and curled up under the arm of the s/o.

I had a sick feeling in my stomach all day yesterday and am definitely off my feed today over this whole incident. You can believe I spent more than an hour charting all this info so that I can explain it clearly when I get called to sit in the 'splainin chair, but I still feel bad.

you did the right thing. If you hadn't of asked her these questions, you would have been remiss. We are obligated to check into situations that seem wrong and you acted as a wise and prudent nurse.

Specializes in Geriatrics, Cardiac, ICU.

What are PTL, ctx, and toco? OB/PEDS is not till next semester and I get the abuse part, but I wasn't following this story at all in the beginning.

Specializes in LDRP.
What are PTL, ctx, and toco? OB/PEDS is not till next semester and I get the abuse part, but I wasn't following this story at all in the beginning.

PTL is pre term labor

ctx is contractions

toco is the monitor placed on the abdomen that picks up contractions.

when mom is having a contraction, as her abdomen tightens, it picks up and the monitor transmits it to paper/computer screen and it looks like a hill, a gradual curve up, a peak and a gradual curve down. since it picks up pressure, if you push down on the monitor with your hands, it picks it up. pt's may think it looks like a contraction, but when you push down and let up, it has more of a sharp up/sharp down instead of the gradual curve, which is how you can tell the difference

I remember that when I was pregnant, I was asked the abuse questions each time I had a doctors visit. Standard care, and I wasn't offended at all. I think you were being a caring, concerned nurse.

Specializes in Geriatrics, Cardiac, ICU.
PTL is pre term labor

ctx is contractions

toco is the monitor placed on the abdomen that picks up contractions.

when mom is having a contraction, as her abdomen tightens, it picks up and the monitor transmits it to paper/computer screen and it looks like a hill, a gradual curve up, a peak and a gradual curve down. since it picks up pressure, if you push down on the monitor with your hands, it picks it up. pt's may think it looks like a contraction, but when you push down and let up, it has more of a sharp up/sharp down instead of the gradual curve, which is how you can tell the difference

Thanks!

I am over here smaking my head. :smackingf

Yes, you did the right thing to ask the patient the questions we also have on our admission forms. Ours says something like ......free from apparent abuse.....now that leaves a big window. Are they talking black eyes, broken bones or the kind of hovering over the patient....not leaving etc. that says they don't dare leave her lest she say something about them. I have seen it many times . I have also seen nurses get in trouble when patients complain no matter what the situation is. The hospital and Press Ganey don't want details and don't care that we are doing our job........as long as the patient and family are happy with their "service" in the hospital. Nursing is not what it used to be. Sadly.

Specializes in Peds.

You did the right thing. As another poster said, she may have been in denial at the moment but you gave her something to think about. I think many of the hospitals around here have abuse/safety questions as part as the ER or admit process. I was in the ER back in Feb. My husband was standing there when they asked me if I were abused or if I felt afraid living in my home. Through severe pain, I laughed and told him no, not really thinking about why he was asking at the moment. I'm not abused in any way but am glad they do ask though. There are those people that are abused by their s/o's or even other family members.

When you are confronted with a situation that makes your "gut alarm" go off, the one thing you can't do is nothing.

The right thing isn't always the easy thing. And it doesn't always look or feel nice on the surface. Sometimes it's messy and awkward, but it's still right.

Any number of factors could be in play with this patient. Maybe she's feeling frightened and insecure for reasons that have nothing to do with abuse. Could be she's afraid of losing the baby and just wants to be in an environment that feels safer and more controlled. BUT, when in doubt, you HAVE to consider worst case and start from there.

If anyone gives you a hard time about the way you handled the situation, ask them what they would have done differently.

I'm just glad you had the police so readily available. Do keep Nice2MeetU's advice in mind and watch your back for a while. Have security walk you to your car if you can't go with a group.

You did well. Now rest in quiet confidence that you gave your best.

Specializes in trauma ICU,TNCC, NRP, PALS, ACLS.

did pt return a couple days later or did u never she her again

Specializes in many.

Thank you all for the support.

Our admissions paperwork does have a screening for abuse, but we don't directly ask if the pt is not alone.

I am amazed I have not been called on the carpet for this event, but have taken copious notes and kept them for myself along with the ones that were in the chart.

Having worked in a jail for few years and then worked in areas that many of our clients came from has made me almost paranoid about my surroundings. Thanks for the reminder, it never hit me that the s/o could be feeling vengeful.

We have not seen the pt in the hospital again recently. I am thinking I may have gotten through to her that the nurses and doc's aren't stupid and she is keeping to the straight and narrow. She has her next prenatal visit the week after Thanksgiving and I will be sure to check with the doc's from the clinic to see if she made it in, or changed providers.

Thanks again everyone.

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