I screwed up! How do I fix it?

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HELP! We had Med Surg clinicals yesterday and my pt was MRSA+, Diabetic. I guess I was soooo caught up in the contact precautions, that I didn't pay attention to the fact that his temp was 95.7! I have to turn in paperwork to my instructor with the temp posted. She's going to want to know why I didn't report it to her.

Here's what the other temps prior had been running: Admission 5 days prior was 95.1. The 8 am temp was 95.3 and the noon temp was 95.7. His HR was running under 60 since admission as well. Is this the infection? What can I say or do to keep myself from getting written up for this. I KNOW I NEED TO LEARN FROM MY MISTAKES. Please be gentle!

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The best thing that I can suggest you do is to be honest. After all accountability is one big trait they are looking for in us while we are in school. So you made a mistake, no one got hurt and this won't be the last one that you make trust me. Take it as a learning experience, just think now that you have done this and face getting talked to about it you will never forget to do something like this again. Don't beat yourself up too much, we all make mistakes and this is why you are a student you are learning and mistakes are a necessary part of the learning process. You will be fine! Try not to lose sleep over it and whatever you do don't lie or fabricate data!!

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Specializes in ED.

agreed, a simple explanation is far more important than anything else, it shows teach-ability and accountability, both of which are imperative for nursing students

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as the others, I would suggest to tell the truth, I don't think you will get into a lot of trouble, and from what you are saying this patient's temperature was pretty low before, sometimes patients just have a low base-line and it's not really a problem, you also have to consider where the temperature was taken, from my experience I learned that when you take it in the mouth it might be low if the patient just had a drink, it could also be the fault of the thermometer...either way, it seems that the patient was fine with this low temperature, so just tell your instructor what the temperature was and don't worry about it too much

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Specializes in Post Anesthesia.

What's the problem with the patients' temp? Yeah, it's a little low but it has been that way for a while- I can't imagine anyone you would have reported it too that would have cared. It would have been better if you noticed the anomaly when you were recording your VS but this is the patients normal, I assume it isn't a core temp so her "real" temp is still in question, but I doubt the fact that you didn't get concerned that the patient had no change real in thier vs is a problem. I'm not sure that there is anything your instructor or the patients RN would have wanted you to do.

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Specializes in Ortho, Neuro, Detox, Tele.

why not just post it...be honest, and if asked "well, that was in conjuction with the normal temperatures that were already taken..." HINT: If the temp is WAYYY below or above "normal"...maybe recheck it 2-3 times? It's possible that someone just got quick, and just kept charting that as normal. Also, was patient anemic? that could account for that temp....infection temps are usually above...

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Specializes in Critical Care.
What's the problem with the patients' temp? Yeah, it's a little low but it has been that way for a while- I can't imagine anyone you would have reported it too that would have cared. It would have been better if you noticed the anomaly when you were recording your VS but this is the patients normal, I assume it isn't a core temp so her "real" temp is still in question, but I doubt the fact that you didn't get concerned that the patient had no change real in thier vs is a problem. I'm not sure that there is anything your instructor or the patients RN would have wanted you to do.

I second this. What exactly is the problem here? Trending ~.5 a degree since admission isn't exactly a cause for alarm, and with a baseline temp in the 95 range whatever method you're checking it is likely inaccurate anyway due to circulation problems or such...

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Specializes in Family Nurse Practitioner.
I second this. What exactly is the problem here? Trending ~.5 a degree since admission isn't exactly a cause for alarm, and with a baseline temp in the 95 range whatever method you're checking it is likely inaccurate anyway due to circulation problems or such...

Me three. I would just say that since this was in keeping with the patients baseline and a bit low rather than high you didn't think it was worthy of reporting prior to shift end but that in the future you will most certainly keep her apprised of low temperatures. :wink2:

Being accountable for your mistakes is huge but in this case I don't think this is a mistake and to implicate that you didn't think a low temperature was a sign of concern in a patient without a history of low temps isn't where I would have wanted to go with any of my professors. Just my two cents though. Good luck.

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Specializes in med/surg, telemetry, IV therapy, mgmt.

First of all, before getting all upset, problem solve this. Use the nursing process. There's a reason they lectured you about it. It's to be used to solve problems.

What is the problem? That you failed to report something to your instructor? Or, that you didn't act on a symptom that this patient had?

Have you now done some investigation of hypothermia? I did, for you.

(From page 263 of Differential Diagnosis in Primary Care, 4th Edition, by R. Douglas Collins, M.D.)

There are three reasons why temperature drops:

  1. Decreased metabolic rate.
    Hypothyroidism and hypopituitarism are the principle conditions that fall into this category. Senility, starvation, and chronic inanition [basically, long-term starvation] may cause hypothermia due to a decreased metabolic rate. Diabetes mellitus may cause hypothermia because of poor cellular absorption of glucose.

  2. Poor circulation.
    Shock from any cause (hypovolemia, cardiogenic, or neurogenic) falls into this category. Hemorrhagic shock, dehydration, CHF, and adrenal insufficiency are all probably based on this mechanism. With poor circulation, there is tissue anoxia and a reduced metabolism in the skin and mucosa where the temperature is taken.

  3. Disorders of the thermoregulatory center.
    Cerebral thrombosis and hemorrhage, certain pituitary tumors, and toxic suppression of this center by barbiturates, alcohol, opiates, and general anesthesia all fit into this category. Any case of prolonged coma may cause hypothermia on this basis.

It seems to me that since your patient is diabetic you have a pretty good case for the cause of the low temperature being due to a low metabolic rate and poor cellular absorption of glucose. Diabetics are known to have poor circulation and perfusion issues. His 5-day history shows that this low temperature reading is an established trend and (did you look in the doctor's progress notes?) that the doctor is not concerned about it because he did not order any warming measures, did he? You might want to add this to your paperwork before you turn it in.

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:yeahthat: That is why we all love Daytonite around here!!

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thank you so much to all of your responses. I feel much better about reporting this to my instructor w/o fear of failure.

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Some good wisdom in this thread. I love these forums!

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