Missed something in clinical

Well, look at it like this... you will never forget to look at heels on anyone ever again! Always take off teds all the way so you can see all of both legs... you never know what you may find underneath!! Consider it a learning experience and take it in stride.

At least you consider it a learning experience and not just an "oops" moment!

We have to give baths, meds...total care in clinicals...and I gave her a bath the week before as I was doing my assessment. She was 1 day post op last Thursday, and the surgeon had removed her dressings just after I got report. Great timing, actually. But, no, I didn't see any signs of breakdown last week.

I had the same pt this Thursday and Friday that I had last week. Little old lady c R hip fx and gamma nail sx, hx of :redbeathe dz and DM. In the week I was in class, she developed ARF and was recovering from that. ....

. Did it happen overnight? No. Did I turn her like I was supposed to and when I was supposed to? Absolutely. True, dementia contributed to her inability to maintain position and she kept rolling back supine. She'd even move the pillows we propped her on and lie on her back. Still, I didn't pick up on these EIGHT areas of breakdown on her legs because I didn't take her TEDs off.

So, what have I learned, you ask? Never again will I make the same mistake. I'll assess everything down to nose hairs now.

This is why so many women over the age of 65 don't survive the year after a fx hip-this (and many other) complications are all too common. I worked in a hospital that required removal of ted stockings and insepction of LE's by a licensed nurse Q shift.It's good practice-especially since many patients went for days without having those ted's removed and re-applied.This type of thing CAN happen overnight-it can happen in a few hours in this type of patient. You learned how inportant it is for you to visualize every square inch of a patient you are responsible for-under teds and dressings,too.How many of us have removed a funky old dressing and found an obviously infected skin tear with no record in the chart of when or how it was sustained? It's doubtful that you caused this patient's problem. The good thing about all of this is maybe this incident will serve as a wake up call to the entire unit.

there are things you miss and will inspect those areas much more the next time. I have missed areas before d/t not having strength/time/supplies/etc at the time of assessment in AM, but make sure I get to those areas throughout the day sometime (checking buttocks during peri care after a BM on an incontinent pt). the other day i had a pt with scd's but never removed them during both days i had taken care of her (definitely my mistake). at the end of my second day with her, one of the scd's were loose so i wanted to adjust it, i removed it completely and found 2 large white areas (black pt) on her shin/calf area what looked to be healed decubs. she told me there was nothing wrong with her skin, but that this was from a saphenous vein removal that got infected after a cabg in 1996. made me feel much better after that and made sure to document in the skin assessment what i had found.