Nurse Guilt

[Amazzei1]

How do you deal with guilt over feeling like you should have caught a patient's symptoms earlier in a shift? I really feel like I let this man down on my shift last night by not catching the signs earlier.

So the story. My patient had a subdural hematoma which had been stable the past few days in repeat CT scans. I'd had him the night before and he was A&Ox3, alert, no neurological deficits. We had a full conversation and everything was fine. The next night I came in and got report from the daylight nurse who told me he had been very drowsy all day, which the trauma team believed was related to him getting 15mg of morphine po q4h, so they cut back the dose to 7.5mg and the patient had been sleeping all day so he hadn't received any doses since 8:45 AM which I didn't think to check until midnight of my shift.

So later on in my shift I went into his room to assess and give him medications. He was definitely drowsy, but easily arousable. His speech was a bit garbled, but he was still A&Ox3 and neuro wise he was still intact so I thought maybe he was worn out from the day and his speech was garbled because he was tired. So I gave him his meds and let him sleep.

I went in to reassess him at midnight and noticed he was still sleeping. I wanted to make sure he was still arousable so I woke him up and noticed his speech was more garbled and slurred. I could still understand him, and he still answered questions appropriately. I had a bad feeling so I notified the trauma PA who said to hold narcotics for the night, but did not come to see the patient at the bedside. I really wish I pushed more here, but for some reason even though I was concerned I didn't do anything else and let him sleep.

I continued to monitor his vitals (I work in the step down unit, so we have our blood pressure cuffs onto central monitors and can have them set for as often of an interval as we wanted. I set his to hourly) and did not notice any critical vital sign changes. I'd peek in the room and he was asleep but I did not wake him up until the morning.

I decided to wake him up one more time when the strange feeling I had earlier came back stronger than before. This time his speech was extremely slurred and garbled and he had a right facial droop. He was actually still A&Ox3, although it was difficult to understand him. He could still move extremities, but his pupils were pinpoint(still reactive to light) and he was only following simple commands with delayed responses. This time I asked the trauma PA to come to the bedside where he ordered a STAT head CT and we took him downstairs.

My shift was up before the CT was read, but the tech said he definitely had a bleed. I suppose I dont know if it was the same as it was previously or not. I have my doubts with his symptoms in the morning. I'm really beating myself up for not being more proactive and helping him earlier. I wish I pushed more. I ended up doing something in the end, but I wish I'd done it before he got worse. I should have known better.

[OneRN50]

I feel like you did the best you could at the time. No one ever intentionally doesnt call attention to a negative symptom. You are human just like the rest of us nurses and hindsight is always 20/20 my friend d. We have all been there. You did what you thought needed to be done at the time. Pray and move forward. ?