I feel like a real DIRTBAG!

  1. Ok I have to confess; I may be an experienced nurse but nearly missed something HUGE last night. It was a busier-than H@ll night last night; you know the kind. When you feel badly cause NONE of your patients gets your best cause you are too busy running around, putting out fires all over the place. It has been raining labor patients where I work this week. The floor looked like a tornado had blown through.... Anywhoooo...

    I had a patient who had had a dense labor epidural (gosh I hate that). She had a foley cath which the OB insisted be pulled for the last stage of pushing (I understand why). Anyhow, I had turned off the epidural by this point and once the placenta was delivered, and I was sure she was firm and not bleeding, I turned down her IV rate to 75cc/hr, knowing her bladder would get full fairly soon. I was hoping the epidural would wear off and she could void at some point! In vain. I tried EVERYTHING to make this happen. Her peri swelled horribly and no amt of ice would bring this down. I continually assessed her bladder and uterine tones and bleeding to ensure she did not become distended. (I thought)....

    Well, about 3 hours later, she began to have HORRIBLE pain. I KNEW this is not normal for a routine uncomplicated primip vag delivery, so I assessed for all the usual things, uterine tone, rule out infection, check bladder tone, etc. The bladder was non palpable, uterus altho 2 fingerbreadths above U, was midline. So, I got my charge nurse and asked her to 2nd my opinion before I called the doctor. I brought a foley incase cath was needed.

    Well, she agreed with me, although the bladder was non- palpable and ute midline and firm, it might be a full bladder, so with MUCH effort, and two sets of hands, we cath'd her. Guess how much urine drained? 1900 cc! I have NEVER seen anything like it. I felt HORRIBLE. What kind of nurse am I to have missed something so basic? Duh. Well predictably, after suffering the discomfort of cathing her (which I truly had wanted to avoid), she reported immediate relief (duh). NEVER again will I overlook the obvious in looking for something more complicated. And never again will I make assumptions based on basic assessments; each patient is indeed unique. Fortunately, no damage was done. Her uterus was firm, we could massage no clots out and her bladder tone was ok. She was a happy camper after this. GRRRRRRRRRRRRRRRR.......Has ANYone else ever felt this badly? I feel terrible about this oversight! Lesson learned, fortunately with no harm to the patient.:imbar
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    Joined: Apr '02; Posts: 38,681; Likes: 15,905


  3. by   mark_LD_RN
    I have been there I feel horrible when i miss something, even feel bad when a pt ends up a section like i should have done more.
    I do the same thing with the cath i give ones like that every opportunity to void before i cath them, because i just hate to do it and inflict any pain. but i know it has to be done. I am always concerned when the fundus gets above the umbillicus now.
    well don't let it bother you to much she is doing fine now
  4. by   baseline
    Been there. Hate it. Carry on!!!!!! There is little else to do but thank heaven all turned out well, and learn.
  5. by   Jolie
    Lighten up on yourself! You assessed her and got a second opinion, then intervened appropriately. She is doing fine. All patients should get such cr**py care:-). You can be my nurse anytime!

    By this time tomorrow, you'll have much bigger concerns to worry about!
  6. by   ShandyLynnRN
    Originally posted by Jolie
    Lighten up on yourself! You assessed her and got a second opinion, then intervened appropriately. She is doing fine. All patients should get such cr**py care:-). You can be my nurse anytime!

    By this time tomorrow, you'll have much bigger concerns to worry about!

    (I always like it when the MD orders a foley for those whose perineum is starting to swell like that, then I can put in the cath while the epidural hasn't worn off)
  7. by   LasVegasRN
    Heyyyyyy now. Don't beat up on yourself, it happens to the best of us. :kiss
  8. by   Sarah, RNBScN
    Your human and you acknowledging how terrible you felt ... you could be my nurse anytime.

    Live and learn.

    No harm.

    We are often our worst critics.
  9. by   HazeK
    oh, we could ALL post some goofs, oversights, mistakes, med errors, et. al.

    being human is acceptable...
    the fact that you learned from this experience and don't take what happened lightly are signs of your caring, professionalism!

    my "bladder classic" was a NCB mom who was a grand multip whose baby just was NOT descending in the pelvis! She was breathing through her discomfort like a champ, and dialating appropriately but the presenting part was not only not descending, but the station was getting higher! I was totally baffled! Her doctor was concerned that he might have to section her for arrest of descent! I finally found the VE to be so bizzare, that I asked a friend to double-check behind me. SHE found the HUGE bladder!

    Uh, some nameless nurse (uh, me) had told the patient she couldn't get out of bed after the patient's water broke, so the poor patient thought, that since she couldn't get OOB to go to the bathroom, that she had to "hold it" until after the delivery! Argh! I was sooooooooooooo embarassed and horrified at missing such a simple thing! The poor dear voided huge amounts of urine on a bedpan over the next half an hour....followed by a rapid descent of the presenting part... and the crazy rush to get the doc here in time for the delivery!

    so, see, we too have some great BooBoos in our history!

  10. by   SmilingBluEyes
    WOW thanks for all your support. I can't say I completely have let myself off the hook here, but I DO feel better for sharing....you guys are so non-judgemental. THANKYOU!!!
  11. by   Sleepyeyes
    OK, here's my story:

    It's midnight, I'm holed up in a strange city hotel because the hospital treating my daughter's MVA-caused pelvic fx is nearby, and I'm juuuust dropping off to sleep after being at the hospital for her all day and most of the night, and the phone rings. It's daughter:

    "Mom, you gotta get down here fast. Nobody's cathed me in 10 hours and I gotta PEE!"

    So I'm like, Hon, I doubt if they'll let me do that---I don't work there.

    "YES, they will! I swear Mom, you HAVE TO! You're my MOTHER!! I have a GN and I swear, she's afraid to try to put the cath in--PLEASE get down here NOW before I get a UTI!!"

    So, OK, that's my baby there, she's desperate, I melt, then I hustle the youngest one into the car, we're both half-dead, and I go racing up to her room---and sure enough, an hour later, she still hasn't been cathed. The nurse and the daughter had the same look of relief when they saw me. So the nurse points me to the supplies and I grab some stuff, wash my hands, and walk her through the procedure. Sure enough, she hadn't done a Foley since clinicals.

    Mind you--this was totally routine, everything was completely visible, and no huge amount of swelling. (Well, yeah, there was some swelling, but the poor lil nurse truly didn't know where to put the cath!)

    Results: 900 cc's out. whew.
    Last edit by Sleepyeyes on Mar 30, '03
  12. by   SmilingBluEyes
    Well now sleepyeyes, I feel like absolute poop again. I am sorry what happened to your daughter. It was poor nursing care. NO excuse for it, just like there was none for me. I feel badly she suffered like she did, just like my patient did cause of my oversight. I think I am thru w/this thread. I feel terrible enough. as it is.
  13. by   ShandyLynnRN
    oh PLEASE don't feel bad! It happens! You totally did what anyone else would have done... you followed up, and fixed the problem. You are a nurse, not a psychic. (or I assume you aren't psychic )
  14. by   SmilingBluEyes
    No not psychic, and apparantly a nurse that needs to examine her practice a wee bit closer. A Graduate nurse would have come to a more reasonable and prudent decision sooner than I did that night. sigh. I just can't let myself off the hook that easily. BUT Shandy I do thank you for your supportive words. Yours and everyone else's here. It means a lot.:kiss