Obsessed ? or Justified?

Editorial Team / Admin · Aug 20, 2005

The other day I had a pt come in 39 wks with severe RUQ pain, for some reason preeclampsia did not cross my mind at the time, I R/O labor and called the OB who to me at the time justifyably gave me orders to transfer her to ER, because she did not seem to have an obsterical complication-------------
My thoughts were it must be gallstones or appendicitis..............................
An hour later it popped into my mind she could have been mistaking her pain for epigastric pain I remembered her B/P was 149/93 and she had +2 protein in her urine with some generalized swelling, I rushed over to the ER to see if she had gotten an u/s, she was not there, I went to the u/s dept. and she was there, they R/O gallstones/appendicitis & hydronephrosis, I thought for sure it had to be epigastric pain, by this time I had my nurse manager with me so she was aware of how I felt. I called the OB and explained to him how I felt and he started yelling that he wasn't aware of her elevated B/P, I assured him I had told him and he continued to yell and swear, I told him to calm down I just wanted him to transfer the pt back to L&D, her pain was probably the reason her B/P was elevated, amazingly he shuted up and called the ER physician. I still was not sure what was up with my pt I checked her labs and her clotting profile was WNL, chest x-ray was -.
It was time for me to go home and I felt so uncomfortable about this case, the pt was still in ER, I asked my nurse manager to look into it, she called the ER and the ER doc did not want to release her until they performed a complete work up, here I was thinking she could have a seizure in the ER instead of in L&D where she belongs :uhoh21: I called in the middle of the night and found out she was going to be transferred back to L&D , but was not there yet, I barely slept thinking why did I let her go to the damn ER (We should have R/O preclampsia first)............
The next morning she was on my L&D floor ,only thing she had was WBC @ 18,000 and RUQ pain all the other test were -...I felt good nothing was wrong with her, but I can't help but to think was I obsessed with this pt's condition? or was I justified to feel this way. Anyways she stayed with us for two days and then we induced her, uncomplicated labor and delivery and we still don't know what was wrong with her. :smackingf

Well, the signs of pre-eclampsia are proteinuria, HTN and edema. Abdominal pain (epigastric) is a sign of impending eclampsia, so..........NO, I do not believe you overanalyzed the situation. I think you were in the correct mindset to be concerned she was pre-eclamptic and possible impending eclampsia.

Peaches N L&D · Aug 20, 2005

Has anyone else had a gut feeling or instinct something may have or might have gone wrong with thier pt. Please share your stories. :)

SmilingBluEyes · Aug 22, 2005

MANY TIMES !!!!

And I have learned to LISTEN.

I had a lady who came in "looking" classic PIH (but did not not have the labs and really high B/P to "prove it".

She had an NSVD w/o complications. But still, she looked "off". The dr went to discharge her---I was realllly hesitant, my gut said this lady was sick. But he reviewed her charts, vital signs, and pp course and said she was fine......

Went to get her out the door, she SEIZED as we were about to leave the room.

Shoulda listened to my gut more. Her B/P was never out of sight---labs never 'off" but she had that "look".....and the reflexes that I should have taken cues and just watched more closely.

She made out ok----got a nice lil trip our ICU for a few days, a week or so more w/us on Mag, and she was fine.

Oh, and this was 3 days out from delivery. You are not always "safe" even outside the "safety window" of PIH/Pre-eclampsia.

I have more stories...hemorrhages, etc . I want to see others' stories first. I have lots of head-slapping "I should have KNOW THAT " moments. I really have had to learn a lot the hard way.

SmilingBluEyes · Aug 22, 2005

I vote "justified". lets just leave it at that rofl.

Peaches N L&D · Aug 22, 2005

I vote "justified". lets just leave it at that rofl.

At the risk of sounding stupid ,what does ROFL stand for :confused:

Editorial Team / Admin · Aug 22, 2005

At the risk of sounding stupid ,what does ROFL stand for

Rolling on the floor laughing :rotfl: :rotfl: :rotfl:

Peaches N L&D · Aug 23, 2005

Rolling on the floor laughing :rotfl: :rotfl: :rotfl:

Thanks siri, I really didn't know that one............Friday one of our OB'S wife was scheduled for a C/S because she had a hemrroidectomy last year so they thought it was a great reason for her to have a C/S, only when she got there her husband was in an emergency hysterectomy with complications, she had been contracting for 2 days she was hydrated and went home Wed. anyways she was contracting the whole day and she refused for the nurses to call her husband because he was busy in an emergency hys.....When he finally got to his wife she was 9cm, pushed for 2hrs and delivered lady partslly, some nurses felt bad because she was in active labor dilating and noone caught it, I say she had a damn good labor and she was meant to go lady partslly :)

Dayray, RN · Aug 23, 2005

Heck no not obsessed. In fact this woman would have been maged and induced where i work.

pre-eclampsia doesnt always have all the S/S. Elevated presure + prot in urine + epigastric pain = Mag and induce. This lady was on her way to getting very sick and term so why keep her pregnant?

I am really surprized that no one cought this before she was transfered to ER and I dont see her LFT's or coags I'm sure that some hospitals dont see as much of this so I guess thats why you missed it in your initial assessment.

I work on a high risk unit and we see allot of things so mabey thats why I'm really haveing a hard time understanding why someone would have missed this and transfered her to the ER for a medical work up. Prot in urine should have bought her a PIH profile add the increased BP and you have sufficant reason to induce throw in the epigastric pain (which is a late sigh in PIH and comes from swelling in the liver) and you need to mag and deliver her ASAP.

I hope I don't sound mean or rude but this woman might as well have had "Pre eclampsia" tattoed on her head or a sighn that said "please induce me" around her neck.

Mulan · Aug 23, 2005

Heck no not obsessed. In fact this woman would have been maged and induced where i work.
pre-eclampsia doesnt always have all the S/S. Elevated presure + prot in urine + epigastric pain = Mag and induce. This lady was on her way to getting very sick and term so why keep her pregnant?
I am really surprized that no one cought this before she was transfered to ER and I dont see her LFT's or coags I'm sure that some hospitals dont see as much of this so I guess thats why you missed it in your initial assessment.
I work on a high risk unit and we see allot of things so mabey thats why I'm really haveing a hard time understanding why someone would have missed this and transfered her to the ER for a medical work up. Prot in urine should have bought her a PIH profile add the increased BP and you have sufficant reason to induce throw in the epigastric pain (which is a late sigh in PIH and comes from swelling in the liver) and you need to mag and deliver her ASAP.
I hope I don't sound mean or rude but this woman might as well have had "Pre eclampsia" tattoed on her head or a sighn that said "please induce me" around her neck.

:yeahthat:

Peaches N L&D · Aug 24, 2005

Heck no not obsessed. In fact this woman would have been maged and induced where i work.
pre-eclampsia doesnt always have all the S/S. Elevated presure + prot in urine + epigastric pain = Mag and induce. This lady was on her way to getting very sick and term so why keep her pregnant?
I am really surprized that no one cought this before she was transfered to ER and I dont see her LFT's or coags I'm sure that some hospitals dont see as much of this so I guess thats why you missed it in your initial assessment.
I work on a high risk unit and we see allot of things so mabey thats why I'm really haveing a hard time understanding why someone would have missed this and transfered her to the ER for a medical work up. Prot in urine should have bought her a PIH profile add the increased BP and you have sufficant reason to induce throw in the epigastric pain (which is a late sigh in PIH and comes from swelling in the liver) and you need to mag and deliver her ASAP.
I hope I don't sound mean or rude but this woman might as well have had "Pre eclampsia" tattoed on her head or a sighn that said "please induce me" around her neck.

She actualluy did get worked up for preeclampsia after I gave the Dr a hint, her LFT's were WNL, her PLTS were WNL, her B/P eventually came down, DTR'S were +2, but yes she did have protienuria and swelling I don't doubt she could have had preeclampsia, because I have seen more unusual things than that happen on my floor(which is not a high risk L&D floor , but we do get a lot of sick pts) any way she ended up delivering 2 days later with out MGSO4 and the whole bit. She hasn't come back yet and hopefully she won't............I do hope she is and will be OK!

SmilingBluEyes · Aug 24, 2005

Some recent literature I read indicates it is appropriate to treat for proteinurea....one the very hallmark signs of Pre-eclampsia. I have to remember WHERE I read that---I think it was one of my AWHONN journals..........