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
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 -.
and we still don't know what was wrong with her. :smackingf