Peds situation-very long! Please help!

Published

Hi All,

I'm usually a lurker but something happened at work and I really need some feedback. I work on a peds floor and our ratio can run from 4-8 kids per nurse. Summer is 4 and the rest of the year is probably 6-7. There's a pretty wide range of kids with some ought to be in PICU types thrown in for fun.

Here's what happened. I got report from the day nurse (let's call her X) and she told me the pt, a 2 month old baby with serious neuro damage from group B strep memingitis, had not voided all day. The last recorded void was mine from 5AM that morning. Pt has lots of associated complications d/t the neuro damage--thermoregulation issues, diabetes insip., electrolyte imbalances. Day shift had not been busy and I think X had 4 low acuity pts. As she is giving me report I asked her if the doctors were aware that the baby hadn't voided and was told that they were. She further said she gave the DDAVP as ordered. Red flags started going off in my head since I couldn't understand why she'd give DDAVP when the pt hadn't urinated. The DDAVP order should have been written to be given based on the urine specific gravity but it wasn't. However if the baby didn't void I don't understand why she'd give it?

Residents came on the floor. I talked to them about these issues and asked some questions. They said they had no idea of the situation and had not been informed until an hour ago of what had been going on. Turns out the DDAVP shouldn't have been given (I hadn't but X had) and a diuretic was ordered (not the one that would have been my first choice because it wasn't fast acting but that's another issue). I go in to assess the pt after getting report. It's about 8 at this time. Pt temp is 90.2 and he looks like a totally different baby than the one I had last night. I didn't freak out. Let my charge nurse know (she's awesome), grabbed the warmer, talked to the docs-basically telling them what labs were needed, reassured the understandably scared parents, and went from there. Parents were at home earlier caring for the healthy twin. Looked at 4 PM vitals. Everything WNL but I know X hadn't been in (cannot prove it) but that's irrelevant at this point.

Get the temp stablized-takes 4 hours. Draw the labs. Sodium is 130, CRP is high, and pt is neutropenic. VBG shows pH okay and confirms the sodium level. Father takes baby out to feed at 7 AM-temp had been stable and I had been decreasing the temp in the isolette slowly throughout the shift. Temp drops quickly by several degrees in the 30 minutes the baby is out even with swaddling. Repeat labs show no improvement. Baby goes to PICU during day shift.

I'm sorry this is so long but I am wondering if I did enough and if what I did do was right. I've only been a nurse for 1 year and have had some heavy situations but this one really scared me (I didn't show it but I came home and cried). For those of you that are probably a lot smarter than I am--How responsible is the day nurse?

Am I wrong in thinking she should have done a lot more? We use computer charting and I always write a clinical note if something significant happens. There was no clinical note from X nor I & O recorded for the shift. Seems like a very important thing to me in at pt like this. X isn't a great nurse but this is a new low to me. I have to see her tomorrow and I am dreading it because I'm really angry. Any feedback would be great-my coworkers and charge nurse agree and are very supportive but the nurse manager is useless. There have been other issues but none this severe. I've gotten very good evals and get along with everyone. I like flying under the radar and staying out of the NM's office is one of my main goals. Pts are great but NM sucks.

Thanks all,

Anna

Up Vote Up Vote ×
Specializes in Peds Cardiology,Peds Neuro,Pedi ER,PICU, IV Jedi.

Sounds as if you did the right things...but you need to write up EVERYTHING that happened in an incident report so that there's a paper trail...that could have ended up being a much worse situation. Good for you for keeping your head and doing what needed to be done. You addressed necessary issues immediately and now the patient is in the ICU...where they need to be.

You did well.

vamedic4

Up Vote Up Vote ×

vamedic4,

Thank you so much for your feedback. I wrote everything down in a clinical note and my charge nurse was there. What are your thoughts on the day shift RN who had the pt?

Up Vote Up Vote ×
Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.

OH honey,

YOU DID ALL THE RIGHT THINGS!! It's okay to cry....let it out....this shows you are human and compassionate and you put the feelings in the right place....the fact that you waited to "unload" them when you got home shows great focus and strength....you kept your head about you....

Sometimes we are "blessed" with following a less than stellar co-worker. It's a shame she didn't inform the docs of the baby's situation, and did some things that could have led to the demise of the baby.

You knew just what to do....and you enlisted the help of your senior nurse and the doctors around you....all for the goal of healing the baby...

I am glad you were the one that day....the baby is alive because you acted swiftly and you kept your cool....

A pat on your back for a good job, well done!!

I agree with the previous poster....you should write this up....just because if there's a pattern here, it can be tracked and dealt with....and also, if you don't, and that same nurse pulls another dumb stunt, you may never forgive yourself for inaction in her case....so write it up....let the manager deal with it....it's her/his job...

blessings,

crni

Up Vote Up Vote ×

crni,

Thanks so much for your kind words! I feel the day nurse did some things (by doing nothing) that made the situation much worse. It is a pattern and I'm sure I'll be in the NM's office at some point this week. How can it be that I have a great supportive charge nurse and a crappy NM? :(

Up Vote Up Vote ×
Specializes in Trauma/Burn ICU, Neuro ICU.

The baby is fortunate to have you as his nurse. Keep up the exceptionally good work. I agree with the other posters.....write it up, and let those in charge deal with it or not. That is not your job. You did YOUR job really well, sweetie!

Up Vote Up Vote ×

First off I'll say this, anything over 5 peds patients is a ridiculous ratio! (And 5 is pushing it, depending on acuity.)

I try really hard not to judge what other nurses did or didn't do. After all, I wasn't there. Who's to say that what seems really obvious to me at 7 would have been obvious to them at 4? Especially since I really don't know what else they had going on.

Important thing is, when you got the patient, you made your assessment, and you did the right thing for your patient. You did a great job, and you got that kid into the PICU where he needed to be. And hugs for you, because it's tough when you have a scary shift like that. Good job on holding yourself together until after it was over!

Up Vote Up Vote ×
Specializes in NICU, Telephone Triage.

You did a great job, the day nurse didn't do her job...period!! That baby was showing signs of sepsis with such a low temp! I can't believe it was so low!

I would write her up, if you can do that...in other words, report her negligence...because it will also cover your butt.

How is the baby doing now in PICU?

Up Vote Up Vote ×
Specializes in NICU, Telephone Triage.
crni,

Thanks so much for your kind words! I feel the day nurse did some things (by doing nothing) that made the situation much worse. It is a pattern and I'm sure I'll be in the NM's office at some point this week. How can it be that I have a great supportive charge nurse and a crappy NM? :(

Does the NM not listen to what you tell her? If she will listen, you have important concerns...if she won't listen, is there someone else you can go to? Another NM?

Up Vote Up Vote ×
crni,

Thanks so much for your kind words! I feel the day nurse did some things (by doing nothing) that made the situation much worse. It is a pattern and I'm sure I'll be in the NM's office at some point this week. How can it be that I have a great supportive charge nurse and a crappy NM? :(

I hope that you made copies for yourself, of all the notes that you made. Documents that supports the care and actions you took, that makes someone else look bad, have a habit of "disappearing from the chart.

Lindarn, RN, BSN, CCRN

Spokane, Washington

Up Vote Up Vote ×

what a wonderful nurse you are, excellent critical thinking skills. this experience will stay w/you for years to come and will be very valuable in your career and need i say the nm will hopefully have learned a lot as well, from you and your skills. my son was 3 days old when he was dx w/meningitis thankfully we had wonderful nurses to care for him, you are the nurse i would want w.my baby and i can only beleive the parents too are thankful and feel blessed that you took care the their little one.

Up Vote Up Vote ×

Hi,

Thanks everyone for you feedback! I too try hard to not judge what other nurses do but this situation seems like an exception to me. Having this sort of pt not void for that length a period of time would be an instant red flag. I feel that X should have done something 6 or heck even 8 hours in instead of leaving the pt in that situation. Also I don't see why X would give the DDAVP. Maybe I am judging and I know I shouldn't but I really feel strongly about it. Probably overreacting--

Anna

Up Vote Up Vote ×
+ Join the Discussion