Want to thank you all for the support, encouragement, and most of all advice. It truly means the world to me right now.
I feel the need to clarify a few details though based on your questions and comments.
The patient did not have an order for suction. In report I was told it was an old trach site that was healing. She was getting 4L of o2 via nasal cannula. I didn't even know it was an open trach until I took the dressing off and changed it. Like I mentioned before I changed it due to the drainage. The opening was very small and it did look open but not like I have seen before (it was very small). When the EMT's arrived they intubated her through the trach and there was a lot of blood from them doing that, so it was partially healed. There was no collar or anything like that, just her skin and a dressing covering it. The lungs did sound congested and I logged for the doctor to take a chest x-ray and evaluate the old trach site. I didn't call the on-call doctor because I took a full set vitals twice and I checked her via pulse ox more time that I remember. I later talked to the admitting nurse about her and what happened and she said the trach was taken out 5 days before I had her (not sure how true that is). I was tempted to ask why she didn't get an order for suction or a suction machine at the bedside after knowing that, but I was afraid to admit my own guilt in the oversight.
I do plan on still continue nursing and I will learn from this and all your advice and input. I just thought I should quit until I find a better hospital or facility. I have been applying at hospitals ever since I passed my NCLEX, but I think if I don't work I'll have more time to look for work and less of a chance at a event like this one. My insurance just kicked in so maybe I'll quit after I get a few therapy sessions in. I still don't know what I am going to do but I will defiantly renew my liability insurance that I had in nursing school for now. If anyone has a good company they would recommend I would love to research them.
One thing that did bring up my spirits (other than these post) was a patient that was just readmitted that I sent out three weeks ago. Turns out my assessments where right and she had a pleural effusion and had 1500ml total removed via thoracentesis. She looked so good and thanked me for my help that night. There was an order for a bladder scan qshift also since she had a foley in the hospital that was just removed. She had 680ml from the scan so I straight cath. her. When I did that I noticed it was malodorous, dark and cloudy. The dip stick showed protein, ketones, leukocytes, and a high amount of blood. I will have to see what is going on when the lab comes back, but this was a good moral booster).
I have one more question in case anyone is still following this or cares to answer.
I had a patient last night who had a hip replacement with staples. He was a 50ish year old male with a history of diabetes and hypertension. When I was assessing the area I noticed the area surrounding the incision site just next to it looked like orange peel skin. I thought orange peel skin only had to do with breast cancer, but it really like it. The skin was more yellow than orange though. This entire leg was swollen, both pulses where present, cap refill was less than 3seconds. A previous nurse logged for a Doppler, it was done this morning and was negative for a DVT. He also had a low grad fever of 100.2. He was taken Norco regularly about every 4-5 hours so I think the acetaminophen in that may have been keeping a higher fever at bay. He said everyone including the doctor said his site looks fine and no S&S of infections. He also said it has looked like this for a while. I know he must be having a infection going on, probably cellulites, but I would like more info about the "orange peel skin" if anyone knows if it occurs in a soft tissue infection and what it may indicate, because the doctor looked at it again and said it was fine (the patient said the doctor looked at it again as long as it take to say his name lol). If it is nothing like the doctor said I'll let it go, but I just feel like it may be infected.
I really want to thank everyone again for the support and input! I will try my best to learn, be better, and move on from this.