Question about preeclampsia need experienced nurses!

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Hello. I am a new nurse (just graduated in May of this year) and got my dream job on L&D right out of school. Recently I had a patient that was severe preeclamptic and was 30 weeks gestation. She was quickly put on Mag and Dr. was called. He came to see her in the middle of the night and saw that she was dilated to 5 and decided to induce her in the early am. Throughout the night her sats would drop into to high 80's and me being new asked my charge nurse for help. We gave her o2 at 10 per mask and it would go back up again. She had no symptoms of resp distress at all but continually we had to remind her to keep the o2 on because it would drop if she did not have it on. The Dr. knew of this when he came in to see her but still chose to wait till morning to induce because she was stable. (as stable as a preeclamptic pt can be) with 2+ protein in urine and BP's diastolic under100 after mag bolus and drip began and epidural given. Only one dose of Apresoline was given early in the night to control the BP and then she was OK. As I was giving report to the day shift nurse the Pt called out complaining of shortness of breath and when we went in there it was like looking at a different patient! She was suddenly swollen everywhere and was gasping for air. I have never been so afraid in my life as I was when the tech started to wheel the crach cart down the hall! Me and my charge nurse both explained that she was not like this at all all night but the day shift nurse seemed aggravated by this sudden decline in the pt. My charge nurse and I were both giving O2 to her all night for the low sats but I was confident that my charge nurse knew best when she said that as long as it was coming back up after applying the o2 and she was asymptomatic that it would be ok until morning when the Dr wanted to deliver the baby. The Dr. knew of her sats too when he came in to see her that night. TO make a long story a little less long, she ended up a c section when the Dr. seen the shape that she was in that morning, and she went to ICU where she is only gotten worse and went into ARDS and ventilated for the last week.

After that day I got the call to come in and talk about what happened and now am being investigated for possibly causing her to become so ill. I am so upset about this. I have not been a nurse long enough to be in trouble yet!! I did nothing that I did not double check with my charge nurse about since I had not had a preeclampsia pt all by myself to that point and called the Dr to come in and see her. he did and left her till morning. My supervisor said to me that " the only thing that was going to save this girl was a C-section stat" but I could not make that call right?

Please let me know what any of you think about this whole thing. I am just so upset right now. I feel bad that this pt is so ill but don't know what I could have done to prevent it! The Dr. told me to calm down that morning and said that " this is what these pts do. they get sick and fast" But am I going to get fired over this or what!

Thanks in advance,

Julie

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Julie first let me say I feel for you in this terrible situation.

It's difficult to comment on a case even when you think you have given all information pertinent.

I do think that you were right to ask the charge nurse for help and support as it's a scary situation when you are experienced let alone when you are newly qualified.

Eclampsia can manifest itself in exactly the way you described, I have seen women begin to become oedematous before my eyes. This can happen even when blood pressure has appeared to have stabilised and protien output in urine is minimal.

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We had a similar case where I work. I knew this patient personally and we had here there on bedrest, mag for a week or so. Long story short she did basically the same thing your pt did....the day after I finished my 3rd 12 hour shift. I felt really bad but even the doctor backed me up and until that day her sats had been fine. I hope things work out for you ...just try to relax and state the facts.

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I suspect you need a RNJD more than this BB right now. Its also not good to post such details on a BB and I would refrain from it further.

If you are being investigated by peer review and risk management, consider calling a nurse attorney stat. (RNJD) She can guide you through this process and even attend the meetings with you if indicated.Call your local bar association and request an RNJD. If you have you will be covered here.

You say you 'double checked everything you did with the charge nurse.' Did you document these words in the chart as well? When I have had a patient I was unsure of I always did, charting ' supervisor_______ informed and advice received, etc. Whenever possible I have her/him physically come into the room and put hands on the patient. None of us know everything about every situation and we learn to cover ourselves. When I have had pregnant women in my ICU I always obtained an order for LD to come check pt and fetus q 4 h (for example) because I am NOT a LD/MB nurse.

I do not know the laws in your specific state but in my area the supervisory staff shares liability, equally if they have 'put their hands' on the patient and this is documented. It is always good to have 'shared the liability'.

I can only imagine how traumatic this is for a new grad. Please take a deep breath, be careful who you trust. Facilities have been known to look for a scapegoat to blame a bad outcome on. I hope your charting was exemplary as it will help protect you.

No need to answer my questions...they were asked for YOUR sake. If I were you I would call a RNJD now and not post further details here...you need someone in YOUR corner.

Perhaps LD nurses here think I may be overreacting... if so I must bow to their superior knowledge of their specialty. I am NOT a LD nurse.

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Specializes in Maternal - Child Health.
I suspect you need a RNJD more than this BB right now. Its also not good to post such details on a BB and I would refrain from it further.

If you are being investigated by peer review and risk management, consider calling a nurse attorney stat. (RNJD) She can guide you through this process and even attend the meetings with you if indicated.Call your local bar association and request an RNJD. If you have malpractice insurance you will be covered here.

You say you 'double checked everything you did with the charge nurse.' Did you document these words in the chart as well? When I have had a patient I was unsure of I always did, charting ' supervisor_______ informed and advice received, etc. Whenever possible I have her/him physically come into the room and put hands on the patient. None of us know everything about every situation and we learn to cover ourselves. When I have had pregnant women in my ICU I always obtained an order for LD to come check pt and fetus q 4 h (for example) because I am NOT a LD/MB nurse.

I do not know the laws in your specific state but in my area the supervisory staff shares liability, equally if they have 'put their hands' on the patient and this is documented. It is always good to have 'shared the liability'.

I can only imagine how traumatic this is for a new grad. Please take a deep breath, be careful who you trust. Facilities have been known to look for a scapegoat to blame a bad outcome on. I hope your charting was exemplary as it will help protect you.

No need to answer my questions...they were asked for YOUR sake. If I were you I would call a RNJD now and not post further details here...you need someone in YOUR corner.

Perhaps LD nurses here think I may be overreacting... if so I must bow to their superior knowledge of their specialty. I am NOT a LD nurse.

mattsmom,

I don't think you are over-reacting, and agree that this is a time when the poster needs the private, confidential advice and counsel of an experienced professional who has only her interests at heart.

Whenever an "sentinel" event occurs, it is the duty of risk management to gather as much information as possible, as soon as possible, so that the hospital will be well-prepared to defend itself in the event a lawsuit is filed. That is best accomplished by interviewing all involved parties ASAP, before memories fade, records disappear, etc. While I'm not certain that the hospital administration will be looking to place blame with you, I doubt that they will be looking to protect your best interests either, especially if your interests are in conflict with theirs. This is why having an attorney, a union representative, or other advocate present on your behalf would be helpful. If you carry , your insurer will provide such assistance for you. If you don't have insurance of your own, then I agree with mattsmom that it would be a good idea to contact a local healthcare attorney who specializes in defending nurses.

Documentation will be a key to this case, as it is with every potential lawsuit. If you have clearly documented your assessments, actions, patient responses, and consultations with other (more senior) members of the healthcare team, and if your actions were in step with your hospital's written policies and procedures, then you will be fine. The concept of "respondeat superior" applies in healthcare liability issues. The superior is responsible for the actions of the staff nurse, and in this case, you acted appropriately by notifying your supervisor of your patient's condition, and requesting help in providing her care. It truly sounds like this is a case of a patient taking a sudden turn for the worse, despite having received appropriate medical and nursing care. Unfortunately, the public does not like to acknowledge that that can happen, and may seek to place blame instead, in the form of a lawsuit. Your hospital is trying to prepare for that possibility.

I'm sorry you are having to go thru this, but please don't let it shake your confidence. You sound very conscientious, and you will learn from this experience. A good friend of mine was named in a lawsuit very early on in her NICU career. She was eventually dropped from the suit because her stellar documentation proved that she acted appropriately. She served as a great role model for us all.

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Specializes in RN, BSN, CHDN.

I am RN and a registered midwife in UK. I did 3 years training to become an RN anf then I had to do a further 18 months training to work as a 'midwife' when I qualified as a just RN I could not have looked after a pre-eclamptic woman, I feel so concerned that you were put in that awful position.

Are you a specialised obs & Gynae nurse.

I just cannot believe that any expereinced charge nurse would have left you in charge of such a situation, it just wouldnt happen here in UK. High care midwifery is not left to newly qualified nurses

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

you received good advice from mattsmom. i wish you the best. I am very sorry this has happened to you and to that girl and her family......what an unfortunate series of events. Best of luck to you!

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