"You put me and my unborn child's life at risk"

[TigerGalLE]

This is what a Dr. told me today..

When assessing my patient this AM I noticed that the patient had a scaly rash on his abdomen. The patient was admitted from the ER last night. I asked him when he developed the rash and he said it was about a week ago. When I came out into the nurse's station his MD was sitting there. I told the MD that I had noticed a rash on his abdomen and no one mentioned it in report so I wanted to make her aware.... She is a very rude doctor anyways and she just looked and me and didn't say anything.

About an hour later I heard her paging me over the intercom system to come to the nurses station. I went and asked her what she needed... (By the way she is pregnant)..... She said in a very snide voice... "You need to go back into that pt's room.... look at that rash... when you've figured out what it is you need to come back and report your findings to me." I said... Well I've already seen it, i'm not sure what it is... She repeated the exact same thing again... I just kind of stood there and looked at her.. she then said... "Well then, take another, more experienced nurse with you, when y'all can figure out what the rash is.. come back and report it to me."

I was very confused at this point but kind of started to get what she meant....... I got another nurse and we looked again.. The experienced nurse told me she was sure it was shingles.. So I went back and said.. "I guess it is shingles." She then said... "I want you to know... that you personally.. put me and my unborn child's life at risk.. You, as a nurse should be able to recognize shingles.. But since you didn't know what the rash was.. My life was put at risk."

I was completely floored..... I just said... "well I am a nurse and I don't diagnose people." And I walked away dumbfounded and angry.... I can't believe she said that to me.. and in front of everyone! Ohhh I was soooo mad and my DON was mad too. If she doesn't want to be put at risk she doesn't need to be a MD in the hospital and if she used standard precautions she's fine. AND she's lucky I even saw the rash.. otherwise I doubt she would of lifted up the pt's gown to look and she'd never of known!!!!!!!!!

Angry

Tiger

[EmmaG, RN]

I agree 100%... I told her he had a rash that was on his abd... he is a r/o cancer pt who is immunocompromised..

Hmmm...

I'm wondering if Dr. QueenBee was smart enough to place that patient on airborne isolation.

[pagandeva2000, LPN]

Screw her...it is up to HER to diagnose, NOT you...you did your job, you assessed, and you reported. Even if you suspected that the patient had shingles and told her, it sounds like she would have said that you had no right as a lowly nurse to do her job. While I hope nothing happens to her child, I say that she needs to choke on her own words.

[TigerGalLE, BSN, RN]

NOPE she wasn't... just place on contact... hope it isn't disseminated

But I've had chickenpox....

Are pregnant women at risk if they've had chicken pox? Or only if they haven't had it?

[EmmaG, RN]

NOPE she wasn't... just place on contact... hope it isn't disseminated

Doesn't matter. Immunocompromised = airborne and contact precautions.

Herpes zoster (varicella-zoster) (shingles):

Disseminated disease in any patient

Localized disease in immunocompromised patient until disseminated infection ruled out--- A,C

http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/Isolation2007_appendixA.pdf

BTW, if I were pregnant (perish the thought!) and someone reported "a rash" I think I'd damned well protect myself until I knew just what I was dealing with; she wasn't too smart to go in to examine that patient without taking the proper precautions. She has no one to blame but herself.

[EmmaG, RN]

nope she wasn't... just place on contact... hope it isn't disseminated

but i've had chickenpox....

are pregnant women at risk if they've had chicken pox? or only if they haven't had it?

judging from her reaction, it sounds as though she isn't immune.

during the acute phase, patients should be counseled to avoid direct skin contact with immunocompromised persons, pregnant women, and individuals with no history of chickenpox infection.

varicella is a common, highly contagious, self-limited disease of childhood that is transmitted by respiratory droplets or close contact. it is usually acquired by 90% of persons in the united states before the reproductive age. thus most women are immune before they become pregnant.[2] the incidence of varicella in pregnancy is 0.7/1000. should varicella pneumonia develop during pregnancy, however, it can run a more fulminant course. maternal varicella infection in the first 20 weeks of pregnancy can cause varicella embryopathy, also called congenital varicella syndrome, in approximately 1%-2% of cases.[2] this syndrome consists of the hallmark cicatricial skin lesions that present in a dermatomal distribution, limb hypoplasia, and contractures and can also involve the eye and central nervous system. the prognosis is poor should an infant be infected.[3]

the fetus

the effect of maternal infection on the fetus or neonate depends on the timing of the infection. the risk of congenital varicella syndrome is some 1% in the first 12 weeks, and around 2% between weeks 13-20 of pregnancy. infection from the beginning of the second trimester up to one week from delivery may lead to herpes zoster in an otherwise healthy infant. infection from one week before to one week after delivery can lead to severe neonatal varicella.

women who are exposed to varicella or herpes-zoster in pregnancy should seek medical attention as soon as possible.

a significant contact is defined as being in the same room (eg house or classroom or 2-4 bed hospital bay) for a significant period of time (15 minutes or more) or face-to-face contact.

if the woman has a past history of varicella or zoster, protection can be assumed and reassurance given.

if there is no history of past varicella or zoster, the woman's susceptibility should be determined urgently and if they are varicella-zoster igg negative then they may be offered vzig if they are within 10 days of the exposure (21). for continuous household exposure (for example when a child in the household is infected), vzig should be offered within 10 days of the onset of rash in the index case.

aciclovir and valaciclovir are not licensed to be used prophylactically and so cannot yet be recommended for this purpose.

the risk appears to be minimal, but our protocol is to keep all pregnant (and potentially pregnant) staff away from these patients.

[dream'n, BSN, RN]

I guess since she is pregnant you are her health screener now? Where I used to work the Dr., when pregnant, was smart enough to look out for HERSELF and get a physician collegue to exam a patient with a rash.

Sorry you have to work with such a rude person.

[MarySunshine]

I agree with everyone else. She sounds rude and dumb.

[emmycRN]

Oh man, this doctor is completely whacky! Good for you for standing up for yourself though!!!

[EmmaG, RN]

NOPE she wasn't... just place on contact... hope it isn't disseminated

But I've had chickenpox....

By the way, my travel company required I have my titers checked (even though I told them I'd had chicken pox as a child). Their explanation was that some who have milder cases don't necessarily develop full immunity. Not entirely sure how accurate that is, but it made sense to me.

[labcat01, BSN, RN]

I've never heard that chickenpox/shingles poses a threat to pregnant women. UGH- It scares me what I don't know!!!!

Edited to say: Everyone else is right! That doctor was out of line and rude! I'm glad that the DON stood up for you.

[nrsang97, BSN, RN]

Doc was WAYYYYYYY out of line. Glad to hear that the DON stood up for you. Some people just amaze me.

[Mulan]

Good response!

She was totally out of line.

Think she would have said the same thing to the patient if he was the one who pointed it out to her????

Maybe the witch should stay home for her entire pregnancy.