Published Apr 13, 2004
Ugh... I forgot to finish filling out my 24hr assessments so I go back up to the hospital to fill it out, when the Unit Sec comes up to me and says your patient in *** just threw a PE... I was like what??? I said she was fine all night... No complaint of anything... The other nurse said as soon as she went in to see her, the lady said she was having SOB.. Said she was SOB a few times during the night but never told anyone!!! Even the doctor came in there this AM and she didnt mention it.... I feel bad, but what could I have done.. She looked fine, wasn't in any Resp. Distress.. How can I help a pt if they don't tell you whats wrong, just say I am fine, when you check on them!!! UGH!! :angryfire
That sounds exasperating to say the least! I'm sure everyone understands though.
What the Pt describes (Pain) is what you chart. If the pt is not having any distress or denies pain then you take the pts. word. goes either way.
So the desk Clerk/nurse gave this dx? Was there a VQ performed, verified By CT? Pt on anticoagulants? Was the pt there for R/O PE? Was there something you didnt do, maybe i am missing something!
What the Pt describes (Pain) is what you chart. If the pt is not having any distress or denies pain then you take the pts. word. goes either way. So the desk Clerk/nurse gave this dx? Was there a VQ performed, verified By CT? Pt on anticoagulants? Was the pt there for R/O PE? Was there something you didnt do, maybe i am missing something!
No.. The patient was in a MVA and broke both her hands and had surgery on them... and she also has a fx on her Right Calcaneous, so she has a Double J Splint on her Right leg.. She TED hose on... Everytime I went in there during the night she told me she felt fine and didn't need anything... I can't believe she even told the doctor that she felt fine, and not 20mins later she tells the day shift nurse she was SOB.. And that she was SOB a few times during the night but didnt tell anyone... At least she admits she didn't mention it..
Nurse Ratched, RN
And that she was SOB a few times during the night but didnt tell anyone... At least she admits she didn't mention it..
The trick is making sure that the day nurse charts that the pt stated she didn't tell anyone.
You can't discover everything. I try to be in and out of a room several times a night so I can check on them when they are and are not asleep, or notice when I am talking to them how they are breathing so they aren't aware that is what I am doing. Sometimes if you sense a person isn't one to tell you things, or is one who "doesn't want to bother the nurses.", you might mention that however busy you are or will be, she or he is your priority and you would feel terrible if they kept something from you thinking they were bothering you. I have had this happen numerous times and have discovered that reminding the patient that you are there because you want to be instead of because you have to be (even though you have to be), kind of takes the burden off some of them perhaps less willing to share their symptomology with you. Plus, they just may not know about what to report..Next time I think you will be thinking of this example and ask the next patient to be sure to report something different, or however you desire to word things. In those patients I have a feeling won't report things, or are stoic and not actually bothered by something such as transient episodes of shortness or breath, I try to establis a rapport with them and tease them that if they don't report something or call me when they think they might or should, I will have to tickle them. Or, figure out some way to personally delivery my speech to the individualized patient. You are human, so you can't always pick up on things, but episodes such as this will get you finely attuned to the individual tastes, attitudes and tendencies of people. You will, if you already haven't, become attuned to the non verbal signals...It will be ok. Don't beat yourself up for being human...
Tweety, BSN, RN
Agree that charting is very important.
P.E.'s can sometimes be very subtle, mainly we count on the patients telling us what they are feeling and being honest about it. That's the main symptom. That and hypoxia.
Don't feel bad, you didn't cause the PE and didn't know about, even the doc didn't spot it.
We are not mind readers..if you see no obvious s/s..and the pt doesn't inform you of problems makes it a littttttle hard to help them.
When it comes to PE's you can never tell. We had a patient ring the call bell and tell us over the intercom that he felt "funny". I walked across the hall into his room and he was dead. PE's happen quick and large PE's can't be predicted. Stop beating yourself up!! We can only report what we see and sometimes there's nothing to see until its too late.
These things happen. The patient herself said she didn't tell you, therefore there was nothing you could do. I, too, take my patients word on how they're feeling, unless they say they are fine but are in obvious distress. I recently had a 91 year old who had surgery to revascularize a leg who began to show resp distress four days post op. Whenever asked, she'd state, "oh, i'm feeling pretty good" meanwhile sats on three liters O2 are 85%, tachypneic, and obviously using accessory muscles to breathe...no medical history what so ever. She ended up being transferred to the critical care unit. In that case, I'm glad I didn't take her word.
Well come to find out the patient didn't have a PE... She has Pneumonia...
Also at your hospital is an unlicensed hospital allowed to take critical lab values etc... and pass it on... I don't think they are suppose to, but this same US who diagnosed PE, took a critical blood glucose lab value from the phone???
Plus, making sure you document properly...no report of pain, no s/s of distress, etc....
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