What's your best catch?

[beekee]

I was reading another post called what was your worst mistake? I find reading about mistakes very informative and educational, but we never get kudos for all the good stuff we do. We just get lambasted (sometimes by others, often by ourselves). So, I want hear about your best "I rock" stories!

I don't have any great stories, but I'll share one recent encounter. I had a CHF patient who became fluid overloaded and went into respiratory distress. Doctor ordered P.O. lasix instead of IV. I took the time to double check that the doctor had indeed wanted PO (he didn't). I was a little hesitant to bother the doctor again, but he had a reputation of belittling staff. But, I did it anyway and he thanked me for calling (and changed the order).

[DextersDisciple, BSN, RN]

I had a pt who had been in our Dept several times during their admission. I was procedural nurse calling time out. As I read the consent for an Hd cath I noticed it did not look like the word "placement" at the end. I had the attending stop and double check the chicken scratch. It in fact was a consent from a few days ago when she had an HD cath REMOVED. Pt was nonverbal so family was called And appropriate consent obtained.

I can't imagine the crap storm and self

Loathing that would have ensued if I just kept going and assumed the chicken scratch said "placement".

[Meriwhen, ASN, BSN, MSN, RN]

My new grad was about to give a patient 80 units of regular insulin in lieu of the ordered Lantus. She thought that since we were out of Lantus, that she could substitute regular instead. Luckily, she came to see me for the double-check first.

[inthecosmos, BSN, MSN, RN, APRN]

My new grad was about to give a patient 80 units of regular insulin in lieu of the ordered Lantus. She thought that since we were out of Lantus, that she could substitute regular instead. Luckily, she came to see me for the double-check first.

Lordy! What a great catch!

[smf0903]

The actual quote is..."If you hear hoofbeats, think horses not zebras". Coined in the 1940's by a Dr. Woodford. It was to teach his medical students to look for the ordinary first before looking for the extraordinary so as not to miss the easily treatable conditions. Somehow it's been turned around.

My "catch" happened to be a zebra. Obtunded, bradycardic, hypotensive, hypoglycemic and intermittently apneic toddler. First thought always goes to sepsis or abuse but something wasn't right. Little guy had been with grandma. Something triggered my brain to ask her what meds she's on. Turns out she let him play in her purse and her Metoprolol was in it. Lid was off and 5 pills missing. She knew he took them but didn't say anything because she thought everyone would be mad at her. All sorts of stupid going on there and darn it kids will freaking eat anything!!

Thanks! I couldn't remember the exact quote :)

We recently had a toddler in our area die and a sibling nearly die after getting into the grandparents' bp meds. Very sad situation

[cardiacfreak, ADN]

A patient had transferred to my unit from ICU, had been on our unit for two days when I became her nurse. She had a dose of digoxin 0.25 mg IV due at midnight. Her heart rate was 72, I looked at the order to see how many doses had been given prior, the patient had been getting loading dose of digoxin 0.25 every 6 hours for 9 days. Digoxin level was greater than 9.

[Penelope_Pitstop, BSN, RN]

Five pound small mouth bass when I was 10 or 11.

[Davey Do]

Five pound small mouth bass when I was 10 or 11.

Nice catch, Penelope_Pittstop!

However, this is allnurses and not

Please remain on topic!

[JBudd, MSN]

Not necessarily "best", but I went in to give a Lovenox injection (is part of standard admit orders for prophylaxis), and as I held the needle over his belly thought "wait a minute, I was giving him Vitamin K just a few hours ago!). Walked out, called the doc who said "OMG, did I order that? No don't give it!!", and thanked me profusely.

[Davey Do]

I was working a 11p to 7a shift on the geriatric psych and received report from a nurse working 7p to 7a. I was to work the desk while the other nurse worked the floor. As per my routine, I went around with a flashlight checking on the sleeping patients.

I saw a dried spot of blood on a pillow and found orbital bruising. On closer inspection, I saw what I believed to be hyphema. I asked the other nurse if she knew anything about it and she relayed what the 7a to 7p nurse told her: The patient had a fall and the psychiatrist had been notified.

The hospitalist was informed and an orbital fracture was found.

The hospitalist told me "Good catch!", but the patient was discharged the next day and my so-called good catch was nothing more than a remedy for incompetency.

[Kayauhs]

Working in a very small, rural ER one night. Family comes in with several kids in tow, the youngest about the age of 7 had a big bloody bath towel on his head that mom was holding in place.

The story was the kids were rough housing just before bed, this one hit his head on the corner of a metal closet door.

I got him seated on the ER exam table and lifted up the towel and a thin bright red stream of blood shot across the room.

I replaced the towel and held pressure while I waited for the on-call doctor to show up.

Practiced my deep breathing techniques while I waited.

On call comes in and asks what we have and I explained in short simple terms. He says, "IMPOSSIBLE!!"

"There are no arteries that run that close to the scalp!"

So, I removed the towel and a bright red stream of blood shot past him and over his shoulder.

He immediately went over to the phone and called for a transport.

Another time I was working in a very small rural, "ICU" and the AM nurse gave me report on a "Rule Out MI" patient. "Oh you don't have to worry about him at all!! I checked him out and hes FINE. I bet he'll go home in an hour." (She had just graduated from RN school about a month before so...)

I went in to do vitals and something was odd about the way he looked. I said, "How are you feeling?" He said, "I'm not sure, I just feel off and my pinky finger on my left hand aches." The telemetry did not show any ST elevation, but as I stood there he started throwing PVC couplets.

I upped his O2 a notch and called the attending doctor. Heart enzymes were climbin and off he went to Cardiology! Massive MI was evolving.

I always felt really good about that. It made up for a whole lot of other stuff.

[Rocknurse, MSN, APRN, NP]

I was working in the ICU and the new nurse with the patient next door was looking very flustered like something was going on, and he was rushing around a lot. I asked him if he was ok and he said no, that the patient was having really high blood sugars and not responding to the insulin drip and boluses. I came in and rechecked the BS myself and sure enough it was over 400. The nurse had been giving him huge boluses of insulin and had his drip up at 10 units an hour. I didn't like the look of the patient so I started thinking outside the box and took a blood sugar sample from his CRRT line (I'm a certified dialysis nurse so I am allowed to access the line). Sure enough his blood sugar was actually 16. The reason was that the previous orientee had hooked up the arterial line flush to a bag of dextrose instead of saline and the orienting nurse didn't notice, so of course all samples were contaminated. The new nurse just about had a cow because he'd only just picked up the patient and had been giving all that insulin. We threw in a syringe of D50 and stopped the insulin and the patient bounced back just fine, but you can imagine there was an incident form filled out. He was so upset, poor thing. It's made me always check that flush bag ever since.

[T-Bird78]

One of my docs had a high school student shadowing to help with his college application process for premed. We were doing a minor in-office procedure, maybe a turbinate reduction, and I just had a "feeling" so I looked over my shoulder to the corner where our student was. He had "the look" and I told him to sit down NOW. He asked if he could be excused and ran out of the room before he could faint. I yelled out in the hall for one of the MAs to check on the kid while doc and I finished the procedure. Student was okay, more embarrassed than anything, but looked at me sideways when I talked about lunch plans immediately after! LOL. Bless his heart.