x-ray eyes weren't working

[schoolnurse2015]

I know I shouldn't beat myself up, but just had a parent come in this morning to let me know that her son's ankle may be fractured. He came in yesterday with a steady gait. There was no swelling at all, no bruising, and had full ROM. I tried to offer him ice but he didn't want that, he said it felt better by the time I was done my assessment. I didn't even call mom about it because he checked out just fine. I know we don't have x-ray eyes, but just wish I would have caught it.

[MrNurse(x2), ADN]

I tell parents the same line, over and over: I can only treat what I am told. I say this when a kid is obviously acting after getting hit in the head and I say it when a kid denies pain. Most ERs around here are reluctant to do pediatric radiographs, so they may have missed it, too, as they often do. Don't sweat it, tomorrow you will be the hero again and all will be right in the universe.

[Flare, ASN, BSN]

so it MAY be fractured? mom isn't even sure yet? had she taken him for an eval or was she just making her diagnosis? sometimes an ankle that gets rolled and feels ok at the time can get a little tender after walking around on it.

Anyhoo - don't beat yourself up. You can only go by what you see. It was fine at the time of assessment. I'm certain that if he came back complaining you would have called.

[kidzcare]

so it MAY be fractured? mom isn't even sure yet? had she taken him for an eval or was she just making her diagnosis? sometimes an ankle that gets rolled and feels ok at the time can get a little tender after walking around on it.

Exactly. MAY be fractured is not a diagnosis.

Double check your documentation and move on. I had a parent complaint a couple weeks ago and my charting was not as detailed as I wish it had been, so you can bet your bippy that all documentation now is on fleek. (Is it hip to use "bet your bippy" and "on fleek" in the same sentence? It is now)

For example, for that student I may chart something like: Student arrives from PE c/o pain to R ankle. No bruising, swelling, or open skin noted. ROM WNL. Able to bear weight and not tender to touch. Declines ice pack at this time. Student in no acute distress. Advised to return to nurse's office if pain worsens or swelling is noted.

[Supernrse01, BSN]

"May be fractured" are the key words here. Mom doesn't even know and hasn't taken him in to confirm.

I'm sorry you are dealing with this but find some relief in knowing we have all been there.

[tining, BSN, RN]

For example, for that student I may chart something like: Student arrives from PE c/o pain to R ankle. No bruising, swelling, or open skin noted. ROM WNL. Able to bear weight and not tender to touch. Declines ice pack at this time. Student in no acute distress. Advised to return to nurse's office if pain worsens or swelling is noted.

I add to that Swelling/Bruising - None Seen at this Time. That leaves it open if swelling/bruising develops after I saw them. I also add - Return for Worsening Symptoms. I asked the student to come back and they did not.

[kidzcare]

I add to that Swelling/Bruising - None Seen at this Time. That leaves it open if swelling/bruising develops after I saw them. I also add - Return for Worsening Symptoms. I asked the student to come back and they did not.

Yes, thank you!

For a lot of PE injuries, I tell the kids to return in an hour for reassessment and add that to my charting. Liability and all

[Farawyn]

I just liked all of you all straight down the line.

[OldDude]

How could you have possibly caught it?; especially since there isn't an "it" to catch. If the kid has a broken ankle the injury isn't associated with his visit to you. Don't worry about it.

[BeckyESRN]

You could always ask the teachers if you can borrow their magic x-ray glasses, since they seem to send a lot of kids down having already decided that "it's broken". Broken to the teacher is usually staticus dramaticus to the nurse:sarcastic: feeling cynical today...

[gemmi999]

As an ER RN, a lot of kiddos come in with ankle rolls r/out fractures. A lot of time the providers will basically xray it and say "It doesn't look fractured now, but there might be swelling that is preventing me from seeing the fracture. Come back for reeval in x days". That is where the "may be fractured" comment from the parent could have come from. Basically the ER provider covering their ass.

[Amethya]

I was scolded by a parent today for not speaking to her daughter with respect, then said she had pneumonia and was in the hospital. I'm like, how did I miss this? She said it happens all the time. And she's at school right now, so... what? Unless I not translating well in Spanish, she said pneumonia.