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The patient on the first day postoperative for a transurethral prostate resection received a unit of packed red cells early in the morning on the...
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The patient on the first day postoperative for a transurethral prostate

resection received a unit of packed red cells early in the morning on the supposition that he was bleeding internally. That afternoon at 3:22pm, the patient's wife informed the nurse that her husband was breathing heavily and requested that the nurse assess him. The nurse according to the testimony of the wife, informed her that the doctor was aware of the patient's breathing pattern and that there was nothing about which she should worry. The nurse did not leave the nurse's station. The patient subsequently died related to a shock from the internal bleeding complicated by a reaction to the blood transfusion. 
            In court some years later, this same nurse testified that she had called the surgeon immediately to report that the patient's respirations were 50, that she had taken vital signs that were within normal limits for this patient, and that she had obtained a pulse oximeter reading that was acceptable. She also testified that she kept calling the physician's office to report these findings. None of this nursing care was documented in the progress notes that the patient's nurse placed in the patient's chart the next day. The nurse testified that she had completed the progress notes from scratch notes she had written during the previous afternoon. The nurse further testified that it was her practice to make handwritten notes during the time that she worked and then to type her progress notes on the hospital system the next day. Additionally, this nurse never documented taking vital signs during the 2 critical hours between the spike in the patient's respirations and the time he was pronounced.
            The surgeon's office nurse testified that a call was received from the hospital at 4:00pm and that the surgeon immediately left the office for the hospital. The surgeon testified that he called the hospital from his car phone and that he immediately called a code as soon as he reached the patient's room.



-Was there negligence on the part of the nursing staff in the care of this patient?
-How would you decide this case?

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