Baby Tim was born prematurely at 35 weeks gestation, very active and healthy but required nursed in an incubator in neonatal unit. Baby sucking reflex was not fully developed required complement the nasogastric tube feeding and intravenous (IV) therapy through his left arm received nutrition sources. IV therapy stopped running after the first 24 hours and registered nurse on duty informed pediatrician and he asks the nurse to continue it. After the following day, Baby Tim parents noticed baby arm turned bluish and cold to touch, continue with third-day arm was totally black and swollen from hand till elbow. Pediatrician informed about the need for amputation due to could not be saved. This incident very traumatic to baby Tim...
Registered nurse carelessness by not allow the parent to stays will baby Tim since admission, if parent stay with baby Tim, them can observe any changes to the baby, and can inform nurse immediately. Second, it also a bonding time between baby and parent if stay together. Another negligence happen is nurse did not do the assessment to the baby due to parent is the first person notice of changes of baby hands but not a nurse in charge. Third, the nurse in charge did not take the first action by notice of baby hand already turned bluish and cold to touch which is indicate of lack of blood circulation.
Element of malpractice
Malpractice is a type of negligence, which is a licensed professional, fails to provide services as per standards set by the governing body.
1. Duty owed to the patient: registered nurse and pediatrician in charge of baby Tim.
2. Breach of the duty : nurses did not follow standard of procedure to do proper assessment on IV therapy line, did not take action on baby hand when notice bluish and cold to touch, ignorance about IV therapy infusion was stop after 24 hours infusion and did not query with doctor about to stop the IV therapy...
This is indicating of too much of nutrition for the premature baby age. According to Malaysia professional code of professional conduct, we need to advocate for the patient by informing the consultant. From the baby Tim incident, IV therapy stops running after infused for the first day but after that order by the doctor to continue IV therapy, then the nurse following instruction. At here, ethical dilemma happens about either to continue doctor order or to stop it according to our knowledge. Solution solve ethical dilemma follow the nursing process, we should assessment by gathering the information about baby Tim receive enough of nutrition by showing him active and healthy, to check on patient weight, intake output chart and referral to the dietician to obtain more accurate data about patient nutrition requirement. b) Analysis and diagnosis about baby Tim vein are very fine, no suitable for continue high concentration medicine IV therapy. c) Planning and implement: firm with our decision by effective communication to consultant suggest stopping continuing IV therapy, or to change IV peripheral line to the central line which is more safer of administer IV therapy solution by reduce of complication on IV therapy via the peripheral line. If consultant still did not agree with our suggestion, inform to ward manager or team leader for the...
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