Re: ER Pet Peeves Originally Posted by almostthere06 The LTC dumps who are dehydrated with a UTI - last time I checked, IVFs could be given in a NH
Nursing home
"dumps"?! Obviously you're not from Florida, aka
Geri-land.
True, IVFs can be given in a LTC setting. But the patient who refuses to eat or drink most likely has something bigger going on than a UTI. Confusion, combativeness, refusal to eat are very common s/s with other life-threatening problems for elders, such as pneumonia.
Typically, these patients need to be restrained at the hospital because they're so loopy with infection and illness that they're always pulling the IVs out. And as you're aware, NHs are "restraint-free"--no exceptions. NH nurses simply can't be everywhere at once, and realizing how time-consuming the med pass is, with accuchecks, tube feedings, crushed meds for about 30 people, and it's easy to realize that there is no time to stick Ms. Susie for the fourteenth time to keep some D5NS running. Plus, NH nurses don't do IV starts very often, and to have to do repeated sticks to a frail, dehydrated resident who doesn't want the thing anyway, and you'll understand the frustration.
Also, nursing homes have a protocol for sending patients out to the ER. If nothing is found wrong with the patient, the nursing home has to eat the cost. So the Charge LPN in a NH can yell all she wants about how concerned she is about Mr. So-and-So's anorexia and worsening confusion and atypical combativeness, unless certain criteria are met, and unless the doc agrees, that patient will not go to the ER.
FTT or failure to thrive is a valid dx precisely because of patients who have nothing more "wrong" with them than a refusal to eat, which malnourishment can lead to some horrible decubs and infections. Catching a patient such as this at the UTI stage and sending the patient for treatment is a cause for admiration of NH nurse assessment skills, not a cause for disparagement of them.
Re: ER Pet Peeves
Can't remember who, but someone else posted this. Well, in Walgreens the other day I found the issue in question to see what else they had to say. It also went on to say that if you are going into the ED, call your physician affliliated with the hospital and tell them that you are going in. The physician will call the hospital to let them know that you are coming in.
Re: ER Pet Peeves
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