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by DutchgirlRN

I have a new home health patient who is elderly he/she was admitted post hospital stay for syncope and resulting fall. He/she has a orthostatic BP's to the tune of Lying: 220/116 Sit: 240/120 Stand: 178/112. I noted that the patient was eating a diet high in sodium, canned soups, salted peanuts, bacon, etc...Naturally I called the doctor. He did not order any meds. Said "no this pt doesn't need to come in for a visit" and he/she can have all the salt he/she wants. The only order was to decrease the pt's dose of Flornef and continue to keep him informed of the orthostatic readings.

What the heck? I documented, documented and documented some more. I also put all this in a fax and have the fax confirmation in the patients chart.
BP was WNL in hospital. Orthostatic BP's at admit visit and visits x 2 following were also very very elevated and doctor was notified. No orders.

I can't force this doctor to do anything and I can't tell the patient to get a new doctor. I can't do anymore than I have. I did tell the patient to limit his/her salt intake even though the doctor said it was ok.

Do you have any suggestions?

[jnette]

Re: What the heck is this doctor thinking? Actually not thinking!

Wow, Dutch, that's outrageous.

You did the right thing by telling the pt. to SEVERELY limit sodium intake (give him some handouts on hi-sodium foods to avoid!) and by calling the doc, etc.

I really don't know WHAT this doc is (not) thinking! I imagine he has been following this pt. for some time? Is there sth. he knows about this pt.'s hx. that you all don't?

I'd be tempted to ask him WHY this is not a concern. What have you got to lose?

[P_RN]

Re: What the heck is this doctor thinking? Actually not thinking!

How old is the patient? Has she been known to be noncompliant before? That's not a good doctor patient situation.

[muffie]

Re: What the heck is this doctor thinking? Actually not thinking!

wowee

[Cattitude]

Re: What the heck is this doctor thinking? Actually not thinking!

You asked this Doc to do something. He chose to do nothing. Still, you are doing your job and he is not.


I may have called the doc and told him about the BP and that I would either send the pt. to him or to the ER, which did he prefer? That would have kind of prodded him into doing something.

Now I know this is tougher for your cases as they have just come home from the hospital, but really, the Dr. NEEDS to do something.
A person with no hx. of HTN certainly does not need to NOT be treated and be told to eat all the salt they want.
Has the pt. ever been treated by a cardiologist before? If so, maybe they could make an appt? It wouldn't have to be the primary following up on this right?

[caldje]

Re: What the heck is this doctor thinking? Actually not thinking!

Without more information I cant honestly say the doc isnt doing what he's supposed to. We have to remember that there are many things we dont know. For example, the vast majority of hypertension is not sensitive to salt intake AND low sodium can actually increase the risk of renal complications when on certain meds. Like I said, a full case presentation of this patient, leaving nothing out, and I think we might find that the doc is not being "bad." Give the guy a break, you wouldnt want someone treating you like you're treating him.

[Cattitude]

Re: What the heck is this doctor thinking? Actually not thinking!

Originally Posted by caldje

Without more information I cant honestly say the doc isnt doing what he's supposed to. We have to remember that there are many things we dont know. For example, the vast majority of hypertension is not sensitive to salt intake AND low sodium can actually increase the risk of renal complications when on certain meds. Like I said, a full case presentation of this patient, leaving nothing out, and I think we might find that the doc is not being "bad." Give the guy a break, you wouldnt want someone treating you like you're treating him.

Isn't is something like only 30% of Hypertensive people are salt sensitive? But still that was a high BP and on several occasions. You would think the Doc would at least have said, "Let's hold off on giving any meds right now because blah blah blah" Give the poor nurse something!!!!

[DutchgirlRN]

Re: What the heck is this doctor thinking? Actually not thinking!

Originally Posted by jnette

Wow, Dutch, that's outrageous.

I'd be tempted to ask him WHY this is not a concern. What have you got to lose?

Thanks jnette, I think that's a very good idea! I better ask my DON first if that's ok.

[DutchgirlRN]

Re: What the heck is this doctor thinking? Actually not thinking!

Originally Posted by CASbeezgirlRN

I may have called the doc and told him about the BP and that I would either send the pt. to him or to the ER, which did he prefer?

That's what I did and he said no need to come in and certainly no need for the ER.

[twinmommy+2]

Re: What the heck is this doctor thinking? Actually not thinking!

Originally Posted by CASbeezgirlRN

Isn't is something like only 30% of Hypertensive people are salt sensitive? But still that was a high BP and on several occasions. You would think the Doc would at least have said, "Let's hold off on giving any meds right now because blah blah blah" Give the poor nurse something!!!!

Even if only 30% of the general population are salt sensitive, it would be prudent to eliminate it as the source wouldn't it? And say if this person were a minority such as African American or Native American, doesn't that percentage go up for those populations?

But on the other hand was he showing other symptoms? Dizzyness, spots before the eyes, headache? Perhaps the Dr. was worried about adding a new med and having the pt plumet too much?

Just wanted to advocate for both sides here.