Am I being too "conservative" here?

  1. Yesturday i had a pt come from GI lab to our recovery room S/P Esophageal stent placement. He was to go home after recovery. We are stage 1, then I send him to a discharge area for D/C stage and teaching etc.. Well, this guy, 84 yrs old, came to me w/ a BP of 220/110. NO history of ANY high BP, in fact he always ran LOW. Anesthesiologist and I worked on him for 30 min with BP meds until he normalized. Meantime he starts having severe nausea and vomiting of bloody tinged fluid. Gave some IV doses of antiemetics. Was nauseated and intermittently continues to vomit for anothe hour. I called the GI doc, he came by an I told him the situation. He brushed it off saying "He SHOULDN'T be vomiting, he shouldn't be nauseous). NO DUH. I said "This guy should be admitted". He refused. Said he shouldn't be N or V.
    Grrrrrr.
    Bottom line is that I felt something was not right. This guy needed to stay overnight nin my opinion. After fighting this moron doc for 2 hours, he finally talked to pts daughter (who wanted him to stay too) and doc said if you want him to stay its o.k with me. I was elated. But was I just being overly worried?
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  2. 9 Comments

  3. by   deespoohbear
    No, you were not being overly cautious. I don't know anything about esophageal stents, but his blood pressure and N&V would be a sign that something is not right. Was he having a CVA? You were correct in standing up for this patient. I hope his family appreciated. Did you ever find out what happened after he was admitted?
  4. by   BadBird
    Always trust your instincts !!! No, you were correct in your concern for your patient. Especially at his age he needs careful monitoring for bleeding. Sometimes it is hard to advocate for our patients but we must.
  5. by   Youda
    Realize that doctors are under pressure to discharge patients as soon as possible. Premature discharges are just another of the long list of problems in healthcare. It comes down to quality vs. cost again. There are some excellent articles about this very subject in most of the nursing journals.
  6. by   sjoe
    sharann--it might be useful to check out this patient's chart over the next few days and see what happened with him. That would give you (and us) a better idea of what was wrong after all.
  7. by   sharann
    I'll look into his chart if he is still there when I go back, or I'll ask around the units. I hope he's ok too. Thanks for the support.
  8. by   Jenny P
    Sharann, you have been on this BB for over a year and a half and I've found your posts show you to be a person who is concerned about her patients and advocates for them. You were right to be concerned about this patient. When you have been a nurse for a while, you travel the road "from Novice to Expert", and, in travelling along this road, you learn to trust your gut instincts. I don't care what that doctor said, your patient WAS hypertensive and N&V and SOMETHING wasn't right here. The hospitalization was needed and necessary; I'm very curious what happened to the patient also. My guess is that the patient and family thank you for caring for him. And if the pt. would have had untoward complications, both you AND that doctor would have your a**es in a sling and your names listed on a lawsuit.
  9. by   sharann
    Jenny,
    Thank you so much for your comment. The daughter did give me a huge hug and profusely thanked me. She said "Doctors think they are gods, thank god for you nurses). I am curious too. I'll have to call and check w/ work in the AM.
  10. by   prmenrs
    oops
    Last edit by prmenrs on Oct 14, '02
  11. by   prmenrs
    You were absolutely correct.

    I think docs get caught up in their "to-do" list, and can't deal w/anything not as expected. That's why you hear of people, or nurses, telling them stuff and them blowing it off. Kinda like--"I don't have time for this!"

    Meanwhile, that's OUR job, to make them STOP, LISTEN, and DEAL w/the unexpected. That's why the pt went to recovery, and why you were checking his vitals, etc.

    YOU DID WHAT YOU WERE THERE TO DO. Don't let the doc make you second guess yourself. If that were MY Mom or Dad in there, I'd be very grateful to you.

    GOOD JOB!!, NURSE! Since he didn't say what he should have, I will, Sharann.

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