Miffed at these Docs

SmilingBluEyes · Dec 20, 2002

ugh if it were THEIR MOM, sister, DAD whatever, it would be DONE huh? Makes ya wanna scream huh.

RN always, BSN, RN · Dec 21, 2002

This irritates me...............What is wrong with those doctors?!?!?

oldnewnurse · Dec 21, 2002

Just got back from a visit with 97 yo aunt, released from hospital yesterday, 10 days post colostomy with pul emb, back to assisted living facility. Released on warfarin 7.5 mg po bid, and lovanox 40 mg bid. Her non-medical type daughter was there. I asked her what the visiting nurse said about the blood thinners as to me (1st year student) this seemed like a lot of blood thinner. She said the visiting nurse said the same thing. The visiting nurse tried to call the surgeon at 2p today and was informed by his receptionist that the doc was off until 12-26. The visiting nurse left msg for his on-call to call back and advise on d/c the lovanox. By 4:30, no call. I got there then, they told me the story and I called the surgeon. The recep. said nobody was on call for the doc as he only does planned surgery (incredible-and nobody ever crashes either, huh?) and that we shouldn't worry because all post-colostomy patients are on this dosage of blood thinner (this from the receptioinist). I called the p.c. doc at 5p, left the story with the service and asked for the doc to call me back. No call yet at 7:45p.

You guys think this dose is OK until 1-3-03 when she goes back to the surgeon or should I continue the pia routine for a doc to call me back?

This lady is a fall risk (THR-on walker).

Thanks!

andrewsgranny, ASN, RN · Dec 21, 2002

Coumadin 7.5mg bid sounds like way too much to me.

I dont think I would sit on this one. :eek:

globalRN · Dec 21, 2002

antifungals may also increase the effect of warfarin/coumadin

neneRN, BSN, RN · Dec 21, 2002

Sounds like an awful big dose- I usually see 2.5mg qd or 2.5mg qd alternating with 5mg qd once or twice a week. I would want it clarified by the doc.

Home Health Columnist / Guide · Dec 21, 2002

BE a PIA--keep calling and documenting converstions ALSO call family doctor. Keep facility staff infomed of signs of immediate trip to ER too. Did you get a look at the discharge instructions from the hospital? When is her next labs: PT with INR due---usually 2 times a week. I think I would call hospital to see what last labs were too. Followup your concerns with call to visitin nurses supervisor too---cover ALL bases.

Hope your aunt does well.

oldnewnurse · Dec 21, 2002

Thanks, nurses, for all your suggestions. As of this moment, no call back from p/c doc. NRSKarenRN, I paged VNS supvr. at 7p after the visiting nurse, who was out to see Aunt Flo today, did not return my page. Supvr. said they would visit on Sat. even though it wasn't scheduled. She also agreed to talk to SOME doctor about the warfarin and lovanox dosages and pass info to the nurse before he/she visits tmrw. I also asked if INR was drawn, and it was today. She also committed to getting that before she speaks to SOME doc. Aunt Flo's daughter is staying with her mom until somebody REALLY talks to us about the meds.

I don't even breathe that I am a student lest they assume I know stuff of which I have no clue. But I did say INR without batting an eyelash!

It is so hard being in the healthcare system at the holidays on top of our getting some poor-responding healthcare personnel.

Thank you again for your guidance.

**canoehead, BSN, RN** · Dec 21, 2002

Sounds like about half the dose might be right...keep trying to get hold of someone, and ask what her last labs were and if she was on this dose in the hospital. Perhaps there was a transcription error?

renerian, BSN, RN · Dec 21, 2002

Yes I would do what Karen says document , document,document and keep calling.

renerian

mattsmom81 · Dec 21, 2002

I tried home health a very short time and this was one of my biggest frustrations too. Hang in there!!!!