Ominous physical symptoms

[catlvr]

Here's a weird question: we were talking about ominous symptoms, like lower extremity weeping edema, that immediately tells you that there's real trouble ahead for the patient. (I just finished helping a new RN admit a pt to our SNF, and I mentioned how I hate to see such a very nice aaox3 lady with weeping legs...just never good). What other symptoms right away sets you off? Here's my short list (I've only been an LPN for three years, in a nursing home, so I am always trying to learn):

Weeping edema

Uncontrolled blood sugars

Uncontrolled blood pressure

TIA, e

[Caffeine_IV]

A sudden change in: BP/pulse or mental status

02 sat dropping or SOB...new onset

[CoffeeRTC, BSN, RN]

weeping legs don't automatically mean a bad outcome. Sometimes they are just so filled up with some fluid, sitting around all day in a WC the dependent legs pull the fluid...no place to go..it leaks out. Elevate and tell the doc. they prob need an adjustment on the lasix etc.

here is more to the list

speaking of death or visiting a loved one who has died

becoming more alert or sane

the "look"

vomiting blood or stool

[TanyaBRN]

I think the worst symptom in my mind is apathy. If a patient doesn't care about their health anymore they are most likely not long for this world. All of the above are manageable but they require the patient to cooperate and follow the plan of care when they get home, if they don't do that they'll end up back in the hospital, dead, or in a nursing home.

[Jules A, MSN]

Just the thought of blood/fluid coming out the ears freaks me out.

[HappyBunnyNurse]

I've never seen this but I remember in nursing school learning that bleeding from an IV site is a sign of DIC. I mean like blood just running from around an intact IV.

[Zookeeper3]

In your elderly... forget the legs... a change in lOC is usually your first sign of trouble. I never assume someone is having an ""off" day... check vitals, blood sugar and watch them closely... sepsis, urosepsis or something is amiss. Acting "wrong" gets me very worried, especially with the screamer or the call button presser that suddenly stops... it never is a reprieve, it's more work and they're sick, bet on it.

[Up2nogood RN, RN]

Weeping legs is only an ominous symptom if it's not reported and treated correctly. I've seen many patients with 4+ edematous weeping legs that with treatment make a full recovery.

I had a patient the other night who told me he felt something was going to happen to him. After reassuring him I notified my CN right away so as to know to come quick if I called from that room. Thankfully nothing came from his feeling and that's the first time an ominous feeling wasn't followed by an event.

[gentlegiver, ASN, LPN, RN]

Any patient who thanks me for the care I have given them because they won't be around much longer.

any change in VS with change in mental or physical status

decrease in body functions (ie; less/no voiding, refusal to eat, drink)

[annister]

A suddenly nonscreaming screamer (especially night shift) takes the cake for me. I never thought that I would be relieved by sound of hollering or a call light.

Next in line is the chronically ill patient, who's normally Oriented, asking me if I see "the people/person/thing that's watching me from the AC vent".... or through the third story window. (about 45 minutes later, I found said pt. in high fowlers, apparently engaged in a Texas hold'em game with [nobody]??

Chronically ill pt. who wouldn't ask for a blanket let alone pain meds, is pleading for something for pain.

Terminal pt., after weeks of being minimally responsive, is suddenly good as new...This creates such confusion with the families.

I certainly have ominous feelings daily, while clocking in to work. Not so much when clocking out.

[msjellybean]

A suddenly nonscreaming screamer (especially night shift) takes the cake for me. I never thought that I would be relieved by sound of hollering or a call light.

Next in line is the chronically ill patient, who's normally Oriented, asking me if I see "the people/person/thing that's watching me from the AC vent".... or through the third story window. (about 45 minutes later, I found said pt. in high fowlers, apparently engaged in a Texas hold'em game with [nobody]??

Chronically ill pt. who wouldn't ask for a blanket let alone pain meds, is pleading for something for pain.

Terminal pt., after weeks of being minimally responsive, is suddenly good as new...This creates such confusion with the families.

I certainly have ominous feelings daily, while clocking in to work. Not so much when clocking out.

This is one of the worst. Also when people start talking about seeing family members that have died.

[Emergency RN]

i hate it when that trauma someone comes in, in a bloody mess and bleeding all over. by the time you get on all your protective gloves, gown and goggles; the patient lost another 20 points worth of systolic...

btw, here's a little ed helpful household hint for the new nurse: in the above patient start at least one of your large bore iv's with blood transfusion tubing even if you don't even have blood ready to give yet. you can run two liters of ivf at the same time, and when the life saving unmatched o neg finally shows up, all you have to do is spike out one bag of ivf and change it for the blood. the tubing would already be primed, connected and ready to go.