Unable to answer family questions about DVT.

[arallenrn11]

I'm an RN with 2 1/2 months experience in Med/Surg following 11 months in LTC. I work 7p to 7a. Recently I had an elderly female pt. admitted for DVT - my first DVT pt.

She had arrived on the floor shortly before shift change. She had 3 family members in the room who had questions for me as soon as report was finished. They were curious what the plan of action was, how long a DVT usually takes to resolve, how did the Dr. know she had a DVT, and how was he treating it? Seems to me this should have been addressed by someone already, but it wasn't, so they asked me, the nurse.

Of course. It's my job to answer questions right? Except, I didn't know the answers. I responded initially by stating that I needed to review the pt's chart before I could answer their questions. I did so and found that an abdominal/pelvic CT had been ordered but not done bc the pt was uncooperative (pt had dementia). I don't even know what it was ordered for.

The DVT was in the lower extremity. Were they trying to rule out others or was this test unrelated? There were no other procedures ordered. There were some labs but I can't remember what they were now, and the pt's leg was warm and swollen.

I felt at a loss trying to answer the family's questions for several reasons.

1) I wasn't sure of the diagnostic criteria for DVT and because I'm an RN not an MD I didn't want to get into how the pt was diagnosed because that's not my job.

2) I have no idea the average length of time a DVT takes to resolve and couldn't just call the Dr. to ask.

3) I don't know how they monitor progress in a DVT pt. Basically, I need a refresher on DVT's I guess. But I seem to be in this situation a lot where I just don't have the answers and I feel like I should. Any advice?

I just feel like there is so much I don't know! I did well in school but feel I have forgotten everything. Probably the 11 months in LTC prior to Med/Surg.

[arallenrn11]

There are many questions I can answer and many I can't or shouldn't. If tests are back and the PCP has not talked to the family "we" can not say a word, so yes there are times when calling the Dr. is the best thing to do. We can only reinforce what the doc has already stated and many times reading the progress notes do not give a clear picture about what has been said. Many times the families want more information than basic answers. In the ICU, I can't tell you the number of questions I have been asked re: treatments, surgery options, survival rates etc and yes, those type questions are more than basic and I will refer them to the doc.

This is exactly what I was trying to get across in my original post. Unfortunately, though it should, reviewing the chart doesn't always tell you what you need to know.

[wish_me_luck, BSN, RN]

GrnTea, I loved your reply and "liked" it. I would like it again if I could. It was spot on. I am definitely going to keep my textbooks when I get my first job. OP, thanks for scenario. I like going through scenarios (real or fictious) and thinking if I were the nurse this is what I would do and I do a quick memory jog of everything I know about the disease (what it is, s+s, dx, tx, education). It helps. That's all. No advice, just a thank you to you both. :-)

[wish_me_luck, BSN, RN]

Oh, and if that was a new patient, I have to agree with OP--I have seen some charts not have much info at all regarding the patients, some don't even have the H&P in chart yet. It was a learning experience.

[Vinniesguy]

By the time patients reach our unit a battery of tests will have been done and the doctors are sually pretty good at telling family what tests are being done and what they are looking for - and quite often the tests are done on the way from ED to us. If a family member asks about the results and they are there generally I tell them what the results are and what they mean. Unless the results are awful and prognosis is poor - then I let the doctor do it:D

the other thing I do after handover is if anything pops up that I don't know too much about then I have a quick look on google before I go to the pt bedside - got cauight out before as a newbie and learned to keep my little dictionary in my bag. It would be quite disconcerting for a patient to be aware that his nurse has no idea what his diagnosis means and doesn't understand the treatment!