unsure what to think

  1. i need to know what other people think about this situration first the patient has a trachea and had congestive heart failure twice they also said she has pneumonia and fluid around around her heart she was in a nursing home and they took into the er because of her heart failure but now they want to release her to go back to the nursing home instead of keeping her at the hospital what do you all think about this
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  2. 13 Comments

  3. by   wtbcrna
    I think you probably meant to say the patient has a trach/tracheostomy. Congestive Heart Failure is ongoing disease process, it is sometimes better and it is sometimes worse. This patient will more than likely end up dying from complications of CHF at some point. The pneumonia is also probably d/t CHF. I don't know about the trach, but if the patient is stable/ no immediate distress and can be managed taking oral medications in the nursing home he/she can be taken back to the nursing home.
    To make a more informed decision I would need to know more about this patient, but I took care of patients just like this when I worked in the nursing home years ago. On the other hand I have had patients sent back to us that never made it out of the ambulance back into the nursing home, because they destablized enroute.
  4. by   jandb917
    Quote from wtbcrna
    I think you probably meant to say the patient has a trach/tracheostomy. Congestive Heart Failure is ongoing disease process, it is sometimes better and it is sometimes worse. This patient will more than likely end up dying from complications of CHF at some point. The pneumonia is also probably d/t CHF. I don't know about the trach, but if the patient is stable/ no immediate distress and can be managed taking oral medications in the nursing home he/she can be taken back to the nursing home.
    To make a more informed decision I would need to know more about this patient, but I took care of patients just like this when I worked in the nursing home years ago. On the other hand I have had patients sent back to us that never made it out of the ambulance back into the nursing home, because they destablized enroute.
    well i just thought it was odd that they were sending her back to the nursing home when they just brought her into the er today and she had congestive heart failure twice already today and then found out she has pneumonia on top of that plus the fluid around her heart i thought they would keep her for observations plus she has parkinsons disease plus she has had a trache for years too
  5. by   nurse4theplanet
    Quote from jandb917
    well i just thought it was odd that they were sending her back to the nursing home when they just brought her into the er today and she had congestive heart failure twice already today and then found out she has pneumonia on top of that plus the fluid around her heart i thought they would keep her for observations plus she has parkinsons disease plus she has had a trache for years too
    You said she had 'congestive heart failure twice that day'. CHF is a chronic condition that a pt is diagnosed with and must be managed long term. Pts often have CHF exacerbations that bring them to the hospital...Shortness of breath due to pulmonary edema. Therefore, I think you are confused.

    Why was this pt initially brought to the ER? What was her chief complaint? For example, SOB, fluid retention, Chest pain, Fever, Change in Mental status, etc. After she received treatment, were her initial symptoms stable....SOB/CP relieved, Fever absent, Mentation clear, etc....whatever went along with her diagnosis.

    I think that you can't see the forest for the trees. LOL. You seem very concerned about her individual disorders...all of which are chronic and can be managed at the nursing home (CHF, parkinson's). This pt probably has had fluid around her heart for awhile...otherwise, I think they would have done a pericardiocentesis and hospitilized her. Probably nothing to be concerned about. No need to get worked up about a pt that has had a trach for two years, unless they are currently experiencing complications that need immediate intervention. It is common for pt's to be trached longterm. The only thing that I see as a concern is the pneumonia...probably secondary to the chronic pulmonary congestion. If the pt's vitals were stable and she recieved antibiotics...then it's perfectly acceptable for her to return to the nursing home for continued care.

    You need to get a feel for what your pt's quality of life was before the admit, what changes brought the pt in, what was done to alleviate those complications, and try not to get hung up on all the pt's chronic disorders.
  6. by   jeanniern55
    jandb917 are you a nurse?
  7. by   jandb917
    Quote from asoldierswife05
    You said she had 'congestive heart failure twice that day'. CHF is a chronic condition that a pt is diagnosed with and must be managed long term. Pts often have CHF exacerbations that bring them to the hospital...Shortness of breath due to pulmonary edema. Therefore, I think you are confused.

    Why was this pt initially brought to the ER? What was her chief complaint? For example, SOB, fluid retention, Chest pain, Fever, Change in Mental status, etc. After she received treatment, were her initial symptoms stable....SOB/CP relieved, Fever absent, Mentation clear, etc....whatever went along with her diagnosis.

    I think that you can't see the forest for the trees. LOL. You seem very concerned about her individual disorders...all of which are chronic and can be managed at the nursing home (CHF, parkinson's). This pt probably has had fluid around her heart for awhile...otherwise, I think they would have done a pericardiocentesis and hospitilized her. Probably nothing to be concerned about. No need to get worked up about a pt that has had a trach for two years, unless they are currently experiencing complications that need immediate intervention. It is common for pt's to be trached longterm. The only thing that I see as a concern is the pneumonia...probably secondary to the chronic pulmonary congestion. If the pt's vitals were stable and she recieved antibiotics...then it's perfectly acceptable for her to return to the nursing home for continued care.

    You need to get a feel for what your pt's quality of life was before the admit, what changes brought the pt in, what was done to alleviate those complications, and try not to get hung up on all the pt's chronic disorders.
    she was brought in because she wasnt breathing that is why they took her to the hospital she quit breathing twice this is also my grandmother that we are talking about that is why im so concerned i mean i would be concerned if it was someone else to
  8. by   jane-long
    [quote=jandb917;2102744]i need to know what other people think about this situration first the patient has a trachea and had congestive heart failure twice they also said she has pneumonia and fluid around around her heart she was in a nursing home and they took into the er because of her heart failure but now they want to release her to go back to the nursing home instead of keeping her at the hospital what do you all think about this[/quot


    could it be different hospital has its own practice though the case sounds weird to let the patient home...
  9. by   SmilingBluEyes
    i would like to know in what context you are asking these questions? is this due to professional concern/interest or personal? if this remains unclear, the thread may be closed as we do not give medical or legal advice on allnurses.com.

    please let us know on what basis these concerns arose.
  10. by   nurse4theplanet
    Quote from jandb917
    she was brought in because she wasnt breathing that is why they took her to the hospital she quit breathing twice this is also my grandmother that we are talking about that is why im so concerned i mean i would be concerned if it was someone else to
    I see why you would be so concerned. I wish your grandmother the best, but I think that this thread will soon be closed. We can't give medical advice, as the Mod pointed out. I think this situation is too personal. Good luck.
  11. by   Gromit
    Not only is it too personal, it appears that you really don't have enough information available for anyone to actually answer your question -and evidently you simply don't understand CHF itself.
    If they treated her immediate problem (shortness of breath) so that she is about 'normal (for her usual status, that is) ' then yes, they would certainly send her back 'home'. There are too many variables to give a good answer to this. MOST of my patients are trached (long-term), many of them are CHF patients -they come in because they have an onset of difficulty in breathing (usually fluid buildup, which is basically what CHF presents as anyway) -and depending on how badly they have decompensated, their stay may be short or protracted.
    But I agree with Asoldierswife05 -this situation is too personal, and we cannot give medical advice (and it would be unwise to seek such advice over the 'net' anyway).
  12. by   ritarunningfeet
    I agree with Gromit, I don't think you understand CHF and it is an ongoing problem, not something you are cured from.

    This subject is too sticky to comment on otherwise without giving medical/legal advice. And it is probably to personal as it is about your grandmother
  13. by   awilhelm
    I know that we can not give medical advice over this forum. In lieu of that fact, I must say to you that if it doesn't feel right to you that she was released please educate yourself. Learn exactly what is going on in a patient with CHF. Talk to a physician. Find your own suitable advice. If the situation bothers you, please empower yourself.
  14. by   wtbcrna
    I am sorry... I wish you and your grandmother the best, but I thought you were asking something about one of your patients.

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