popliteal anerurysm

Sounded more like that patient already had an arterial clot when you sent him out. Probably saved his leg.

Good job!

fuzzball - are you saying that they hadn't already called the doc?!!

Sometimes you see some things that just amaze you. Years and years ago while going to school for my RN, I worked in a nursing home that was close to home, as an LPN.

I only worked part-time, and one day I came in - one of those LOL who only weighed about 90 pds. had a belly swollen like she was 9 months pregnant!! They told me that she hadn't had a bowel movement, so they'd called the doc who ordered an enema.

So for several days, they used a FOLEY CATHETER (I never understood that part.) and filled her up with fluid - which wasn't coming back out! I called the doc, who came right out - took one look at her, sent her to the hospital, where she died shortly after arriving.

I asked the nurse who reported to me why they would keep doing that - she told me "Well, she does have bowel sounds." You bet she did - they were hyperactive!

http://www.mayoclinic.com/health/aneurysm/AN01196 - "What is a popliteal aneurysm?"

http://newsletter.mydna.com/health/heart/atherosclerosis/toptenpopaa.html - Top Ten Popliteal Artery Aneurysm Facts

http://www.ohiohealth.com/bodymayo.cfm?id=6&action=detail&ref=2419 - Popliteal aneurysm. Includes a drawing.

You were right. The ice compresses were wrong. Immediate nursing care of popliteal aneurysms is similar to a Thrombophlebitis in the lower extremity. With known popliteal aneurysms this patient was at risk for blood clots in the lower extremities and with a risk of any clot going to the lungs. The nurses should have realized that severe pain in the knee is a symptom of a possible complication in a patient with a popliteal aneurysm. It should have been on his care plan. His peripheral pulses should have been assessed. The color and temperature of the skin of his legs should have been noted. Pain should have been assessed. Measurements of his legs should have been taken to determine if edema was occurring. At the first sign of acute pain a doctor should have been notified, if only to get the patient some pain relief, for crying out loud. I can't tell you how many times I've seen similar complications happen to patients that were ignored by other nurses in LTC. This is one of the problems that face all DONs of LTC facilities. Just because people are old and/or demented doesn't mean that when they start to have a new, acute complaint, especially pain, that it should be ignored.

By the way, this condition got a lot of publicity when Vice-President Cheney had bypass surgery for it.

Had a LTC patient who was a post op hip replacement who insisted her new hip was dislocated because it wasn't moving right and she was just hooting with pain. No one was doing anything for her until I came on shift and listened to her, did an assessment and found the affected leg shorter than the other one and rotated outward at a funny angle. I called the doc immediately, we got her x-ray'd and, sure enough, the new prosthesis was dislocated! Strangest thing I ever saw. YA GOTTA LISTEN TO WHAT YOUR PATIENTS ARE TELLING YOU AND ACT ON IT.

Originally Posted by fuzzball

Still this nurse thinks she super nurse.

It's ignorant nurses and managers like this that got me aggravated and drove me from some of my nursing homes jobs in my earlier years. What you do with idiots like this is to make a point of getting a specific order from the patient's doctor of what to do when he has a symptom such as acute onset of knee and pain as well as a specific order for "No ice packs to the popliteal or leg area". If you are working night shift, what I would do is hang about early in the morning before going off shift and page the patient's doctor and get him on the phone myself around 7 or 8am through his answering service. If he makes rounds in the hospital, get him through the hospital operator. Tell them you are nurse in xyz nursing home and the call is urgent that you must speak to the doctor. Talk with the doc yourself, tell him what has been happening without sounding like there is a nursing war going on and that you are concerned about the patient, get specific orders that outline parameters of what nurses can and cannot do for acute knee and leg pain for this man, write them yourself in the chart and transcribe them onto the treatment sheets. Don't trust the Fax system because someone else could very easily throw a fax away if they are determined to sabotage other nurses. That, fuzzball, is how you exert your power and authority as a charge nurse and advocate for the patient.

With a patient like this I would probably make sure there were specific orders in the chart and on the treatment sheet that a specific assessment of this man's knees and legs be done on a regular basis (daily?) and include pulse checks, edema checks and even calf measurements. As a separate order I would have "Notify Dr. xyz if patient has sudden onset of acute knee pain that is unrelieved by (whatever medication)" and "No ice to knees or lower legs because of compromised circulation." This is also how you and the facility cover yourself with the State if they ever go looking into this chart for some reason.

Something I thought of after the last post I made was that the State (using this generically, as in any State) usually has a hissy fit when they find a facility has failed to notify the doctor and family when the patient has had a change in his condition. And, the situation you described certainly does qualify as a change in condition, so someone made a boo-boo by not notifying the doctor and family ealier on this.

She makes med errors, but covers her tracks. No matter where I work I will protect my residents from stupidity and careless mistakes from others. People do tell me that their are smart nurses out there?

You can only be responsible for yourself and what you do. You can correct others mistakes to benefit the patients. After that, let the ignorant ones hang on their own. You can't make anyone do anything they don't want to do. They're like donkeys. This is one of the commonest problems that occurs in LTC. I believe it is because there are too few people working in them to double check what is going on. In acute hospitals there are so many people scrutinizing everything that is done for a goof ball to stay in the system for very long. It's very easy for an ignorant or incompetent manager, supervisor or charge nurse to slip into the LTC system and carve out a nice long career for themselves. All you can do is maintain what you know are the good principles of nursing integrity and patient care. That makes you a role model for others. Believe me, others see it. You'd be surprised at the larger number of the silent majority out there who just watch on silently at the shenanigans that go on. Part of this goes to possessing the confidence within yourself to KNOW you are doing the right thing. Unfortunately, that often only comes with time and experience. Incidents like this one you describe, however, are what add to your experience. Hang in there. Watch your back and just correct errors as you see them. If you find someone deliberately trying to sabotage you, get witnesses and document. In trying to hurt you, they are calling attention to themselves and possibly hurting the patient. Time for you to learn that the power you have as a charge nurse is just as equal to that of an RN who is also in a charge nurse position. Don't be afraid to take the reins here with the doctor backing you up. My best to you.

can't add a word to that but I agree!

Daytonite - I think I'm going to start taking your advice more!! I think sometimes because I spent so long in critical care, that the LTC facility DON thinks I'm 'over-reacting'.

Recently a resident started c/o right back pain, and it kept getting worse! I asked the day nurse, then finally called the DON about it. Unless it's an emergency, the day nurse is supposed to call. It took them over a week to get anything done, and to order her any pain meds.

They finally diagnosed sciatica, and she also had a UTI! Granted, if I had called and asked for something stronger than Tylenol, it would have had to be ordered from the pharmacy, but I would have felt better.

Sunday nite when I went in, it was reported that one of the residents had blood in his foley - not just a little, either. He's A/O, doesn't remember pulling on it - and they never called the doc. I just don't understand it.