Latest Likes For Anna Flaxis

Latest Likes For Anna Flaxis

Anna Flaxis, ASN 20,808 Views

Joined Oct 15, '10. Posts: 2,822 (67% Liked) Likes: 8,441

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  • Jun 26

    A headache certainly can be an emergency, although I do agree that most of the time, it is not. But this is what the triage process is for - to use the tools at our disposal to determine whether we suspect an emergency condition exists and get that patient in front of a doctor sooner, or if it is less likely that an emergency condition exists and the patient can wait.

    I went to the ER last night & was diagnosed with an ear infection. Are you telling me that I should've waited until Monday to see my PCP? I think we both know that, that's a bad idea.
    Yes, assuming that you are not immune suppressed, you could have waited until Monday to see your PCP. Treating uncomplicated ear infections with antibiotics right away is no longer the standard of care, and a wait and see approach is reasonable. If, after 48 hours, there is no improvement or there is a worsening of symptoms, it would be reasonable to call your family doctor.

    Migraine sufferers need help right away. It's not a life threatening emergency, but their suffering is profound.
    As a person who suffers migraines and as an ED nurse, my opinion is that a person with chronic migraines should be under the care of a primary doctor who can prescribe medication for their condition, and they should try this before seeking further treatment. An Urgent Care clinic is capable of providing effective treatment for a migraine headache. While it's understandable that there may be issues with insurance or hours of operation that drive people who have migraine headaches to the ED, the ED should be the last resort. Unfortunately, many use it as a first resort, before they've explored other reasonable alternatives. I think, for some of us, that is where the frustration lies. It's like the person who has a PCP, who vomits one time and comes to the ED without even calling their doctor's office - calling your PCP and trying simple home care measures for the first 24-48 hours is appropriate for most simple and non-life threatening illnesses.

  • Jun 25

    Quote from OrganizedChaos
    Well I guess since I have had the throat/ear pain for awhile & was prescribed an antibiotic, the doctor felt differently.
    I'll let you in on a little secret. Lots of doctors just follow the path of least resistance. ;-)

  • Jun 24

    Quote from OrganizedChaos
    Well I guess since I have had the throat/ear pain for awhile & was prescribed an antibiotic, the doctor felt differently.
    I'll let you in on a little secret. Lots of doctors just follow the path of least resistance. ;-)

  • Jun 24

    A headache certainly can be an emergency, although I do agree that most of the time, it is not. But this is what the triage process is for - to use the tools at our disposal to determine whether we suspect an emergency condition exists and get that patient in front of a doctor sooner, or if it is less likely that an emergency condition exists and the patient can wait.

    I went to the ER last night & was diagnosed with an ear infection. Are you telling me that I should've waited until Monday to see my PCP? I think we both know that, that's a bad idea.
    Yes, assuming that you are not immune suppressed, you could have waited until Monday to see your PCP. Treating uncomplicated ear infections with antibiotics right away is no longer the standard of care, and a wait and see approach is reasonable. If, after 48 hours, there is no improvement or there is a worsening of symptoms, it would be reasonable to call your family doctor.

    Migraine sufferers need help right away. It's not a life threatening emergency, but their suffering is profound.
    As a person who suffers migraines and as an ED nurse, my opinion is that a person with chronic migraines should be under the care of a primary doctor who can prescribe medication for their condition, and they should try this before seeking further treatment. An Urgent Care clinic is capable of providing effective treatment for a migraine headache. While it's understandable that there may be issues with insurance or hours of operation that drive people who have migraine headaches to the ED, the ED should be the last resort. Unfortunately, many use it as a first resort, before they've explored other reasonable alternatives. I think, for some of us, that is where the frustration lies. It's like the person who has a PCP, who vomits one time and comes to the ED without even calling their doctor's office - calling your PCP and trying simple home care measures for the first 24-48 hours is appropriate for most simple and non-life threatening illnesses.

  • Jun 24

    A headache certainly can be an emergency, although I do agree that most of the time, it is not. But this is what the triage process is for - to use the tools at our disposal to determine whether we suspect an emergency condition exists and get that patient in front of a doctor sooner, or if it is less likely that an emergency condition exists and the patient can wait.

    I went to the ER last night & was diagnosed with an ear infection. Are you telling me that I should've waited until Monday to see my PCP? I think we both know that, that's a bad idea.
    Yes, assuming that you are not immune suppressed, you could have waited until Monday to see your PCP. Treating uncomplicated ear infections with antibiotics right away is no longer the standard of care, and a wait and see approach is reasonable. If, after 48 hours, there is no improvement or there is a worsening of symptoms, it would be reasonable to call your family doctor.

    Migraine sufferers need help right away. It's not a life threatening emergency, but their suffering is profound.
    As a person who suffers migraines and as an ED nurse, my opinion is that a person with chronic migraines should be under the care of a primary doctor who can prescribe medication for their condition, and they should try this before seeking further treatment. An Urgent Care clinic is capable of providing effective treatment for a migraine headache. While it's understandable that there may be issues with insurance or hours of operation that drive people who have migraine headaches to the ED, the ED should be the last resort. Unfortunately, many use it as a first resort, before they've explored other reasonable alternatives. I think, for some of us, that is where the frustration lies. It's like the person who has a PCP, who vomits one time and comes to the ED without even calling their doctor's office - calling your PCP and trying simple home care measures for the first 24-48 hours is appropriate for most simple and non-life threatening illnesses.

  • Jun 24

    Quote from Dany102
    Perhaps you would like to educate me. I would like to benefit from your insights and experience in this matter.
    Okay. The process is that when the person presents to triage with a chief complaint of suicidal ideation, a risk assessment based on current evidence/best practice is performed by the triage nurse, and based upon the level of risk, the patient is assigned an acuity level and either roomed in an appropriate room, or in the case of a person who receives a low risk score, sent back to wait in the waiting room if there are more acute patients that need roomed. A moderate to high risk would be assigned an ESI level of 2 and placed in a safe room, while a low to moderate risk could be assigned a 3 and placed in a medical bed or as previously stated, wait in the waiting room for a bed to open up.

    I will agree the ED is a unique environment but only to the point that it can, as is the case here, lead to very poor practices that do not contribute to the well being of a non-violent, willing person who is seeking help because they are contemplating ending their life. Never mind the traumatic experience, or distress, and anxiety this will leave them with.
    Agreed. That's why there are standard practices and protocols in place. Everything is based upon evidence-based, best practices, not the feelings or intuition of staff. I'm certain there are EDs that do not follow current best practice, and they are opening themselves up for a world of hurt, should there be a bad outcome as a result.

    If a person verbally agrees not to harm themselves until they get a chance to talk with a therapist, there is very little risks (assuming a good preliminary assessment is done), to allow them to remain as is. They are, after, willing. You keep an eye on them until the psychological evaluation is done. That isn't to say that a combative or overly aggressive person might not require higher safety measures. A distinction must be made. Cookie-cutter solution here is not adequate, let alone acceptable.
    Actually, there is no evidence that verbal no harm contracts reduce the likelihood of suicide. Even a calm, cooperative person can hide objects on their person, and a resourceful person can find something in the room with which to cause harm. People have successfully committed suicide while in the ED. As an RN, I am not qualified to perform a psychological evaluation and determine the true level of risk the person poses. I only have the screening tools I am given to work with, and base my actions upon the results of those screening tools.

    While one can argue that it is a "cookie cutter approach", which can have derogatory implications in the mind of the uninitiated, standardized practices are really at the backbone of most everything we do in the ED, from treating sepsis and AMI, to psychiatric emergencies.

    Failing to take appropriate precautions with a patient presenting with suicidal ideation who's assessed risk is moderate to high because the RN determines it's not necessary is akin to failing to undress the trauma patient and examine their entire body for injury because we want to protect their privacy, or failing to get an EKG on the chest pain patient because we don't want to expose their chest.

    In the words of one of the docs I work with, sometimes we can "Nice them to death", meaning that there is a very real danger in failing to take adequate precautions to ensure safety simply because we want to be nice to the person.

  • Jun 24

    Quote from Farawyn
    Yep, we use "suicide contracts", both written and verbal in my high school often.

    ED RNs, do you utilize this?
    So called "Suicide Contracts" should not be relied upon, as they are not evidence based. In fact, evidence points to the opposite- that they are unreliable and result in bad outcomes.

  • Jun 22

    I was just curious how others handled this type of situation.
    I am rarely caught by surprise when an otherwise sweet LOL suddenly turns into a raving lunatic. I actually kind of expect it.

    Some potential causes are UTI, constipation, hypoglycemia, sundowners syndrome, a pulmonary embolus, worsening illness, or even just being afraid and feeling helpless. A change in mental status should trigger inquiry into what could be causing it.

    UTI would be one of the more common causes, and constipation can be a contributing factor to UTI due to compression of the urethra by bowel contents, leading to incomplete bladder emptying and thus, urinary stasis. So maybe, your LOL's complaint about being constipated might not be too far off the mark. One of the more common symptoms of UTI in the elderly is altered mentation/delirium.

    Also consider the reason this person was admitted-for pneumonia. Her change in mentation could be related to a worsening of her condition.

    Another consideration is that often, elderly folks with milder forms of dementia compensate well at home in their normal, predictable environment, but once they are in an unfamiliar environment with different routines, the altered mentation is more noticeable. Family members may tell you that "Grandma has all her marbles" or is "as sharp as a tack", but that's in the home environment where she is able to compensate. The hospital environment interferes with this ability to compensate, and so you will see behavioral changes that would go otherwise unnoticed.

    So, to answer your question, how I handle this type of situation is first, I do what I need to do in order to keep the patient safe. Make sure the room is free of clutter, the patient is wearing nonskid slippers, and offer to toilet her. I will offer warm blankets, another pillow, PO fluids or a snack. I will offer a distraction, such as TV, or ask her about her life- her children, pets, where she grew up, etc etc. Once the patient is calmed down and safe, I will take a complete set of vitals, including a temperature; if diabetic, check a CBG; and I will then notify the physician of this change in condition. The physician may want to order a UA, or a repeat chest xray, as her change in mentation may be related to worsening pneumonia.

    I would then document the patient's behavior, the actions I took to ensure her safety, my assessment data, that I notified the physician, and whether any new orders were received.

  • Jun 21

    I was just curious how others handled this type of situation.
    I am rarely caught by surprise when an otherwise sweet LOL suddenly turns into a raving lunatic. I actually kind of expect it.

    Some potential causes are UTI, constipation, hypoglycemia, sundowners syndrome, a pulmonary embolus, worsening illness, or even just being afraid and feeling helpless. A change in mental status should trigger inquiry into what could be causing it.

    UTI would be one of the more common causes, and constipation can be a contributing factor to UTI due to compression of the urethra by bowel contents, leading to incomplete bladder emptying and thus, urinary stasis. So maybe, your LOL's complaint about being constipated might not be too far off the mark. One of the more common symptoms of UTI in the elderly is altered mentation/delirium.

    Also consider the reason this person was admitted-for pneumonia. Her change in mentation could be related to a worsening of her condition.

    Another consideration is that often, elderly folks with milder forms of dementia compensate well at home in their normal, predictable environment, but once they are in an unfamiliar environment with different routines, the altered mentation is more noticeable. Family members may tell you that "Grandma has all her marbles" or is "as sharp as a tack", but that's in the home environment where she is able to compensate. The hospital environment interferes with this ability to compensate, and so you will see behavioral changes that would go otherwise unnoticed.

    So, to answer your question, how I handle this type of situation is first, I do what I need to do in order to keep the patient safe. Make sure the room is free of clutter, the patient is wearing nonskid slippers, and offer to toilet her. I will offer warm blankets, another pillow, PO fluids or a snack. I will offer a distraction, such as TV, or ask her about her life- her children, pets, where she grew up, etc etc. Once the patient is calmed down and safe, I will take a complete set of vitals, including a temperature; if diabetic, check a CBG; and I will then notify the physician of this change in condition. The physician may want to order a UA, or a repeat chest xray, as her change in mentation may be related to worsening pneumonia.

    I would then document the patient's behavior, the actions I took to ensure her safety, my assessment data, that I notified the physician, and whether any new orders were received.

  • Jun 21

    ^^ Ugh, Ambien comes to mind...

  • Jun 21

    I was just curious how others handled this type of situation.
    I am rarely caught by surprise when an otherwise sweet LOL suddenly turns into a raving lunatic. I actually kind of expect it.

    Some potential causes are UTI, constipation, hypoglycemia, sundowners syndrome, a pulmonary embolus, worsening illness, or even just being afraid and feeling helpless. A change in mental status should trigger inquiry into what could be causing it.

    UTI would be one of the more common causes, and constipation can be a contributing factor to UTI due to compression of the urethra by bowel contents, leading to incomplete bladder emptying and thus, urinary stasis. So maybe, your LOL's complaint about being constipated might not be too far off the mark. One of the more common symptoms of UTI in the elderly is altered mentation/delirium.

    Also consider the reason this person was admitted-for pneumonia. Her change in mentation could be related to a worsening of her condition.

    Another consideration is that often, elderly folks with milder forms of dementia compensate well at home in their normal, predictable environment, but once they are in an unfamiliar environment with different routines, the altered mentation is more noticeable. Family members may tell you that "Grandma has all her marbles" or is "as sharp as a tack", but that's in the home environment where she is able to compensate. The hospital environment interferes with this ability to compensate, and so you will see behavioral changes that would go otherwise unnoticed.

    So, to answer your question, how I handle this type of situation is first, I do what I need to do in order to keep the patient safe. Make sure the room is free of clutter, the patient is wearing nonskid slippers, and offer to toilet her. I will offer warm blankets, another pillow, PO fluids or a snack. I will offer a distraction, such as TV, or ask her about her life- her children, pets, where she grew up, etc etc. Once the patient is calmed down and safe, I will take a complete set of vitals, including a temperature; if diabetic, check a CBG; and I will then notify the physician of this change in condition. The physician may want to order a UA, or a repeat chest xray, as her change in mentation may be related to worsening pneumonia.

    I would then document the patient's behavior, the actions I took to ensure her safety, my assessment data, that I notified the physician, and whether any new orders were received.

  • Jun 21

    This is unacceptable and needs to stop now. This type of behavior undermines the primary nurse, reinforces attempts to split staff, and can result in medication errors or other mistakes because the nurse who is trying to "help" does not know the patient.

    The first step is for you to talk to this nurse face to face. Tell her that you appreciate her willingness to help, but that in the future, she needs to check in with you first. If speaking with her does not result in the desired change in behavior, then take it up the food chain to the charge nurse next time it happens, at the time that it happens. If the episode is repeated again, then take it to your manager in the form of a formal, written complaint documenting each episode using objective language and leaving any emotion out of of it.

    It's one thing to help one another as part of working as a team, and this is appropriate behavior. It's an entirely different thing to insert oneself into a situation without knowledge of the patient situation and without checking in with the primary nurse first to see if they even want/need assistance.

  • Jun 21

    A headache certainly can be an emergency, although I do agree that most of the time, it is not. But this is what the triage process is for - to use the tools at our disposal to determine whether we suspect an emergency condition exists and get that patient in front of a doctor sooner, or if it is less likely that an emergency condition exists and the patient can wait.

    I went to the ER last night & was diagnosed with an ear infection. Are you telling me that I should've waited until Monday to see my PCP? I think we both know that, that's a bad idea.
    Yes, assuming that you are not immune suppressed, you could have waited until Monday to see your PCP. Treating uncomplicated ear infections with antibiotics right away is no longer the standard of care, and a wait and see approach is reasonable. If, after 48 hours, there is no improvement or there is a worsening of symptoms, it would be reasonable to call your family doctor.

    Migraine sufferers need help right away. It's not a life threatening emergency, but their suffering is profound.
    As a person who suffers migraines and as an ED nurse, my opinion is that a person with chronic migraines should be under the care of a primary doctor who can prescribe medication for their condition, and they should try this before seeking further treatment. An Urgent Care clinic is capable of providing effective treatment for a migraine headache. While it's understandable that there may be issues with insurance or hours of operation that drive people who have migraine headaches to the ED, the ED should be the last resort. Unfortunately, many use it as a first resort, before they've explored other reasonable alternatives. I think, for some of us, that is where the frustration lies. It's like the person who has a PCP, who vomits one time and comes to the ED without even calling their doctor's office - calling your PCP and trying simple home care measures for the first 24-48 hours is appropriate for most simple and non-life threatening illnesses.

  • Jun 21

    CSnyder823, a ruptured eardrum isn't an emergency. But, I can understand how a person might not know that, and think something seriously wrong is happening, and be scared, and go to the ED. I'm guessing the doctor was being kind to you and didn't want to make you feel badly or stupid. Regardless of whether a person comes to the ED for something that can wait to be handled by their PCP, there is no reason to be unkind. :-)

    Having said this, ED overcrowding is a serious issue. There are all kinds of ramifications from putting a strain on resources, increasing costs, and the safety of those truly emergently ill who are stuck waiting for a bed that is being occupied by someone who is not emergently ill. The reason so many EDs have "Fast Track" areas is for the sole purpose of off-loading stable patients with minor complaints off of the main ED where you have people actually trying to die.

    I have had a patient with a minor complaint that could have waited for an office visit with their family doctor come out of the room to complain about the wait, while the doctor was in another room trying to resuscitate a baby. And yet, I was still kind and professional toward the person.

    But back to the original topic, again I will state that most of the time, a headache is not an emergency; however, it could be. This is why we have the triage process.

    Here is a good article that I think sums up the situation from an ED staff member's point of view nicely:

    ER misuse in our instant gratification society

  • Jun 21

    Quote from OrganizedChaos
    Well I guess since I have had the throat/ear pain for awhile & was prescribed an antibiotic, the doctor felt differently.
    I'll let you in on a little secret. Lots of doctors just follow the path of least resistance. ;-)


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