485 and facesheets

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    Ok,so I had a question on the general nursing discussion and fell bad for asking it.In any event,I now know some of my pts aren't "brain dead" but they might be in a persistant vegetative state.I have never,ever seen that on any of the facesheets and 485.Meanwhile,I don't really know if the kids are in a vegetative state.Some of the kids I wokr with have no purposeful movements,their pupils don't react with light,have no spontaneous respirations,and are unresponsiveto external stimuli. Most have aw/as cycles.The only thing I've seen are "global developmental delays".It isn't asking the same question as I asked in the general forum,but how would you describe in under "Neurological" on the assessment sheets? Also,how do you describe it under "activity" on the assessment sheets? I just put either Aw or As.Its frustrating to have to explain to Emt's sometimes what's going on......
  2. 15 Comments so far...

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    I believe the brain death or vegetative state labels only apply to pts who were neuro intact at some point. I have a few patents who are globally delayed and were such since birth. Others who have TBI or anoxic injuries are labeled as in a vegetative state or similar diagnosis.
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    I document "WNL" under the neurological section, if there have been no changes, seizures, etc.
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    Quote from big al lpn
    I believe the brain death or vegetative state labels only apply to pts who were neuro intact at some point. I have a few patents who are globally delayed and were such since birth. Others who have TBI or anoxic injuries are labeled as in a vegetative state or similar diagnosis.
    Thanks,and I wish I would have asked this question here first. I had no idea those labels referred to people who were intact at some point. Most of these kids were born that way,although I have one who was in a car accident.
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    I always thought "Global Developmental Delay" meant something similiar to a "vegetative state" but wasn't sure.
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    Quote from smartnurse1982
    I always thought "Global Developmental Delay" meant something similiar to a "vegetative state" but wasn't sure.
    Not necessarily. I was taught it refers to delays in all areas of development present since young childhood, if not birth. I have patients with this label who are most definitely not in a PVS. They had a brain insult near birth resulting in CP or a genetic anomaly/chromosome disorder. Two are significantly mobility impaired but definitely have the ability to communicate and definite purposeful movements, both follow 1-2 step commands and can use AC devices like large button switches. Obvious sleep-wake patterns. One is more active than the others and can even take steps in a gist trainer.
    KelRN215 and SoldierNurse22 like this.
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    Global developmental delay does not mean anything close to persistant vegetative state. GDD is a delay in skills in multiple areas of development (speech, vision, motor, cognitive, social). The delays can be mild, moderate, severe. The delays can be related to TBI, Down's, autism, neglect or any one of many other diseases and disorders.
    BuckyBadgerRN and KelRN215 like this.
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    Quote from smartnurse1982
    Ok,so I had a question on the general nursing discussion and fell bad for asking it.In any event,I now know some of my pts aren't "brain dead" but they might be in a persistent vegetative state.I have never,ever seen that on any of the face sheets and 485.Meanwhile,I don't really know if the kids are in a vegetative state.Some of the kids I work with have no purposeful movements,their pupils don't react with light,have no spontaneous respiration's,and are unresponsive to external stimuli. Most have aw/as cycles.The only thing I've seen are "global developmental delays".It isn't asking the same question as I asked in the general forum,but how would you describe in under "Neurological" on the assessment sheets? Also,how do you describe it under "activity" on the assessment sheets? I just put either Aw or As.Its frustrating to have to explain to Emt's sometimes what's going on......
    You just describe what you see...labeling them with a medical diagnosis is not within your scope.

    patient remains unchanged/comatose. Patient is non responsive to noxious stimuli (painful stimuli) and has no spontaneous/purposeful movement. Pupils are non reactive @ 4mm no self resps.

    To document AW/AS cycles in a comatose patient I would think you would have to see that on a EEG.

    To describe to EMT/medics...the patient remains comatose since....what ever event that made them this way....and is essentially unchanged...the pupils are non reactive @ 4mm patient doesn't respond to noxious stimuli and had no spontaneous/purposeful moment/respirations at base line.
    Last edit by Esme12 on Dec 30, '13
    SoldierNurse22 likes this.
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    I don't think there is any harm in trying to understand WHY our patents have a specific diagnosis.
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    of course not.....but charting that a patient is in a persistant vegatative state is not nursing responsibility.
    KelRN215 and SoldierNurse22 like this.


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