Had a patient today... 90-some year old, demented LOL. Came in with an H&H of around 7 & 21. Had her colonoscopy today. Of course, I am the one who gets chewed out for her not drinking her go-lytely last night. :stone
Gave her a fleets & 2 tap waters. (Why didnt they order any Senna or Dulcolax like they normally do???). By that time, it was time for her to go to the colonoscopy but was still not running clear (I made them aware before she left).
They irrigated her, cleaned her out and found a couple of polyps, a little bit of diverticulosis in one portion of her colon, no bleeding. They went ahead and did an endoscopy to check out her small bowel and found nothing there either.
Now, this morning she had a big goopy tarry black stool. I definitely thought maybe she had a bleed in her upper colon or small bowel. But no bleed was found.
How can this be? (Pt hadnt been eating anything to cause it to be dark like that and was not on an iron supplement)
they have done the simplest, testing......the line is when you are causing the patient discomfort/pain, that they have no capacity to understand...in short the answer to your question may well be YES
Agreed....after simple testing if the cure is futile it's not worth the pain to the patient.
Patients with dementia are a challenge sometimes, especially if they don't have a pre-existing terminal diagnosis. They come in with dehydration and UTI, and then pull out their IV, so we force them to take the IV and restrain them to much discomfort and pain. Kind of inhumane, but then they get hydrated and their fevers come down and they feel better and return to their baseline.
We had a LOL come in, tarry stools, completely demented. She got scoped --EGD, colonscopy, ultrasound, ct, etc., couldn't find anything, nothing on med reconciliation that would cause the tarry stool; it was heme neg, but looked just like a bleed to the point where I borrowed the test kit from another floor to make sure ours wasn't just offl. I pop in the room , (I swear I knocked) and see the granddaughter giving grandma a pill. Turns out granddaughter was sure her grandma was anemic, and had been feeding her iron pills several times a day. Granddaughter stopped -- she didn't report it as a med, it was "just vitamins" and once we explained that her iron pills had caused all the testing for nothing, the granddaughter stopped, grandma got a chelator to take the iron down, her stools resolved, and all was well.
We had a LOL come in, tarry stools, completely demented. She got scoped --EGD, colonscopy, ultrasound, ct, etc., couldn't find anything, nothing on med reconciliation that would cause the tarry stool; it was heme neg, but looked just like a bleed to the point where I borrowed the test kit from another floor to make sure ours wasn't just offl. I pop in the room , (I swear I knocked) and see the granddaughter giving grandma a pill. Turns out granddaughter was sure her grandma was anemic, and had been feeding her iron pills several times a day. Granddaughter stopped -- she didn't report it as a med, it was "just vitamins" and once we explained that her iron pills had caused all the testing for nothing, the granddaughter stopped, grandma got a chelator to take the iron down, her stools resolved, and all was well.
:yeahthat:
Good illustration of how important it is for us to remind patients AND family AND friends to tell us about ANY "pills" the patient is taking. So many lay-people don't think of OTC meds (from benadryl to iron supplements to MVs) as "medications." They just have no idea (as your case clearly illustrates) what effect these other "medications" can have.
Tweety, BSN, RN
36,257 Posts
Agreed....after simple testing if the cure is futile it's not worth the pain to the patient.
Patients with dementia are a challenge sometimes, especially if they don't have a pre-existing terminal diagnosis. They come in with dehydration and UTI, and then pull out their IV, so we force them to take the IV and restrain them to much discomfort and pain. Kind of inhumane, but then they get hydrated and their fevers come down and they feel better and return to their baseline.