Published Jan 29, 2009
carbaminohemoglobin
94 Posts
last shift i worked, a resident's family member came up to the nurse's station and let me know that a resident in the assisted dining area was "shaking and acting weird." okay -- the resident in question has advanced alzheimer's and a myoclonic sdo.
first thing i think is seizure, but being the best little nurse i can be .. i jump up and check her out. and whaddyaknow? she is in fact shaking and acting weird. she looks like she's in labor (which is probably not the case unless some serious abuse/ divine intervention was going on considering she's 73 years old). well, this was really a sight to see! she was having insane tremors, moving a huge table with one hand, clenching her fists, eyes are rolling, back is arching while neck is extending, regulating her breathing (hoo, hoo, hee, hee, hoo, hoo, hee, hee), clamping her eyes shut then opening them wide. if you had tried to hold her hand, i'm sure she'd break off your finger! and all of this happens over a period of 5 minutes.
well, i call the attending. dr. orders the resident to be sent to the er for an eval. okay -- call the appropriate ems company, gather the necessary paperwork, and call the resident's dpoa, her daughter. the daughter seems very shocked to hear her mother has had a seizure! she asks "is she shaking uncontrollably?" me: "errr, yes..?" dpoa: "well, she's probably just pooping." me: "...come again?" dpoa: "yeah, she does that.. when she hasn't pooped in a while, she shakes uncontrollably to get the poop out." (okay, i'm thoroughly lost for words at this point.) me: "well, ma'am, it says in her chart that she has a seizure disorder and the dr. feels it'd be best at this point to have an emergency evaluation at the hospital of your choice..." (go, me! i found something appropriate to say!) dpoa: "well, okay. take her to saint so-and-so hospital, i'll meet her there."
okay, now personally, i would never have deduced that she was just having a bm. i mean, wow! i've never had an experience like that, not to say that they don't happen, but come on! so, i blow off the dpoa, because she's hasn't had superb medical training unlike myself... **eyeroll**
ambulance comes, takes her away.. the rest of the night goes smoothly and i go home..
the next day, i come to work and during report i am told that the resident has returned and she's just fine. i ask the offgoing nurse if it had been a seizure. the nurse laughed and said "no, apparently she just had to poop."
so: i've learned to never disregard patient's or their family's personal experience.
and i've cemented my newest motto deep in my brain "better safe than sorry!"
gotta laugh so you don't cry, right? hehe
gregmotz
21 Posts
"is she shaking uncontrollably?" me: "errr, yes..?" dpoa: "well, she's probably just pooping." me: "...come again?" dpoa: "yeah, she does that.. when she hasn't pooped in a while, she shakes uncontrollably to get the poop out."
i have personally seen this behavior in more than one patient later diagnosed with bowel impaction. it is frightening to watch and was described later as being very painful 7/10. one went to the er. another underwent digital disimpaction confirming the diagnosis.
a patient for whom i was responsible.. well, we missed all the other symptoms. in addition, no one was watching preventative steps, like stool softeners, hydration, fiber, checking when was the last bm, and connecting the dots with meds that increase the likelihood of constipation. i've never let it happen twice.
probably wrong, 'cause two cases does not a study make.
BerryHappy
261 Posts
Wow! Thanks for sharing. I know to check when BP suddenly drops for poo, now I will check when it kinda (controlled breaths?) looks like a seizure. BTW, I always give myself a Hi-Five when I send a pt out 911 and they end up being admitted. YESSSSssss!
Haha! I know what you mean.
I have personally seen this behavior in more than one patient later diagnosed with bowel impaction. It is frightening to watch and was described later as being very painful 7/10. One went to the ER. Another underwent digital disimpaction confirming the diagnosis.A patient for whom I was responsible.. well, we missed all the other symptoms. In addition, no one was watching preventative steps, like stool softeners, hydration, fiber, checking when was the last BM, and connecting the dots with meds that increase the likelihood of constipation. I've never let it happen twice.Probably wrong, 'cause two cases does not a study make.
I have personally seen this behavior in more than one patient later diagnosed with bowel impaction. It is frightening to watch and was described later as being very painful 7/10. One went to the ER. Another underwent digital disimpaction confirming the diagnosis.
A patient for whom I was responsible.. well, we missed all the other symptoms. In addition, no one was watching preventative steps, like stool softeners, hydration, fiber, checking when was the last BM, and connecting the dots with meds that increase the likelihood of constipation. I've never let it happen twice.
Probably wrong, 'cause two cases does not a study make.
She did have a fecal impaction! Although this resident is on miralax QD, Senna tab BID, and Colace BID. The daughter wants to remove all stool softeners/ laxatives. Gah!