can going to the hospital make you sicker??

chuckster, ADN, BSN, RN, EMT-B · Jan 13, 2011

louis mayer, the movie mogul from the 1930's (metrogoldwynmayer - mgm with the roaring lion intro) was famous for his malapropisms. one of the more well known of these is his statement that:

"a hospital is no place to be sick!"

there's a lot of truth in that - basically, hospitals are filled with sick folks and control measures are often not particularly effective.

Esme12, ASN, BSN, RN · Jan 13, 2011

ONe simple answer.....YES. Especially in the elderly!

GHGoonette, BSN, RN · Jan 13, 2011

i have encountered a patient who initially came in for just shoulder pain from falls. after 3 days, this patient was doing good, aaox4, i was about to discharge him. but for some reason they decided to keep him just for pain management. Then after those 3 days, the diagnosis got longer and longer. First the patient has been reluctant to get out of bed/ immobile for days even to use the restroom -> UTI. Then somehow they found something in the xray so they did surgery. which leads to post-op pain, and the patient decided not to get out of bed even some more.. then comes respiratory failure. then comes ICU intubation. then it even went more downhill.. then the patient somehow got anemic, then pneumonia.. now he's dying. i'm just shocked at the cycle, and it was even more shocking i was about to discharge this fellow weeks ago when he was walking, talking, joking.. now he can barely open his eyes. i cant help but to think, what IF i discharged this patient weeks ago, would they be as ill as they are now.. did all these hospital treatments make him sicker..???

This sounds really strange...he was admitted for shoulder pains after falling; I presume this is an elderly patient. He shouldn't have been on strict bedrest, so if he appeared to be unwilling to get up, it's his nurse's duty to see that he does. I think this patient was a prime candidate not only for UTI, but possibly DVT as well.

Following surgery, mobilization was even more imperative, yet you're saying this wasn't done. Respiratory failure...due to what? Atelactasis? Pulmonary embolus? Who was supervising his breathing exercises?

I pray this patient does not die, and recommend that all those involved in his "care" review their actions, and do a little self-examination....

lovescapeRN · Jan 13, 2011

i dont know where it actually went wrong, i was actually involved in the care in the beginning, and just recently i had this patient again 3 weeks later. this guy is severely obese, reluctant to walk much. i remember it was an extremely back breaking shift awhile back. pt was very unsteady on the feet, unable to get up on his own, UTI so i pushed fluids, on lasix, unwilling to do much other than going to bedside commode/bathroom.

GHGoonette, BSN, RN · Jan 13, 2011

i dont know where it actually went wrong, i was actually involved in the care in the beginning, and just recently i had this patient again 3 weeks later. this guy is severely obese, reluctant to walk much. i remember it was an extremely back breaking shift awhile back. pt was very unsteady on the feet, unable to get up on his own, UTI so i pushed fluids, on lasix, unwilling to do much other than going to bedside commode/bathroom.

Ah ok. Sigh, yes, obese patients are very difficult to manage, and mobilizing them is a nightmare. We used to call teams of porters to assist the physios getting the obese patients up. Probably there were other health problems simmering below the surface that came to a head during hospitalization. Hope he makes it...

rkitty198, BSN, RN · Jan 13, 2011

This is why documentation is so important....I document when someone refuses to walk. Document the benefits and consequences and whether or not pt still wants to refuse. Document that you offered to ambulate.

Did you call to get a PT order to ambulate? SCD's? Heparin?

Did you utilize incentive spirometry?

Does your care plan reflect your teaching?

Did you notify the doctor of patients refusals?

I am not at all blaming you, or questioning your nursing. I was reading over a thread about patients being non-compliant. If they are being non-compliant and in the hospital, it can drag you down as not being a compliant nurse.

I had a co-worker where something similar happened, she documented everything she did. When the doctors and family went back to accuse the nursing care of being sub-optimal, she was protected.

I will admit that I have had days where I may not have pushed for ambulation for a patient when I have a critical one, as nursing is 24 hour care and there are other members of the healthcare team as well to help.

littlemammanurse, BSN, RN · Jan 13, 2011

Yes!With all the superbugs it is definitely possible to get sick when staying in the hospital.

Caffeine_IV · Jan 13, 2011

I definitely think a prolonged stay can make you sicker if you aren't getting up and walking, eating, etc.

But also many of our patients have comorbidities that place them at risk.

pdxmomazon · Jan 13, 2011

I'm not a nurse (yet But it seems like for this gentleman, going to the hospital was inevitable. If he had shoulder pain from falls, he was bound to end up at some hospital. The cascade of events seems tragic I hope he is able to recover.

RNperdiem, RN · Jan 14, 2011

Some injuries seem minor when a patient is first admitted, and over the course of days, the symptoms "blossom".

I see patients with rib fractures and pulmonary contusions come in alert and on nasal cannula, and over the course of a couple of days, require more oxygen, have more difficulty breathing and end up on the ventilator.

nurse2033, MSN, RN · Jan 14, 2011

Some patients are medically fragile and only just able to keep it together at home. Once in the hospital, they are unable to bounce back from their original problem, which allows three other problems to take over. This is one reason why a hip fracture in elderly women has such a high mortality. Patients are ever getting older, sicker, and with more complicated histories. We manage so many conditions these days that they live long enough to get more and more problems. It is sad when that happens.