can going to the hospital make you sicker??

[lovescapeRN]

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..???

[goingCOASTAL]

Sounds to me like your patient (if he was elderly) was experiencing the "Geriatric cascade" - which is where older adults can succumb to frailty and a downward spiral JUST from laying in bed constantly. Was just learning about it in my RN-BSN classes - and it suggested that ALL older adults, unless clinically contraindicated, MUST be encouraged to get out of bed by the second admission day (up for meals, up to restroom, etc.), or they risk ending up exactly like your patient - either in the nursing home, or the funeral home.

I hope to learn more about this phenomenon and use it in my practice.

[momwithlicense]

I couldn't agree with you more about the documentation, that was one of the things my instructor always emphsized, C.Y.A. (cover your ass) A sad but important story to share with us all. Its hard to help a pt who won't help themselves.

[steelydanfan]

The underlying conditions for admission are still not clear. One does not usually get admitted to hospital for 'shoulder pain after fall", if as you said, xrays were clear.

Thus said, the complications of hospital admission are:

1. Exposure to bacteria not usualy found in the community.

2. A tendency towards taking on the "sick role", which for a person of dependant behaviours, and/or comorbidities, may tend to put them at higher risk for iatrogenic problems.

[steelydanfan]

We had the same discussion on another thread about obese pt.s. They are at SUCH high risk when something fairly benign occurs, such as shoulder surgery. The lack of or unwillingness to achieve mobility can quickly cascade into all the problems your patient suffered.

My take is that obese pt.s should never undergo non-emergent proceedures without EXTENSIVE pre-operative education, (and we all know just how likely THAT will happen) because a painful shoulder can be borne a lot more easily than a PE post-op. JMHO.