concerned about my dad and grandmother

[ACNP 2B S1S2RRR]

Hi, all. Thanks for taking the time to read my post. I am a nursing student and I am finishing up my first year in nursing school. I am really concerned about my father AND my grandmother. I know that none of us are doctors and we are not supposed to diagnose our patients, but this is my family and I am concerned. I would love to hear everyone's thoughts and opinions about the two situations, and I am open to criticism and correction. I know that my phrasing may be a little off, but I'm not going back through to revise after typing this post. I have homework, but I need to get this off of my chest first.

My father is about 60, smokes 2 ppd @ 69 pack years, does not drink, has chronic back pain and is prescribed talwin for management of his pain. I convinced him to go to the doctor last semester when I noticed that he complains of chest pains. His heart sounds are very hard to auscultate, probably r/t hyperinflation of the lungs (they've found a spot on his CXR... I don't know where or how big it is). I noticed that his HR was very irregular, and I also auscultated crackles @ posterior left. His BP was through the roof, his feet were swollen bilaterally... etc. When I found how hard it was to auscultate his heart sounds, I broke down because I knew right then. The clinical picture of my father matches the clinical picture of just about every patient that I have had, and just about every patient that I have had has been a CHF patient, or something along those lines. I hate for ppl to see me cry, so I tried to keep my back to him, but my dad knows me. I tried to be optimistic and tell him that it could be treated and I guess that scared him even more because he could see that I was trying to convince myself. I guess it scared him to see that I was so upset about my assessment findings because he went to the ER that evening and was in the hospital for 7 days.

He was Dx'd with COPD, HTN, and hypercholesterolemia, and I am pretty sure that he was Dx'd with CHF or something along those lines and that he doesn't want me to know. They also went up through his inguinal region (through his stapled inguinal hernia... yeah... another big risk) to put a stint in. I have begged him to quit smoking, but he won't budge. He was prescribed nitroglycerin tabs (the ones that dissolve and action begins in seconds), coreg, simvastatin, plavix, and albuterol (I think it was albuterol, either way a 'roid inhaler). Well, my dad is not old enough to get the free meds (medicare), so I guess you know that he is no longer taking hardly any of this stuff. He was keeping the inhaler, but he ran out and they are really expensive. He is still taking the nitro prn with angina, and he was taking the plavix until he ran out a few weeks ago.

Well, today when I came over to see my folks, my mother called me into the living room because he was having chest pains. he had his eyes closed and was gripping his chest. I had my steth and BP cuff with me. He took a nitro, and I immediately checked his apical (I heard gurgling--- regurgitation/ a faulty valve maybe?) and his BP. His radial was weak and thready. His BP was WNL for him since his hospital visit (115/78), BUT his HR was 43. Yeah. WOW. So, the books are not always exactly right. I remember reading that a bundle block at the SA node will result in HR

Okay, my grandmother now....

My granny is 76, and she REFUSES to go the doctor. She has a positive puddle sign and visible veins covering her abdomen. She has pain on her left side (yeah.... bad news), and she is always constipated. Her mother died of colon cancer. Well, because she won't go the MD, I rigged up the toilet two days ago so that she could not flush it. This may sound a little extreme, but this is my grandmother and I love her very much. She said she'd just taken her ex-lax (has to take it daily or no BM, EVER), and I ran to the RR and rigged the toilet. When I went up there to fix it for her, I lifted the lid and her urine was very cloudy and dark green, like an ugly dark green. Her stool was not formed, just kind of loose pieces in the bottom of the toilet and floating in the urine. The stool was also green (like "baby poo green"). I am thinking that this may be gallstones, and that the problem may be advancing to her liver. Anyone got any input for this case?

She will not go to the MD and I don't know what to do. Can I get a urine sample and send it to a lab that is not affiliated with the hospital or to her primary care provider (whom she has not seen in like 6 years), or does a doctor have to order the labs? Is there an alternative to getting the gallbladder removed? She also had to get her uterus removed about 15 years ago because she had tumors (she says that they were benign, but I am not sure) and was losing a lot of blood (they had to give her 2 units of blood when she got to the hospital).

Thank you all so much for taking the time to read my post and help me :)

God bless all!

Well, my dad is also a truck driver (DVT city).

[Nascar nurse, ASN, RN]

Unfortunately we can't help you. We are not doctors and can not diagnosis. They are sure to close this thread to protect terms of service. Both your Dad and grandma need to see a Dr. Good luck

[jorjaRN]

Due to the TOS of this website, we can't offer you any medical advice. Sounds like both of your family members should see a primary care physician. I would also suggest looking into reduced rates for prescriptions, which are offered through many pharmacy chains, especially on generic drugs, for your father. Best of luck to you.

[casi, ASN, RN]

One thing you'll learn once your out of nursing school. You can't force people to do things they don't want to do. I could write a laundry list of some of my mother's health issues that she refuses to address. I've honestly given up. If she is happy smoking 2 packs a day and she knows the risks it's her choice.

It's really hard because it's my mom, but if I keep pestering her it will only strain our relationship.

Don't push your family to see MDs you've educated and now you have to let them make decisions.

[prmenrs, RN]

I need to close this thread because you're asking for medical advice, and that is against the Terms of Service you agreed to when you registered on allnurses.

We wish you and your family the best. I hope they are able to get the help they need.

Respectfully, prmenrs, moderator