Published Apr 11, 2003
Ok guys- here's another one of those resident advocate threads. In the LTC where I work- I am considered the floater. The one who covers each hall on the days when the regular nurse isn't there. No big deal- I actually enjoy it. But sometimes I find things that have gone on for days, is charted and has had nothing done about it. Today- one of my residents had severe pitting edema to his bilat lower extremities- from his knees to his toes. It was so bad- this man couldn't put his own socks on past his heels! They had been steadily getting worse, as was documented, for the last four days- with no edema present before than. His VS were WNL(BP showing a very gradual increase)- no temp. Faint bilat. wheezes in the posterior bases, no SOB. Moist sounding, non-productive cough only present when supine. No h/o CHF. Elivating ex. x 2 hrs. showed no changes. While this had all been documented for several days, I couldn't find where anyone had notified the MD. So I called. I reported everything I have stated- and she gave me an order for an ATB, Expectorant and told me to elivate lower ex.
I know it's not my job to dx- and I truely wasn't. But an ATB and expectorant just didn't seem like what this guy needed. But this particular MD is brutal- and VERY intolerant of new grads, and some older nurses too. Making any suggestions is purely off limits. So I went to my DON- told her my concerns and asked her to take a look at the guy and give me her opinon. After two seconds- she calls the MD and asks for labs and a CXR, just to "cover our bases."
My question is- given the assessment findings- do you guys think I did the right thing to be concerned with the ATB and expectorant? To me- and I will be the first to shout my inexperience here- I'm thinking new onset CHF. Please add your input here. I value your experiences where I am lacking- and your opinions have often helped me see things from another angle. Thank you!
screams of chf...ya done good, sweets....
I think that you did the right thing. I personally do not see where the ABT and expectorant is going to help the edema but that is the doctor's choice. Keep us informed.
dawngloves, BSN, RN
Keep documenting!!! CYA!!!!
Don't be afraid to speak up to the doctors. They have plenty to do and it certainly couldn't hurt the patient with your concern. With so much pitting edema I would be worried too. I am glad to here someone speak up and not just let things slide. Patients need more like you. :) Kathy
Thank you so much! I love you guys. I have been fretting over this all night! It's sooo nice to have the backup here. Once again- you guys are great.:)
P_RN, ADN, RN
jenac, you are what we call a real patient advocate!!!!
You were wise enough to know what you didn't know. I imagine your message lost some in the translation between you and the doctor. Good on you for going to the DON and good on her for believing you and following through!!!
What you did was possibly avert a serious event.
Lets say you didn't persue it any further and the edema
became worse and eventually the pt. had to be sent out.
Then it falls on all the nurses who took care of that pt. to answer
why wasn't the MD called and when the orders seemed inappropriate why weren't they questioned.
Nursing homes are always noted for their faults and rarely commended for the positive good care thats given.
My hat is off to you.
You did exactly right. And I share your suspicions about the CHF.
I am in AWE of you LTC nurses/ aides. You rock. You done good from where I sit. Bless you!
Sounds like CHF to me too. and if your intervention keeps him out of the hospital . YEAH! Hopefully you can treat him in the environment he is familiar with rather than going thru the stress of a hospital stay.
You rock. I did LTC and my mom is currently in one. I would be very grateful to have you as a coworker as well as the care provider for my mom. Keep up the good work and please let us know what happens.
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