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!
