Doc have right to get upset with me?

xtxrn, ASN, RN · Sep 1, 2011

I definitely would have called ... I work with quads and paras so it is different for them. A maybe not so high temp for a quad can mean a plethora a things. Nurses need to familiarize themselves with AD and other things that can happen from an innocent temp.

Yeah- AD was something I thought about with the co-existing disorders....and nobody wants to mess with AD....

MassED, BSN, RN · Sep 1, 2011

????????

it's called a joke.

xtxrn, ASN, RN · Sep 1, 2011

it's called a joke.

Thanks for clarifying :)

MassED, BSN, RN · Sep 1, 2011

Thanks for clarifying :)

although someone beat me to the point about calling that resident for other (lesser than necessary) 0300 pages.... but I digress...

I respond to the OP, initially, without reading other posts, so I essentially echoed what you wrote....

VICEDRN, BSN, RN · Sep 1, 2011

I just started at a teaching hospital but I have already figured what the op probably already knows...don't listen to the residents. They turn every mole hill into a mountain. You couldn't even get another symptom of ad or repeat evaluated temp on this dude.

I would find out facility policy and shove it in his face next time you see him. It's not my fault little learner that you sweat every little thing.

RNdiva505 · Sep 1, 2011

Some docs are orifice holes *lol* and let there "status" get to their head... especially the new M.D..... I once had a new M.d. ask me what my patient was wearing on their legs and to take them off... I stated they were scd's and y they just had hip surgery with no prior history of blood clots....Lordy

RNperdiem, RN · Sep 1, 2011

Please don't lose sleep over this.

The doctor was snippy. Write him a fools pass and realize you did fine.

One thing I did think about- how about his lungs? Quadraplegics are very prone to respiratory infections.

ObtundedRN, BSN, RN · Sep 2, 2011

My hospital's policy is call for temps of 101.5 or greater. And our trauma services dept doesn't like to treat fevers unless very high. If I had called for those temps I probably would've gotten more attitude for calling about it, lol.

Butterfliesnroses · Sep 2, 2011

I work in a nursing home and each MD takes his/her own call for their pt unless they are out of town, in which a designated person takes their call. I'm a fairly new nurse on nights and have gotten yelled at more times than I can count for calling. Never gotten yelled at for NOT calling. But I probably would have NOT called. If this happened to me I would pass on in report for them to follow up, but nothing else. I've kind of learned to let getting yelled at roll off my back. I use it as a learning experience and move the eff on.

Esme12, ASN, BSN, RN · Sep 2, 2011

i don't know the exact policies on this to be honest. i think it is just nursing judgement. she originally got a temp of 101 something, she repeated it on the other arm, because the arm she got 101 on he was laying on that side. so she did it on the other side and got 100.4 and thats the one she charted.
i feel like he would have gotten more upset with me if i would have called him at 3am with this. because working nights im always hearing "this could have waited till morning rounds" and i really felt this could have.

i haven't read the whole thread but it is important for you to look up and know your policies. when things go wrong it is the policies and acting within those policies that will save you. acting "outside" hospital policies and procedures no matter how mundane can cause you your job if the right circumstances occur. i only say this because i care and wouldn't want anything to happen..... :clown: and it's plain to see that you care or you wouldn't care about what that putz of the md said to you. if i had a dime for everytime a doc made a mountain out of a mole hill, or got p.o'd about something, i'd be richer than warren buffet. :smokin:

that being said....i probably would have called. in quads the way they respond to small little changes can be quite dramatic especially in the presence of autonomic dysreflexia.

autonomic dysreflexia, "ad" also known as "autonomic hyperreflexia or hyperreflexia, is a potentially life threatening condition which can be considered a medical emergency requiring immediate attention. ad occurs most often in spinal cord-injured individuals with spinal lesions above the (t6) spinal cord level. acute ad is a reaction of the autonomic (involuntary) nervous system to overstimulation. it is characterised by severe paroxysmal hypertension (episodic high blood pressure) associated with throbbing headaches, profuse sweating, nasal stuffiness, flushing of the skin above the level of the lesion, bradycardia, apprehension and anxiety, which is sometimes accompanied by cognitive impairment. the sympathetic discharge that occurs is usually in association with spinal cord injury (sci) or disease (e.g. multiple sclerosis). ad is believed to be triggered by afferent stimuli (nerve signals that send messages back to the spinal cord and brain) which originate below the level of the spinal cord lesion. it is believed that these afferent stimuli trigger and maintain an increase in blood pressure via a sympathetically mediated vasoconstriction in muscle, skin and splanchnic (gut) vascular beds.

the diagnosis is usually not subtle, although asymptomatic events have been documented. autonomic dysreflexia differs from autonomic instability, a term used to describe the variety of modest cardiac and neurological changes that accompany a spinal cord injury, including bradycardia, orthostatic hypotension, and ambient temperature intolerance. in autonomic dysreflexia, patients will experience hypertension, sweating, and erythema (more likely in upper extremities) and may suffer from headaches and blurred vision. mortality is rare with ad, but morbidity such as stroke, retinal hemorrhage and pulmonary edema if left untreated can be quite severe. older patients with very incomplete spinal cord injuries and systolic hypertension without symptoms are usually experiencing essential hypertension, not autonomic dysreflexia. aggressive treatment of these elderly patients with rapidly acting antihypertensive medications can have disastrous results.

the risk is greatest with cervical spinal cord lesions and is rare with lesions below t6. it has rarely been reported in spinal cord lesions as low as t10. the first episode may occur weeks to years after spinal cord injury takes place, but most people at risk (80%) develop their first episode within the first year after injury.

this condition is distinct and usually episodic, with the patient experiencing remarkably high blood pressure (often with systolic readings over 200 mm. hg), intense headaches, profuse sweating, facial erythema, goosebumps, nasal stuffiness, and a "feeling of doom". an elevation of 40 mm. hg. over baseline systolic should be suspicious for dysreflexia.

proper treatment of autonomic dysreflexia involves administration of anti-hypertensives along with immediate determination and removal of the triggering stimuli. often, sitting the patient up and dangling legs over the bedside can reduce blood pressures below dangerous levels and provide partial symptom relief. tight clothing and stockings should be removed. catheterization of the bladder, or relief of a blocked urinary catheter tube may resolve the problem. the rectum should be cleared of stool impaction, using anaesthetic lubricating jelly. if the noxious precipitating trigger cannot be identified, drug treatment is needed to decrease elevating intracranial pressure until further studies can identify the cause.

drug treatment includes the rapidly acting vasodilators, including sublingual nitrates or oral clonidine. topical nitropaste is a convenient and safe treatment—an inch or two can be applied to the chest wall, and wiped off when blood pressures begin to normalize. autonomic dysreflexia is abolished temporarily by spinal or general anaesthesia. these treatment are used during obstetric delivery of a woman with autonomic dysreflexia.

autonomic dysreflexia can become chronic and recurrent, often in response to longstanding medical problems like soft tissue ulcers or hemorrhoids. long term therapy may include alpha blockers or calcium channel

blockers.

complications of severe acute hypertension can include seizures, pulmonary edema, myocardial infarction or cerebral hemorrhage.

the cause of autonomic dysreflexia itself can be life threatening, and must also be completely investigated and treated appropriately to prevent unnecessary morbidity and mortality. the consortium for spinal cord medicine has developed evidence-based clinical practice guidelines for the management of autonomic dysreflexia in adults, children, and pregnant women.

http://www.spinalcord.org/news.php?dep=17&page=94&list=1178

but the doctor didn't have to be such a putz......he could have explained this to you and taught you something in the process. what a jerk....... :rolleyes: .

maelstrom143 · Sep 2, 2011

Wow. I have learned a lot of important information regarding quads from this post. I will probably be eyeing them more closely from now on when getting low grades, as I was not aware a small spike could cause them to become unstable o.O Thank you for all the info!

maelstrom143 · Sep 2, 2011

I would have called toward the end of the shift, as the patient was getting discharged and the temp could signal a serious problem. at our facility we get blood cultures for temps =/> 100.5F, so preemptive orders might have been given and held discharge.