485 and facesheets

[smartnurse1982]

Ok,so I had a question on the general nursing discussion and fell bad for asking it.In any event,I now know some of my pts aren't "brain dead" but they might be in a persistant vegetative state.I have never,ever seen that on any of the facesheets and 485.Meanwhile,I don't really know if the kids are in a vegetative state.Some of the kids I wokr with have no purposeful movements,their pupils don't react with light,have no spontaneous respirations,and are unresponsiveto external stimuli. Most have aw/as cycles.The only thing I've seen are "global developmental delays".It isn't asking the same question as I asked in the general forum,but how would you describe in under "Neurological" on the assessment sheets? Also,how do you describe it under "activity" on the assessment sheets? I just put either Aw or As.Its frustrating to have to explain to Emt's sometimes what's going on......

[Alex Egan, LPN, EMT-B]

I believe the brain death or vegetative state labels only apply to pts who were neuro intact at some point. I have a few patents who are globally delayed and were such since birth. Others who have TBI or anoxic injuries are labeled as in a vegetative state or similar diagnosis.

[CloudySue]

I document "WNL" under the neurological section, if there have been no changes, seizures, etc.

[smartnurse1982]

I believe the brain death or vegetative state labels only apply to pts who were neuro intact at some point. I have a few patents who are globally delayed and were such since birth. Others who have TBI or anoxic injuries are labeled as in a vegetative state or similar diagnosis.

Thanks,and I wish I would have asked this question here first. I had no idea those labels referred to people who were intact at some point. Most of these kids were born that way,although I have one who was in a car accident.

[smartnurse1982]

I always thought "Global Developmental Delay" meant something similiar to a "vegetative state" but wasn't sure.

[JustBeachyNurse, LPN]

I always thought "Global Developmental Delay" meant something similiar to a "vegetative state" but wasn't sure.

Not necessarily. I was taught it refers to delays in all areas of development present since young childhood, if not birth. I have patients with this label who are most definitely not in a PVS. They had a brain insult near birth resulting in CP or a genetic anomaly/chromosome disorder. Two are significantly mobility impaired but definitely have the ability to communicate and definite purposeful movements, both follow 1-2 step commands and can use AC devices like large button switches. Obvious sleep-wake patterns. One is more active than the others and can even take steps in a gist trainer.

[ventmommy]

Global developmental delay does not mean anything close to persistant vegetative state. GDD is a delay in skills in multiple areas of development (speech, vision, motor, cognitive, social). The delays can be mild, moderate, severe. The delays can be related to TBI, Down's, autism, neglect or any one of many other diseases and disorders.

[Esme12, ASN, BSN, RN]

Ok,so I had a question on the general nursing discussion and fell bad for asking it.In any event,I now know some of my pts aren't "brain dead" but they might be in a persistent vegetative state.I have never,ever seen that on any of the face sheets and 485.Meanwhile,I don't really know if the kids are in a vegetative state.Some of the kids I work with have no purposeful movements,their pupils don't react with light,have no spontaneous respiration's,and are unresponsive to external stimuli. Most have aw/as cycles.The only thing I've seen are "global developmental delays".It isn't asking the same question as I asked in the general forum,but how would you describe in under "Neurological" on the assessment sheets? Also,how do you describe it under "activity" on the assessment sheets? I just put either Aw or As.Its frustrating to have to explain to Emt's sometimes what's going on......

You just describe what you see...labeling them with a medical diagnosis is not within your scope.

patient remains unchanged/comatose. Patient is non responsive to noxious stimuli (painful stimuli) and has no spontaneous/purposeful movement. Pupils are non reactive @ 4mm no self resps.

To document AW/AS cycles in a comatose patient I would think you would have to see that on a EEG.

To describe to EMT/medics...the patient remains comatose since....what ever event that made them this way....and is essentially unchanged...the pupils are non reactive @ 4mm patient doesn't respond to noxious stimuli and had no spontaneous/purposeful moment/respirations at base line.

[Alex Egan, LPN, EMT-B]

I don't think there is any harm in trying to understand WHY our patents have a specific diagnosis.

[Esme12, ASN, BSN, RN]

of course not.....but charting that a patient is in a persistant vegatative state is not nursing responsibility.

[Esme12, ASN, BSN, RN]

I always thought "Global Developmental Delay" meant something similiar to a "vegetative state" but wasn't sure.

Global developmental delays ......

[h=3]What Are Developmental Delays in Young Children?[/h] There are many different types of developmental delays in infants and young children. They include problems with:

• language or speech
  
• vision
  
• movement -- motor skills
  
• social and emotional skills
  
• thinking -- cognitive skills
  

Sometimes, a delay occurs in many or all of these areas. When that happens, it is called "global developmental delay." Global developmental delay may occur for any of the following reasons:

• a genetic defect, such as Down syndrome
  
• fetal alcohol syndrome, caused by a mother drinking alcohol during pregnancy
  
• fragile X syndrome, an inherited type of cognitive impairment
  
• severe medical problems developing soon after birth, often associated with prematurity
  

Persistent vegetative state.....

A persistent vegetative state is a disorder of consciousness in which patients with severe brain damage are in a state of partial arousal rather than true awareness. It is a diagnosis of some uncertainty in that it deals with a syndrome. After four weeks in a vegetative state (VS), the patient is classified as in a persistent vegetative state. This diagnosis is classified as a permanent vegetative state (PVS) after approximately one year of being in a vegetative state

The vegetative state is a chronic or long-term condition.

This condition differs from a coma: a coma is a state that lacks both awareness and wakefulness. Patients in a vegetative state may have awoken from a coma, but still have not regained awareness. In the vegetative state patients can open their eyelids occasionally and demonstrate sleep-wake cycles, but completely lack cognitive function. The vegetative state is also called a "coma vigil". The chances of regaining awareness diminish considerably as the time spent in the vegetative state increases.

The persistent vegetative state is the standard usage (except in the UK) for a medical diagnosis, made after numerous neurological and other tests, that due to extensive and irrevocable brain damage a patient is highly unlikely ever to achieve higher functions above a vegetative state.

This diagnosis does not mean that a doctor has diagnosed improvement as impossible, but does open the possibility, in the US, for a judicial request to end life support^. Informal guidelines hold that this diagnosis can be made after four weeks in a vegetative state. US caselaw has shown that successful petitions for termination have been made after a diagnosis of a persistent vegetative state, although in some cases, such as that of Terri Schiavo, such rulings have generated widespread controversy.

[Alex Egan, LPN, EMT-B]

^^^^^^ now that's informative. Thanks.