Frustrated Patient

roser13, ASN, RN · Nov 25, 2017

Way too few details for anyone to understand the situation. But please do not post any more details that could potentially identify the patient.

MunoRN, RN · Nov 25, 2017

The answer to whether she could benefit from further testing is why we have physicians and other LIPs, she would need to pursue that with her physician, NP, etc.

It's certainly not unusual for patients to not get a diagnosis with initial testing, and require additional testing. It's also not unusual for patients to be convinced there is something physically wrong with them when no actual problem exists, as in the case of Factitious disorder (Munchausen disorder) and others.

amoLucia · Nov 25, 2017

sounds like homework

Orion81RN · Nov 25, 2017

sounds like homework

OP is an MA that works in a primary care clinic setting who, in another post, responded to this statement:

"Nurse and MA don't have much in common beyond taking vital signs. You'll pretty much be starting from scratch," (refering to starting nursing school) with

"My MA program was actually pretty comprehensive and I know the scope of practice can be different by state, but here I was trained in basic phlebotomy, pharmacology, injections, in-house labs, EKG, and assisting in minor office surgeries, on top of vitals/a&p/med term and all of my insurance and office admin classes. And the only one of these skills I don't deal with at my job is venipuncture, because all those are sent out. Everything else I do regularly."

So I took this as OP saying she already has much of the knowledge a nurse does.

OP, since you previously claimed you had comprehensive education on A&P and labs in your MA program, how about you tell us the answer to your question.

LovingLife123 · Nov 25, 2017

OP is an MA that works in a primary care clinic setting who, in another post, responded to this statement:
"Nurse and MA don't have much in common beyond taking vital signs. You'll pretty much be starting from scratch," (refering to starting nursing school) with
"My MA program was actually pretty comprehensive and I know the scope of practice can be different by state, but here I was trained in basic phlebotomy, pharmacology, injections, in-house labs, EKG, and assisting in minor office surgeries, on top of vitals/a&p/med term and all of my insurance and office admin classes. And the only one of these skills I don't deal with at my job is venipuncture, because all those are sent out. Everything else I do regularly."
So I took this as OP saying she already has much of the knowledge a nurse does.
OP, since you previously claimed you had comprehensive education on A&P and labs in your MA program, how about you tell us the answer to your question.

I love this. Lol.

KelRN215, BSN, RN · Nov 26, 2017

There is not nearly enough information in the OP to make a judgment. What are the patient's symptoms? What has been done as far as testing in the past?

This thread made me think of everything I went through as a patient 7 years ago, though, after routine labs came back with my K+ at 3.2. Repeat testing confirmed hypokalemia with a K+ of 3.1 and it took weeks for my potassium to normalize on supplements and I required 60 mEq KCl/day to even get my level to 3.5. I continually expressed concerns that the Topamax I had been started on for my headaches was the cause and was brushed off by multiple people- PCP, 1st Nephrologist I saw, Neurologist, Pharmacist. I went through many months of testing and was diagnosed with partial central diabetes insipidus (I also have a history of a brain tumor and, at this point in time, there were changes on my MRI that were concerning for "possible tumor recurrence") but, even though I responded to the DDAVP I was started on with resolution of my polyuria/polydipsia, my potassium levels still didn't improve. Central DI wouldn't really explain hypokalemia anyway. During this time, multiple MDs also overlooked that my serum bicarb was hanging out in the 19-20 range. It was a pediatric Rheumatologist who I knew in my personal life who found an article for me on the link between Topamax and Renal Tubular Acidosis (which causes hypokelamia).

I sought a second opinion from a different Nephrologist, he repeated some tests- had me hold my KCl supplements and I immediately became hypokalemic again- and diagnosed me with Renal Tubular Acidosis. Topamax was the likely culprit. He had me stop it and stop potassium supplements and within a week off supplements, both my potassium and bicarb levels were back to normal. The first Nephrologist I saw was all set to diagnose me with psychogenic polydipsia and call it a day. I really had to push my PCP to give me a referral for a second opinion, too.

allnurses Guide · Nov 26, 2017

Way too few details for anyone to understand the situation. But please do not post any more details that could potentially identify the patient.

I concur - but if her symptoms are significantly altering her quality of life then I would suggest a referral to a medical school with a differential diagnosis program.

Hppy

Mavrick, BSN, RN · Nov 26, 2017

There is a patient fairly new to our clinic who has been struggling to find a dx and subsequent treatment for her symptoms for almost 2 years. She has had recent labs done that came back almost all within normal range except for a few minor ones like cholesterol that was slightly elevated, but nothing that would sick right out and explain her symptoms. But she does have a lot of lab values that are just barely within normal range. So my question is, could she possibly benefot from further testing? Has anyone else seen a pt like this?

Of course any patient could possibly benefit from further testing depending on what kind of testing you mean, but I don't think this is the real question. I think the OP is the one who is frustrated, not so much the patient. I see the question as, after 2 years of testing why hasn't our clinic found a diagnosis for this poor woman and prescribed some sort of treatment?

The erroneous assumption is that every human condition has lab tests that can identity it and then subsequently treat/correct it.

An amazing show on TV is "Mystery Diagnosis" where people have all sorts of strange symptoms that sometimes takes years to develop a pattern that the properly informed physician can recognize. The disease itself can be extremely rare or have a very rare presentation. In some cases it takes a physician who will carefully listen to a patient history and can diagnose from that. And, of course, a diagnosis does not always have any meaningful treatment. Sometimes all you get is an acknowledgement that others have it too and nobody has figured out what to do about it.

jodispamodi · Nov 26, 2017

Isn't this a question you should be asking the LIP's at your clinic? If you are concerned the patient has labs that might indicate subclinical disease or pathology you should talk with her providers about your concerns.

FSZ Student Nurse, RN · Nov 27, 2017

OP is an MA that works in a primary care clinic setting who, in another post, responded to this statement:
"Nurse and MA don't have much in common beyond taking vital signs. You'll pretty much be starting from scratch," (refering to starting nursing school) with
"My MA program was actually pretty comprehensive and I know the scope of practice can be different by state, but here I was trained in basic phlebotomy, pharmacology, injections, in-house labs, EKG, and assisting in minor office surgeries, on top of vitals/a&p/med term and all of my insurance and office admin classes. And the only one of these skills I don't deal with at my job is venipuncture, because all those are sent out. Everything else I do regularly."
So I took this as OP saying she already has much of the knowledge a nurse does.
OP, since you previously claimed you had comprehensive education on A&P and labs in your MA program, how about you tell us the answer to your question.

Ouch!!! Orion81, I think you misinterpreted OP's response.

I went back to the thread you mentioned, and I didn't notice any claims from OP that she believes she has "much of the knowledge a nurse does". I only saw a clarification that MAs do more than "take vitals"; they also have BACKGROUND knowledge in some of the subjects taught in Nursing School. Also, I believe she was referencing MA skills when she said that the only one skill she didn't deal with is venipuncture...

And in support of MAs, I have one in my class and she definitely knows her stuff! Perhaps she doesn't have the same skill level in terms of acute care, but she seems to know more than some of the LPNs!

As for OP's question, as Roser13, ASN mentioned above, I do not think you provided enough information to answer the question, nor do I believe would it be wise to do so.

Without more specific information, these questions came to mind:

- What is the severity of her symptoms? What is the potential gain of a dx, in her case?

- Would a dx enable tx? How effective is that tx? What is the quality of life for a pt undergoing these txs?

- Some diagnostic tests and procedures carry risks or inordinate expense; are these justified in the case of this patient?

Depending on the answers to the above questions, further testing might be a question for the patient's MD/NP or an ethics committee.

No Stars In My Eyes · Nov 27, 2017

OP is an MA that works in a primary care clinic setting who, in another post, responded to this statement:
"Nurse and MA don't have much in common beyond taking vital signs. You'll pretty much be starting from scratch," (refering to starting nursing school) with
"My MA program was actually pretty comprehensive and I know the scope of practice can be different by state, but here I was trained in basic phlebotomy, pharmacology, injections, in-house labs, EKG, and assisting in minor office surgeries, on top of vitals/a&p/med term and all of my insurance and office admin classes. And the only one of these skills I don't deal with at my job is venipuncture, because all those are sent out. Everything else I do regularly.".

She may very well do all the work she claims, but does not have the education required to INTERPRET the results.

That, OP, is outside of your scope of practice.