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Discussion

Help Me! with changes in condition to report to M.D?

I am a fresh new LVN student, i have a question about what changes in condition of a patient would require the LVN to go notify or report them to the M.D? would it be a drop in blood sugar? new respiratory sounds identified? I HAVE NO CLUE, PLEASE HELP GUIDE MY THINKING INTO THE RIGHT DIRECTION :( all i have at the moment is my fundamentals book of nursing but it isnt much help, ive looked all over for it and i cant find which changes of condition would be reportable to a M.D???

Sorry if this is dumb question, ive only been in school for one week. i want to learn & i know asking question is the best way to learn so any help would be really appriecitated guys

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    A lot of this depends on what's normal for the patient and what the patient is admitted for. Things like chest pain in a cardio patient, a severe drop or rise in blood sugar, and decreasing O2 sats in a bronchitis patient would be examples of items I'd call to report.

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    First look at vital signs. A patient who was afebrile at the beginning of your shift develops a fever of 103 degrees that persists. Add to that profuse perspiration, a productive cough, vomiting, incoherent speech, etc., etc. At some point you are going to call the doctor to report. Also look in the set of orders or the MAR for parameters to report. "BP 30 minutes after administration of ......is above ......, report to MD." Sure bet that if the doctor included parameters within his/her order, you can't go wrong by following those instructions.

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    Any change in baseline should be reported. Especially within MD's orders. Vital signs, a good assessment, and reviewing all of your orders and medications will prepare you to gather any information that is not at a patient's baseline.

    And to follow chain of command as an LPN--is the policy that you discuss findings with RN, charge RN?

    But I would think the answer would be any change in condition.

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    All changes in condition that require further diagnostic testing or can't be safely managed with existing orders should be reported, the only question is when they should be reported. A lot of things can wait until the MD rounds ...or at least until the MD is more likely to be awake.

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    Generally you would call the physician when theres a change in the patients status. Pretty much when they aren't their usual self. Things you would call for would be a decreased LOC, new/unexpected s/s like vomiting, diaphoresis, pain. You can call for significant changes in vital signs. Like someone previously mentioned, usually there are parameters as when to notify the MD. You would call if the pts urine output is

    Also like someone mentioned, you can always ask the charge nurse if you're unsure as to how urgent the situation is. Ex: If its 2AM, you wanna know if this issue can wait till the doc will be there in the AM or is it something that needs attention ASAP.

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    I think you are getting a little too ahead of yourself :)

    You just started school. Your fundamentals textbook sounds more like a compilation of skills. Later on in your studies, you will learn normal baselines, normal growth and development, a little about normal physiology and the pathophysiology of specific diseases. Then, you will know what is abnormal and worthy of reporting to the doctor.

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    Agree.....

    I think you are getting a little too ahead of yourself :)

    You just started school. Your fundamentals textbook sounds more like a compilation of skills. Later on in your studies, you will learn normal baselines, normal growth and development, a little about normal physiology and the pathophysiology of specific diseases. Then, you will know what is abnormal and worthy of reporting to the doctor.

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