"I'm having chest pain" and you work the night shift at a LTC facility!??!!
I'm new, still have MANY things to learn.
If a patient says this you have him sit down or elevate the bed, ask him about the pain (intensity, location, when it began and what makes it worse), take vitals, search for nitro or aspirin then do what??????? Do you wait to see if the chest pain goes away with nitro or aspirin? Do you go ahead and call the doc anyway? Do you send him out?
What if someone is vomiting and has no order for any anti-nausea meds? Vitals, again question them when it started ect.. do you call the doc or wait until morning if it's "normal" looking?
Just curious, but of course give the nitro if ordered, but wouldnt a persons living will come into play, as far is calling a doc? I may be wrong, as i am just a student. But if they have a DNR and have certain specifics about a living will, wouldnt you just look up their LW before even bothering a doc at 3 a.m.
I used to work in a LTC as an aid for years and when pt's would complain of chest pain and what not, we would give them stuff to make them comfortable and what not, but the next step was to find out what their DNR status was. Some are teminal and dont want to be sent to a hospital. I was just curious since with all your replies nothing was mentioned about DNR. Maybe i am missing the obvious.
Just curious, but of course give the nitro if ordered, but wouldnt a persons living will come into play, as far is calling a doc? I may be wrong, as i am just a student. But if they have a DNR and have certain specifics about a living will, wouldnt you just look up their LW before even bothering a doc at 3 a.m.
I used to work in a LTC as an aid for years and when pt's would complain of chest pain and what not, we would give them stuff to make them comfortable and what not, but the next step was to find out what their DNR status was. Some are teminal and dont want to be sent to a hospital. I was just curious since with all your replies nothing was mentioned about DNR. Maybe i am missing the obvious.
DNR means "Do Not Resuscitate," not "Do Not Treat." If a person is having chest pains, they need to be treated. Of course, whether a patient has a DNR or not, if they are alert & oriented X 3, they can refuse to go to the hospital, but the nurse who is on the unhappy end of that stick needs to educate the patient as to what kind of risk that entails. Of course, the risk will be very different for the terminal patient.
The saddest thing is that "time is tissue" and the sooner the patient gets the heart problem fixed (we've done caths and stents - even pacemakers - on 90-year-olds and most of them come out of it just fine), the faster they recover.
I am an LPN since '92 but recently have done mostly pediatric home health. I am looking for work in a new state, possibly doing home visits mostly with elderly and where it's likely this very problem will occur.
When I worked in LTC, we followed the facility protocol, which incuded monitoring the patient from that point until some resolution, VSs, checking orders for the NTG and giving as ordered. Calling the doctor if no change in patient or symptoms worsen. The patient's life is at stake so don't worry about the attitude of the doctor or anyone else. The nurse must do what is right for the patient.
By the way, when I was a NEW CNA, on my very first home visit, my patient came to the door, after a long delay, with half her face hanging on her neck from an apparent stroke! Was I scared? It was work to convince her to let me call 911 but she went to the hospital and was successfully treated.
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Daytonite, BSN, RN
1 Article; 14,604 Posts
Excellent points, Angie.