I'm a new nurse with a (probably) pretty novice question, but here goes. Pt of mine in late seventies, admitted with ARF, UTI, dehydration, anemia, and COPD. Has hx. of an AAA that is currently inoperable. Over the last 3 days he has had 2-3+ pitting LE edema, BP's sometimes reaching over 200 systolic, 100 diastolic ( and PRN clonidine), SOB, and some crackles in the lower right lobe and heartburn. Both times of SOB his sat's have been 95%+ and his pressure WNL. No c/o tightness in chest or pain, just unable to catch his breath. No hx. of anxiety issues.
My nursing judgment had me worried so I called the doctor at 3am expecting SOMETHING from him, but got nothing other than clonidine. Not even a CXR or BNP! I gave him the exact list of symptoms that I wrote here but he did not seem concerned. I know the feeling of doctor's not listening to me, since I sound very young on the phone and am new. Meanwhile, this pt has continuously high BP's, renal issues and an AAA and edema that is unaffected by his current dose of torsemide. I really feel there is something more going on here but doc isn't concerned... I personally have no rapport with this doctor and I don't know how he practices since he has very few pt's at my facility. I think the poor guy needs more of a work-up but doctor is apparently waiting for him to go into (if not already) CHF or have an MI.
What do you think?
ETA: I also want to mention that his heart sounds were muffled. Not necessarily 'adventitious' (if that can be used as a cardio term), just somewhat difficult to auscultate. Every patient sounds different and some people are harder to heart than others, I guess due to their anatomy. Then again, I don't have a super duper cardiologist stethoscope either.
so why are they not going to fix the AAA, you can't live long with one. I had a pt with a AAA and it was asending and desending and they had it fixed that night.
Of course you can. Not all of them are even noticible to the pt. People know they have them, know they need to be careful and manage their BP; this patient was diagnosed in the 80's to have it. His doctor's say it is unchanged, remarkably, and does not require surgery at this point.
Oh I loooooove docs that don't listen! Be persistent....remember that you are your patients advocate, you have the knowledge that is screaming at you there is something wrong with this pt., so by all means, be persistent with this doc.
AND make sure that you are charting when you notify the doctor of pt. change in condition and the response (or lack of) he gives you.
And don't be afraid to say "Dr. Jones, I really think that we need to get a CXR/BNP/ect on Mr. AAA because of ______________"
I think this shows the doctor that your just not talking to hear yourself talk, but because you know there is something wrong.
I agree. Don't be afraid to tell the doc what you want/need for this & future patients. A very good doc told me one day, "you guys are my eyes and ears."
I had a Dr like that, refused to listen to my comcerns. One night I called and quickly stated that even tho VS & assessment appeared wnl I truely felt something was not right. He finally listened to a report of what had been going on over the last few days, ordered some tests & found the pt was heading south in a major way. Pt was taken care of and is still here a year later. Sometimes you just need to jump in and talk fast to get them to hear you.
Cat_RN, ASN, BSN, RN
298 Posts
Of course you can. Not all of them are even noticible to the pt. People know they have them, know they need to be careful and manage their BP; this patient was diagnosed in the 80's to have it. His doctor's say it is unchanged, remarkably, and does not require surgery at this point.
Depends on the pt.