I'm going to stick 2 questions in one here. In my hospice we take vital signs routinely on visits. If we don't one time, no big deal, but we usually do. My question is why? What do we do with them? I mean I guess if a patient choses to stay on a BP medication or Dig or something it's good to monitor. But if now, I don't understand why if we are not going to treat the VS!
And, another tricky/annoying case I have. Man has many comorbidites, is bed bound, contraced, peg, foley, and on hospice. Wife is NUTSO. His skin is sooooo fragile, the man sweats, the wife doesn't touch him from like 9pm ot 7 am..... so in the morning his back is awful, closed skin, but red and perspiring and the sheet was greenish, but after cleaned, and aired out, back looks great. No reason to call the doctor right away. because he had recently seen his back according to her. patient is afebrile, the most comfortable I have ever seen him, no pain. Wife goes off, because I do in a few days call the doctor because she was worried about something else, turns out he was going to make a home visit that day. She tells me today after some other big fiasco he has a horrible infection and was prescribed antibiotics which she didnt even start yet. I look at his back and it looks better than I have ever seen. She was mad, I consoled her.... she has alienated pretty much every hospital in the area and nursing home already so I didn't take it personally.
But in a hospice nurses opinion..... if he is comfortable, pain free, back looks good after actually being cleaned...... are you running to the doctor?
My supervisors fine me not at fault at all thank god. But it makes me question myself, how far do you take it in hospice?
Jul 11, '12
I think it's really dependent on the situation.. Remind yourself what are the goals? In a perfect nurse world, that patient would have been turned q 2 hours BUT this is hospice. The goals are equally as important to the patient as it is to their families. If he has no pain/discomfort issues with the long stretch of no movement at night then u are probably meeting their goals. It sounds like the spouse is doing the best they can, and to ask her to interrupt her sleep to make sure he is repositioned might cause her to burn out. If she gets to a state where she can no longer care for him effectively while meeting their goals you might want to discuss looking for alternatives to care services. But again, it's dependent on the specific situation
As far as vitals go, my company needs to keep record for purposes of documenting decline. VS are much more than numbers. Putting them with clinical assessment can give u clues to pain, discomfort, infections, and so forth. Sometimes it feels unnecessary, and maybe it is, but VS give you a base for your assessment.
Jul 11, '12
Vital signs are a good indicator of how your patient is doing. If his RR has always been 18 and now it is 12 - is there a reason? did he have an increase of opioids or is he declining? If his HR is usually 90 but today is 120 that may indicate that he is in pain. If you came on shift and he seemed ok, but you didn't take vitals and now he is declining; What are you going to tell the doctor? you can't tell him, his HR was 90 and not it is 120 because you don't have baseline vitals.
I always take vitals on my patient during my assessment.
Jul 12, '12
How often VS are measured is often a combination of the practice expectations of the agency, the medical director, and the RN. They can be a useful measurement when describing changes in patient condition.
They also can be upsetting and uncomfortable for the patient, especially the BP.
I do not require hospice nurses at our agency to measure VS unless they feel that it is adding something to their care or documentation that is pertinent and necessary...I allow the nurses to use their clinical judgement, and our medical director is comfortable with that philosophy. Often the HR and RR are the only numbers the nurses report unless there is need for a specific temp or BP measurement.
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