when a hsopice patient goes to the hospital

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okay, i have a patient who has copd and chf. his chf has been worsening for the past couple of months but symptoms have stayed under control. he is 89 years old and lives alone out in the country.

the day after christmas i was on my way to his house for a meeting with his daughter and son and our sw. i get paged and it is the pt's home number. i got there within several minutes of being paged and the patient is having severe cp and is nauseated. bp is 189/77 p is 86, afebrile and cp is nonradiating. patient stated he had been having cp since christmas morning and had been taking nitro sl but didn't call hospice even though the pain was more severe than normal anginal pain. he also stated he had not taken evening or morning meds.( he is on over 20 meds daily).

he had taken 3 nitro sl within 30 minutes before i arrived. i gave him 10 mg of roxanol and called my nurse manager. i was thinking mi she was too and the patient was in severe pain. the only thing i had to work with was the roxanol. i gave another 10mg and the pt had noimprovement in his symptoms. since i could not get his pain under control i called the squad and they took him in. he was admitted for exacerbation of chf and i went to the hospital to talk to his nurse and give her report( we do this whenever a patient gets admitted).

the nurse was soooo rude to me. i know she was busy i used to be a floor nurse. i was talking to her about the o2, they had him on 4 liters. i told her to watch him on the much o2 (i know my patient). she asked what he sat'd at home. i told her hospice treats symptoms and we do not check sats etc. i got a very rude comment from her. then i tried to tell her about his normal anginal pain and his use of nitro sl.... again a rude remark and she walked away. i tried to talk to three rns and not one made any effort to listen to me. finally i gave the paperwork about the patient to the unit secretary who placed it in front of the chart.

i felt really stupid standing there while three nurses walked away from me. are we not all supposed to work together?????

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Wow. Whenever I've had a patient on hospice I have been SO grateful to the hospice nurses for teaching me about how to help their person.

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glad to hear it!!! i try not to get in the way and be helpful when i have a patient in the hospital. i don't want them there. i want to care for them at home. it just seems like it always happens t me on this particular floor...:o

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I don't totally understand hospice and how it all works, and if I were taking a hospice patient I'd appreciate the insight. I wonder why the nurses on the floor treated you like that. Jeez.

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Specializes in Palliative Care, NICU/NNP.
I don't totally understand hospice and how it all works, and if I were taking a hospice patient I'd appreciate the insight. I wonder why the nurses on the floor treated you like that. Jeez.

I wonder if the floor nurses were so rude because they don't realize what an opportunity they have taking care of someone at the end of life. Maybe they see hospice patients as not as important as someone with an acute illness that's getting better.

For the OP, why is this man still on so many meds? Does he have Roxanol readily available to him?

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