I feel so stupid. What should I have done?

[arelle68]

A CNA came to me and told me that one of my residents was walking fine yesterday, but couldn't walk today. I went to assess her, and had the CNA's lay her down. She was screaming and sobbing. I felt of her hip, and tried moving it around. She was in obvious extreme and unusual pain, and I didn't know what was wrong with her. She is in a very advanced stage of Alzheimer's, and was especially confused today. She really is not capable on any day of telling us where she hurts. She is very delusional. Anyway, I called the Dr, and had her sent out to the ED to be evaluated for her pain. Her son met her there. She came back with antibiotics and pyridium. Dx:severe UTI. The son was upset, and didn't understand why we didn't just give her a PRN pain med. He also thought we should have known about the UTI without sending her out. They had given her pyridium in the ED, and I get her back feeling a lot better. I feel bad that he was annoyed. I feel dumb that I thought it was a hip. What should I have done? How could I have done better?

[yalienne]

I think you did the right thing. It is better to be safe than sorry especially with a dementia patient who is unable to communicate with you. Her son is just a jerk.

[Not_A_Hat_Person, RN]

You did the right thing. Even if you know about the UTI, you can't treat it without a doctor's order. Giving a PRN pain medication won't do anything.

[JessicaSN]

You did the right thing. How does the son expect you to "know" about a UTI? If someone cannot tell you where it hurts, and it isn't causing a fever (yet), it's not like you're psychic.

Severe UTI's in elderly people can lead to sepsis quickly so you totally did the right thing. You had a feeling in your gut that something wasn't right and you followed it. I don't know what you could have done better.

[Virgo_RN, BSN, RN]

What could you have done differently? You could have taken your crystal ball to work with you instead of leaving it at home, duh!

But seriously, I think you did the right thing.

[GQRN]

You actually did the patient a favor by sending her to ER. First of all, if you had suspected a UTI, you'd be on the phone trying to get a hold of the doctor for an order to do U/A with C/S. Then you'd send it to the lab and probably get it back the next day. If her UTI was severe, another day could had led it to Urosepsis, you never know especially at that age.

Sometimes the Doc will see the UA results and choose to wait for the pending C/S results, further delaying treatment.

Another thing, it was a change in condition. Severe pain should be enough to send a patient to the ER for evaluation.

Great job on getting her on ABX sooner.

[canoehead, BSN, RN]

You should have sent her to the ER, which you did. The son is a dummy.

[emmalou*]

You managed her the way I would have. The thing I found the most difficult about aged care when I first started, was some of the relatives. Some people will try to use emotional blackmail to make you feel bad - don't take this on board! They might have their own issues or feelings of guilt placing their parent in managed care and this can have an effect on the way they communicate with the staff.

One of the most common issues for older people are UTIs - the fact that the lady has dementia and isn't able to communicate makes it even harder to assess her. The good thing about her being in the ER is that they would have given her IV fluids and ABs which would have resolved the condition.

You did the right thing.

[morte, LPN, LVN]

son is projecting....politely ignore him

and make sure your aide is aware of how much you appreciate her/his input!

[dskrninpa]

UTIs = Sepsis if not treated properly. You did the right thing.

[Ruthiegal]

You absolutely did the right thing. Elderly can quickly become septic with a UTI. If they are unable to communicate what hurts and when, how would you know! I worked LTC for a very long time, and the son is just being a jerk, he doesn't like spending Mom's money for her. I've seen it time and time again.... We even had one man who's brother was his POA and he would come to our meetings and say.... "why does he need this or that, there should be something left over to give his nieces and nephews..." What about the residents quality of life, he isn't dead yet?? Good job you probably saved a hospitalization with sepsis and further grumbling from the son....

[iwanna]

You absolutely did the right thing. I think some family members will complain, no matter what. Why were they so upset that she was sent to the ED? If it was my mother, I would be happy that they were pro-active, checking everything out.

I had sepsis twice before. Both times I was admitted with IV antibiotics. The last time that I had sepsis, I had no warning signs. I was totally asymptomatic, and woke up in extreme abdominal pain, had shortness of breath, nausea, vomiting, and was in so much pain that I could barely walk. So, I can see how it can just sneak up on you. Again, I reiterate that you did the right thing.