Lame admit Dx's

l.rae · May 25, 2002

50 yr old female w/ no hx...23 obs on tele..dx=numbness of lower lip, throat burning assc. w/chest tightness. pt smokes, has been on ativan long term but has been out of vitamine a for about 5 days..felt a lot better after an im dose was given. duh:uhoh3: lr

mercykitten · May 25, 2002

At my hospital, we consider "near syncope" as pt falls, or maybe comes close to falling but never actually loses consciousness.

Last week we got a transfer from oncology. The diagnosis resulting in the transfer "dehydration." So I asked, "can't oncology treat pt for dehydration?" We still got the pt, who it turned out was having a lot of diarrhea stools and took at least two people to clean up with these frequent incont. stools.

Also, we get a lot of admissions from ER, where the diagnosis is one that if WE (hospital employees with the hospital' insurance) showed up in ER, we were get sent home....definitely not admitted (because the hospital would lose money).

Mietze · May 27, 2002

I just completed a travel assignment working on Peds. Come Friday afternoon the admissions would pour in. All good, however most of the patients were admitted because it was getting close to 5PM on a Friday and the physicians didn't want to stay over. So it was easier to admit and get them off their hands than to deal with the problem. Now granted, some of the admissions were medically necessary.

I wonder...do Dr. ever get labeled as lazy? Go figure!

SmBaxter · Jun 2, 2002

My personal favorite bad dx is CHANGE IN MENTAL STATUS...then they always turn out to be a&ox3-just really weird!

whipping girl in 07, RN · Jun 5, 2002

Sunday night I was "tasking" in ICU (the nurse there for admissions, we always have to have admitability for two pts at the beginning of the shift). Call me crazy but I love to get admissions. You just never know what's going to roll through the door.

Nsg supr calls and says we might get a pt from post-op; no BP, no UO, temp 94 on a bear hugger! Pt's doc happens to be rounding in ICU (pt had been in ICU and I had taken care of him about 10 days before) so I told him about the pt. He said, "Sounds like he's dry to me," which I agreed with based on what I'd been told on the phone.

Nsg supr calls back and says we're not getting pt; then MD calls and tells me he's going to transfer pt to ICU out of pity for the nurse caring for him. "Poor thing, she can't stay in there all night, she has too many other pts and I'm ordering blood for him." He then proceeds to give me the pt's orders and then says, "Use your judgement on verbal orders from me; do what you think you need to do."

Got the pt, LR bolus infusing, lungs sound wet and congested, so we snogged him (I hate doing that to a conscious pt!!) and started blood. After two units and lots of fluid, pressure still 60s-70s, no UO, temp up to a whopping 95. But in the midst of all this drama, I got another admit, pt with pressure 210/120, tachy, confused, completely out of the box, probably DTs! I spent an hour never leaving the second pt's room (titrating Tridil, pushing Ativan and trying to keep him in the bed), and another hr taking him to CT (a CYA order if I ever saw one). Now granted, pt #1 was on a monitored bed, but we weren't aggressively treating the BP (no gtts) and the doc was going to talk to the son about making pt DNR in the AM.

Now I've floated to post op before, and most of the pts are basically self care. It went against my normal habits to not be bouncing in all the time waking them up, checking pulses and vitals. I've seen this particular nurse work, as she's on the same weekends I am (or maybe she's weekend option or something). We get a pt from her every time I work, and she literally runs the whole time she's working, while everyone else seems to have an easy night. They staff by acuity, so I know she's not just getting shyt on.

I guess what I'm getting at is the pt didn't get any better care in ICU than he would have on the floor, as my other pt was out of the box and I was off the unit and some of the other pts were keeping us pretty busy too. I know we have less pts per nurse, but our acuity is so much higher. The pt didn't belong in ICU, but the MD put him there to give the nurse a break?! Now granted, after the fluid bolus and the blood didn't raise the pressure or get some urine going, then I could see transferring him. But I guess the doc was saving himself from getting awakened by this nurse.

Any comments?

dawngloves, BSN, RN · Jun 5, 2002

Originally posted by konnihall

Any comments?

Yeah dude, what the heck is snogged???!!! :eek: