LTC- resident in clear distress

[anonymous1919]

You enter your residents room and notice they are having respiratory problems. Their breathing is rapid and shallow and the pulse ox says low 80's. What do you do? Call the doctor and get an order for oxygen? Put oxygen on and then get the order? What if the doctor refuses the order and you put it on? Do you chart you applied oxygen before getting an order?

Just interested to know what you do as a nurse in this situation, thanks.

[CoffeeRTC, BSN, RN]

Apply O2. Give Aerosol tx if they have PRN order. Check MAR/Hx of COPD etc..and Code Status! Call Nursing Supervisor. Call Dr.

I had a resident who went on resp distress; DNRCC with Hx of Asthma/COPD...etc. I applied O2 + Aerosol tx; check MAR for Hx and Code Status. Contacted Dr. He did not want her sent out; ordered PRN Morphine. Contacted Family

to update on changed of condition. She passed away peacefully 2 days later..provided Comfort Care.

That is what I would have done!

(Skip the supervisor part since I am the supervisor) add in reassess after the O2 and neb tx.

Most LTCs do not have standing orders due to the regs.

[Spacklehead, MSN, NP]

Compound fracture is two breaks on the same bone. Open fracture is when the bone breaks through the skin.

She hung up on you? I can't imagine.

Not to drag this out, but compound fractures and open fractures are the same thing - and the term is used interchangeably.

[JulieCVICURN, BSN, RN]

Spackle is correct. A compound fracture is one associated with tissue laceration and is the same as an open fracture.

[anonymous1919, LPN]

Rude.

[Schmoo1022]

Ok not to sound stupid, or to change the subject but...I work in a small, and I mean small facility. What types of things do you notify the supervisor about? Do you let her know before you send a resident out?

[misschiatia]

Previous responder is right. Code status is your deciding factor. A resident who is a full code wants you to fight for his or her life to the finish. That means O2, nebulizers, ambulance, intubation, and the whole 9 yards before you give up. If you do not apply oxygen in a situation like that, probably the ambulance and intubation will eventually not be necessary, your patient could seriously deteriorate while you're waiting for Dr Joe Blow to call back:confused:.

Also, I would be careful about saying ALL nursing homes have standard orders to apply O2. I've worked places where it's a case by case basis. If it's not written in the medical record where you can see it, i would not assume that i was covered by standing orders.

That being said, I wouldnt even let the order bother me. As a nurse, I have a responsibility to my patient. I would definitely apply O2 per my nursing judgement while I waited for the doctor to call back. And if I had reason to fear for the outcome of my resident, I would and have sent my resident out to the hospital for treatment. The doctor can yell at you, but YOU are the nurse that is there with the patient. :idea:His or her life is in your hands. I believe that if you are using sound clinical judgement and have thoroghly evaluated your patient and have reason to fear for their condition, you can do nothing less. Im not saying to start pulling out and administering meds, but basic needs like your ABC's call for you to use your judgement and act .

Have you spent any time in a hospital? I am long term care to the core, but i still did 1 year hosp. It gives you a stronger clinical background and helps you feel more comfortable making and justifying those judgement calls

[kaliRN]

"Also, I would be careful about saying ALL nursing homes have standard orders to apply O2. I've worked places where it's a case by case basis. If it's not written in the medical record where you can see it, i would not assume that i was covered by standing orders.

That being said, I wouldnt even let the order bother me. As a nurse, I have a responsibility to my patient. I would definitely apply O2 per my nursing judgement while I waited for the doctor to call back. And if I had reason to fear for the outcome of my resident, I would and have sent my resident out to the hospital for treatment. The doctor can yell at you, but YOU are the nurse that is there with the patient. :idea:His or her life is in your hands. I believe that if you are using sound clinical judgement and have thoroghly evaluated your patient and have reason to fear for their condition, you can do nothing less. Im not saying to start pulling out and administering meds, but basic needs like your ABC's call for you to use your judgement and act ."

The theme I have seen on this topic, from those with the most expertise, is to know what your standing orders are wherever you are working. Never assume! I have been in facilities where ICU RN's because of their autonomy had standing orders for everything from the ABC's to lyte/blood replacement and the telemetry units had no standing orders unless written by the MD on admission (i.e. "Hello, Dr. Joe Blow, may I please have orders for seizure protocol on Pt. E. pilectic?"). I would presume an even greater variance in LTC. By knowing your standing orders, you CYA and make sure the Full code gets the appropriate amount of intervention.