MarcusKspn 3,976 Views
Joined: Sep 23, '02;
Posts: 173 (2% Liked)
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I think that I remember that PT/INR is not a very good test that checks for the effects of Lovenox, but shouldn't we have been running some sort of test to see how the Lovenox that we gave for 30 days is affecting thinks
OK, so right now I am feeling like a worthless piece of excrement. I just wanted to post here and let you guys know what happened to see what you think about happened. I also want to post this to serve as a warning to everybody else out there. So here I go......
On Oct 17th we admitted a patient to our floor (LTAC) with Dx of Closed Head Injury/Subdural Bleed d/t MVA. He has been awake this whole time but did not follow any commands, non-verbal, non-tracking, moves all 4 extremities. He's on Lovenox 30mg to prevent DVT's. He has made great progress, he's not pulling on his tubes anymore, has great muscle tone and will hold up his upper body when standing, actively sniffing when you hold a candle to his nose. A couple of days ago his wife started to notice a change in his behavior, yesterday his doc ordered a MRI, showed fluid around the same area of the brain that was originally injured. Surgeon came by and talked to family about doing surgery tommorow. They agreed and he left, no orders written about anything. This evening I called the doc up, asked him if he would like for us to hold the Lovenox, do any pre-op labs for him, anything of that nature. Got an order to draw PT/PTT in the morning, and any labs that have not been done in the last 7 days. Here is where it turns bad in my eyes:
I pulled up his records and since he has been admitted on 10/17, there has been a CBC, BMP on 10/19 and that is IT!!!!! No orders to draw any labs since then and today is 11/17/05. Now here is what makes me feel like I should just go and hand my Nursing License over.
Patient was admitted on 10/17/05 for rehab s/p subdural bleed, has been getting Lovenox 30mg daily x 31 days, has not had any PT/INR drawn in those 31 days, and now he is having a Bilateral Frontal Craniotomy tomorow for a sudden buildup of fluid pushing on his brain. Now granted - it could be a very slow buildup of fluid due to the old injury - but I am pretty sure its a hematoma thats causing all his problems.
I have had the patient 4-5 times in those 31 days. I have given the Lovenox without thinking "Gee, we are giving him a blood thinner, lets see just how thin his blood is, gee, we sure haven't done a PT/INR in a couple days, lets check that" and none of the other nurses or his doc or his surgeon thought about checking the PT/INR. I was thinking about going to our QA/PI nurse and talking to her about this, I think we should report this as a Sentinel Event if his PT/PTT is through the roof tomomorow. I think this would be a wakeup call to really shake us all through the core and teach us to pay attention to details. I talked to some of the other nurses about why his PT/INR slipped through the cracks, and there seems to be some concensus on the floor that goes "It's his doctors job to order meds and order labs, we just follow orders." So here is what I think.
1) Everybody is responsible for what happened to this patient, I had him as a patient, and I feel this is just as much my fault as anybody elses.
2) It is our responsibility to check that if we give any meds, we need to make sure that this med is save to give - Check lytes for diuretics and lyte administration, PT for blood thinners, Levels for Vanco, etc...
3) I think we should report it as a Sentinal Event, if for nothing else as to learn from this.
I agree that you have to uncover someone to examine the injury. But if you knew that it was an isolated leg injury you only need to uncover the leg to examine. You can do a "feel" exam through the rest of the clothing to check from head to toe for crepitus and see if any other injuries are present. I always try to leave the patient covered up as much as possible. Even during a bath I don't leave my patient laying there naked. They have a bath blanket and I will uncover one arm-wash-cover up, other arm-wash-cover up, chest-wash-cover up, private parts-wash-cover up. There is no point in having a patients breast uncovered if you are washing her feet, and vice versa.
I got this a couple years ago for my birthday.
All Puppy Dogs Eat Iams
(Atropine, Pace, Dopamine, Epi, Isuprel)
I have heard conflicting information about whether or not Vasopressin can be given down the tube?
I always liked NAVEL to remember drugs that can can down an ET Tube
Of course, things may have changed since I last certified last year!Good luck.
Just remember the basics: Atropine SPEEDS up the heart etc...
ABC's of course
Basic heart arrythmias and normals
I will read its articles and get back to you....
What does everybody think about the European Union signing a member-wide Constitution.
I would really like to hear what our European members have to say about this.
Read about it here:
With 303 Electoral votes, I'm gonna go out on a limb here.
I pray that you bless this nation on this day. I pray that you are with the people standing in the lines, waiting to make their voices heard. I pray that you are with the election workers, working to keep the american dream flowing shmooth. I pray that you are with all the candidates today, that you are with their families.
I pray that people vote based on the convictions of their hearts. I pray that every person that is able will go out and make his or her voice heard. I pray that your angels protect the United States on this day.
I pray that the candidates will accept the decisions of the people. I pray that the people who voted for the other person will come together with whose person won, and that they celebrate that they had the oportunity to be a part of such a great thing.
I pray that this election will not bring more division to this nation, but that we will be able to accept the decision that has been made.
Lord, bless this nation and keep it safe.
I hope everybody stays safe, people and nation, and that the will of the population of the United States will be done.
Before voting even began in Philladelphia -- poll watchers found nearly 2000 votes already planted on machines scattered throughout downtown... One incident occurred at 2601 N. 11th St., Philadelphia, Pa: Ward 37, division 8... pollwatchers uncovered 4 machines with planted votes; one with over 200 and one with nearly 500... A second location, 1901 W. Girard Ave., Berean Institute, Philadelphia, Pa, had 300+ votes already on 2 machines at start of day... INCIDENT: 292 votes on machine at start of day; WARD/DIVISION: 7/7: ADDRESS: 122 W. Erie Ave., Roberto Clemente School, Philadelphia, Pa.; INCIDENT: 456 votes on machine at start of day; WARD/DIVISION: 12/3; ADDRESS: 5657 Chew Ave., storefront, Philadelphia, Pa... Developing...
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