Most annoying reason for admission?

[HakunaMatata<3]

I work at a rural hospital and I feel like we admit patients for just about anything...

(Ex.- patient with COPD c/o being out of breath when walking long distances up an incline [sats are WDL otherwise and while in ER])

While I can rationalize a patient being admitted for SOB or something r/t a chronic illness if it is r/t ABCs in any way (regardless if it is a chronic or expected issue) there are some reasons for admissions that drive me CRAZY!

For example "malaise". Really?

The MOST frustrating admitting dx to me is constipation. I mean really? You haven't gone poo in 3 days? Wow, me neither!...(yea probably TMI but working 4 12s and not eating healthy can do that to ya...) But i'm not going to the damn ER am I?

So you're being admitted and i'm going to give you mineral oil/ an enema/ whatever (stuff you can do at HOME) while I have other patients that need actually medical nursing care....

Maybe after drinking a bottle of milk of magnesia for a week and still having trouble i can take you seriously...But really, being admitted as an inpatient for CONSTIPATION just drives me crazy....

(this is regarding average people who do not have any other illness/are not taking opiates or other drugs that can cause constipation)

Am I the only one that is bothered by this?

Am I a horrible nurse for being annoyed by this?

Is there any admitting dx that irks you??

[cardiacfreak, ADN]

I work on a certified stroke unit and get admits for UTIs on 80 y/o people all the time. MRI is negative, no deficits except confusion, CT scan negative, etc. After a few rounds of IV antibiotics they improve. It is exasperating.

[AnnieOaklyRN, BSN, RN, EMT-P]

I had a women who looked well, eating and drinking normal, not in severe pain get admitted for a sinus infection...she showed up in the ER because she was suppose to be a direct admit but we were all out of med surge beds... Yes that is right... she had a sinus infection and was admitted!

Annie

[AnnieOaklyRN, BSN, RN, EMT-P]

Intubated in the field or ER for suspected inhalation injury. No thermal burns. Often for fires in non-enclosed spaces. The patient then gets flown to our burn center. We run parameters, extubate, and often send the patient home the same day.

Just remember most ERs, as well as EMS agencies do not have the ability to look down into an airway with a scope, nor do most ERs or EMS agencies have a lot of experience with significant facial/trunk burns since they are few and far between. It is much better to over intubate burn patients than to misjudge who needs intubation, for it is easy to remove and ETT from someone who doesn't need it, but impossible to intubate someone who's airway has closed from swelling!

As an example I have been in EMS for going on 18 years, to include working in a busy city, I just had my first major burn patient, that is how rare it is. This one required intubation and he was still on fire when we got to him, he was intubated and then trached and in ICU for two weeks, but is alive, imagine if we didn't intubate him... he would have never made it to a burn center alive!

Annie

[dirtyhippiegirl, BSN, RN]

Just remember most ERs, as well as EMS agencies do not have the ability to look down into an airway with a scope, nor do most ERs or EMS agencies have a lot of experience with significant facial/trunk burns since they are few and far between. It is much better to over intubate burn patients than to misjudge who needs intubation, for it is easy to remove and ETT from someone who doesn't need it, but impossible to intubate someone who's airway has closed from swelling!

They do not need a $40,000 helicopter ride to a burn center though. I am talking about patients that we do not even bronch before extubating. If the decision has been made to intubate, than it can be managed locally. People who walk into the ER hours after a car or grill flashover with a sore throat can do with a little watchful waiting or managed intubation at the hospital.

[MECO28, BSN, RN]

I hate when someone is admitted for cyclical vomiting syndrome- and then throw a fit about wanting to eat Cheetos and fast food instead of the clear liquid diet they are usually put on. Maybe you wouldn't need that Q2 Dilaudid if you weren't cramming your face with crap!

[NurseSpeedy, ADN, LPN, RN]

To avoid violating HIPAA, I'm going to have to be vague but you can get the point: Patient is a frequent flyer, dropped off before holidays/weekends/etc all the time by caregiver to the hospital ER. All diagnostic tests are clear. Patient is admitted to the hospital for a few weeks with a diagnosis "(insert medical diagnosis here) per PCG"! I couldn't believe it yet it happened all the time!

Other less annoying ER admits include constipation while residing in a nursing home on a Friday night (I guess the doctor couldn't order a magcitrate or enema over the phone to the facility, instead he ordered it in the ER. No prior efforts done to relieve constipation), Confusion (whith a long term history of Alzheimer'D dementia), and toothache (I guess the dentist had no openings so the ER had to do?)....the list goes on...

[Twinmom06, ASN, APN]

I've seen a constipation admission before - also "abdominal pain" - CT negative, CXR negative, troponin negative WBC WNL- admitted for pain management - which means Q2 dilaudid with 10/10 pain while on the cell phone, tablet etc and asking for the internet password

[Libby1987]

I work on a certified stroke unit and get admits for UTIs on 80 y/o people all the time. MRI is negative, no deficits except confusion, CT scan negative, etc. After a few rounds of IV antibiotics they improve. It is exasperating.

What would you have done with a patient who is normally A&O and not palliative? I can't imagine keeping a family member home who is newly altered.

[Libby1987]

I work on a certified stroke unit and get admits for UTIs on 80 y/o people all the time. MRI is negative, no deficits except confusion, CT scan negative, etc. After a few rounds of IV antibiotics they improve. It is exasperating.

What would you have done with a patient who is normally A&O and not palliative? I can't imagine keeping a family member home who is newly altered.

Well, I have had families who delay several hours after patient becomes altered and by then they're septic. As a rule, we don't manage sepsis at home.

[B52, ADN, BSN, MSN, RN]

A place where I once worked had a rule that any fall was an automatic trip to the E.R. The average age of these patients was early 20s.

[gettingbsn2msn, MSN, RN]

Hate to be cynical but reimbursements must be good on those patients.

[ClaraRedheart, BSN, RN]

We had a morbidly obese patient a couple of months back with PERFECT vitals that had called management to her nursing home, management to the local ambulance companies, heaven and HELL to get to our hospital. Of course they admitted her... she wanted to be here. Admitting diagnosis was "pneumonia"... for which she was being treated for at the facility that she escaped to reach ours. However, Our beds could not fit her. We had to use a patient lift to get her into bed. She hollered so much while in the hoyer, she caused one of my spinal surgery patient's (who really SHOULD NOT have been moving) to awaken and remove all lines, drains, and tubes and really could have fallen had she gotten up. (Lesson here... Set bed alarms on those you don't even expect to be confused!) A nurse on her way to help with our oversized patient found my other patient in this state. Thank GOD she was there. A fall COULD have happened, and didn't. And... this sweet little lady explained that she thought that she heard someone who was hurting and wanted to help