oncology RNs... please help this home health RN...

wunzieRNBSN · Nov 4, 2011

First of all, I'm a home health nurse. I just admitted a patient to our agency with main dx of DMII, CHF, and multiple pressure sores.

Anyway, my pt is a female, 37 yrs old, but morbidly obesed. close to 600 lbs. non ambulatory. completely bedridden. and recently diagnosed with uterine cancer while she was hospitalized. She was diagnosed with uterine cancer when they did a D and C to stop her heavy menstrual bleeding that lasted for 3 wks. pt is on coumadin d/t hx of pulmonary embolism x2. She had a group of physicians talk to her about her diagnosis and their plan... I guess they decided that since her cancer is stage 1. they need to prioritize her bariatric gastric bypass first before beginning treatment. they dc'd her to a snf for monitored weight loss. pt was started on megace 40 mg and ended up gaining more weight there. pt just ended up with pressure sores at the home. as soon as healed dc'd to home.

And that is where I come in.. I had to admit her while I was the on call for the weekend bc she said her catheter was leaking. As i'm getting a history for this patient... she sees a visiting MD. who I don't think is affiliated with any hospitals. and that's it. no oncologist. The doctor that was going to do her bypass decided that he can't do it bc it is too much risk.

now, i'm having trouble getting this patient treatment. She cannot go in and out of her home. She is almost 600lbs and can't walk. The only way she can get out is through ambulance or fire truck. MD offices can't accomodate her size for visits. I even called the oncologist that she was referred to at the hospital. he told me to get her to lose weight and make sure she is taking megace 80 mg BID... she is only on 40mg... now, who am i suppose to get this order from? they've never seen the pt in their office so technically she is not his pt. Then follow up with someone who is closer to the pt's home. The only way I see her getting an evaluation is if she was admitted at a hospital, and the doctors go to her. hehe. if life was a dream right? Well, I called the cancer treatment of america. they can't take her either bc they are an outpatient facility. They adviced me to reach out to big organizations like American Cancer Society etc.

I need help. Ive only been a nurse for a little more than a year. In home health, we really have to be the pt advocate. I am running out of ideas on who to call and what to do. I called her visiting md office, there are no visiting oncologists here in IL that I know of. I can't just let this patient have her cancer sit there... it breaks my heart, but I don't know who to reach out to so that someone will see her. I've even told the pt... next time she goes to the ER, don't leave without seeing an oncologist and getting a work up or something!

I sent her to the ER the other day, bc of uncontrolled pain to her knee. they said she needs an MRI bc it looks like she may have torn something. and sent her home!!!! how am i suppose to get this pt to an MRI? i guess their machine can't accomodate her size. I don't know... :uhoh3:

help:nurse:please.