anne919

I am reading the threads. I learned so much insights from the replies. Thank you so much. Now it makes me wonder on what field of nursing that I really want to be in. This had been a reality check for me that ltc is not going to work for me.

Ltc wouldn't send out their resident to ER as much as possible. But when the md wouldn't give appropriate orders and we see the pt deteriorating that is the only time we send them out.

Thanks for your help. Really apreciate it.

Maybe it is just really hard to explain the scenarios. He only order to monitor the patient in most of the cases not just this one. To make the story short to fully describe this is that most of the old nurses in the facility are the ones who orders their lab without the md order. I know that is malpractice. I dont medically diagnose my patient. Nurses do have nursing diagnosis based on signs and symptoms. Maybe the thread had become so inconsistent with the time frame im so sorry. First off, the patient had audible wheeze. Auscultated the pt learned that the resident has inspiratory and expiratory wheezing. Use of acessory muscle but denies everything. States that wheezing is nothing. Patient daughter asked for re-assessment from md because the resident is to be discharged for the next day. I called the md. Described how the resident was. His order was just keep on monitoring the patient. He hanged up on the phone cause he is with another patient. Gave the md some time to call back for clarification. Told him again that the resident exhibits inspiratory and expiratory wheezing and the daughter thinks its best to send out the resident. Then now the md ordered cxr abt

Initially he did not order abt neither cxr. His only order was monitor the pt. He would not o rder anthing besides monitor.

He ordered that cxr and abt after I told him that I really think and the other nurse-happens to be the resident's daughter- thinks the resident should be sent out to the hospital. We have a low census and that doctor is running out of residents in the facility because the resident asks for another md to tend to them since he does not even visit them. He gives new medication to the resident without seeing them, no labs to confer it to. The residents asked for discharged because of his actions. Sorry if I did not fully describe the circumstances here for I am so tired from work thinking and trying to keep the residents alive and satisfied with their care since they do not like how the md works for them.

This is the first time I had seen a doctor who does not order labs or xray or other exams. All he ever order is continue to monitor the patient.

As described by the resident's daughter, the resident does not complain or say anything. The resident tend to keep everything on her own. Last month I saw the resident grimacing appearing as if in agony of pain. I assessed the resident but the resident denies anything. Maybe if the resident was not wheezing audibly we would not treated her and she would have been discharge.

That is what I dont really get. I need to study more in depth about hospice for it is confusing for me.

As much as I want to call 911, my hands are tied with sending the resident out cause we do have a policy that the md should give an order first before sending the patient out. hence the md ordered cxr. I know it is unethical and unlawful. As a novice nurse i carried out the md's order. hoping the resident will be fine. Until now I am monitoring the resident. Maybe the md will actually visit the resident when he goes to the facility for which he do not do.

Yes for the flu. What I documented was runny nose, febrile and muscle aches.

I also did not hang up on him I said to him that I needed to go off the phone for I have many other patients to tend to. And ill keep on monitoring the pt like the md asked me to. We do have a protocol but the protocol isnt much very clear.

Thanks for all your help. I might have had not fully described somethings but the patient denies difficulty of breathing but you can see that the resident is using accessory muscles. So I took that as labored breathing and you can audibly hear her wheezing i theb listened to her lung sound and she has inspiratory and expiratory wheezing. It isnt much of a lie. I was not the only one who assessed this resident nor the diabetic resident. I always ask for another nurse to also assess the resident. I dont document things outside the scope of nsg. I only document matter of fact so that my license will be covered.I know that you only document what you see what touch what you yourdelf had witnessed.

As for the diabetic hospice resident, the pt is fine, eating well and fighting for her life. But the md simply stated 'she is hospice what do you want me to do? She is dying'

The pt with atelectasis is not responsing with the neb treatment and she was supposed to be discharged on the next day but she started wheezing. To describe this fully: His inital order was just robitussin. I lied to him that the pt is having difficulty of breathing even though the resident says that everything if fine cause my gut feeling is telling me that it isnt just a regular wheezing since the resident has inspiratory and expiratory wheezing.and so he ordered a stat chest xray and antibiotic. Then the xray revealed that the pt has atelectasis. Case rested with that one cause the doctor does not seem to care to treat if the pt is being discharged or hospice or no code. And yes, I basically describe every pt sibjective and objective symptoms with nsg observations. I dont medically diagnose.