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pt. suspected drug user

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If a patient comes in to the hospital for an OB check with heart rate in 115-120's consistently, do you need the patient's consent to send urine sample for tox screen? Pt was scared and complaining of ABD pain. OB patients always give sample every visit to dip anyway so can you just tell them after they give you a sample that you're going to send it to the lab for a tox screen and U/A? As an OB nurse, what would you do in this situation. I'm a student. Thanks.

crysobrn

Specializes in OB L&D Mother/Baby. Has 7 years experience.

If I provide the assessment to the doc and they order a tox screen we run it without the knowledge of the pt.

Many times if we do get someone who is a user they will ask "why do you need my urine" when you ask for a sample... I mean we get them on everyone for a ua but the people that seem to know they will drop dirty get offended at the prospect of giving a sample.

If I provide the assessment to the doc and they order a tox screen we run it without the knowledge of the pt.

Many times if we do get someone who is a user they will ask "why do you need my urine" when you ask for a sample... I mean we get them on everyone for a ua but the people that seem to know they will drop dirty get offended at the prospect of giving a sample.

what would you do if they expressly forbid you from doing a tox screen?

Becca608

Specializes in med-surg.

If I provide the assessment to the doc and they order a tox screen we run it without the knowledge of the pt.

Many times if we do get someone who is a user they will ask "why do you need my urine" when you ask for a sample... I mean we get them on everyone for a ua but the people that seem to know they will drop dirty get offended at the prospect of giving a sample.

www.allnurses.com is not as private as you think.

bagladyrn, RN

Specializes in OB.

Check with your docs - some practioners have permit to do drug screen and other labs as part of their general consent for prenatal care for all their patients - signed when the pt. initiates care with the provider, or the admission consent may be worded to cover tests deemed necessary by the practioner. In that case just obtain the specimen and send it. If the patient refuses accept that but note exactly what the patient says in charting the fact. The infant should then be screened after birth for the presence of drugs (can be done on mecomium).

If a patient asks, I tell her what we are testing for. I also ask her what drugs she has been using, telling her that I don't really care what she's been doing as a moral issue, but want to be prepared to treat her infant for the withdrawal symptoms it will experience some hours/days after birth. Surprisingly, some women are actually honest about it at this point. (Had one who said "Just read the list and I'll tell you which ones I haven't done".

bagladyrn, RN

Specializes in OB.

By the way, looking at the ads at the bottom of this thread - is it really appropriate on a board like this to have all these ads for "beating" drug screens?

crysobrn

Specializes in OB L&D Mother/Baby. Has 7 years experience.

By the way, looking at the ads at the bottom of this thread - is it really appropriate on a board like this to have all these ads for "beating" drug screens?

I have a different ad on the bottom of my screen but that is interesting isn't it??

"Just read the list and I'll tell you which ones I haven't done".

Ok...this is pathetic...and funny as all get out at the same time.:rotfl::rotfl:

everthesame, LPN, LVN

Has 12 years experience.

By the way, looking at the ads at the bottom of this thread - is it really appropriate on a board like this to have all these ads for "beating" drug screens?

The ads at the bottom of the screen are auto-generated based on keywords detected in the text of the original post and the replies. I too have an ad about beating a drug test a the bottom of my screen.

A lot of websites are set up like this and I don't think Allnurses has any control over the individual ads that pop up.

As to the original post, drug testing was part of the treatment consent. It was also part of our prenatal clinic's treatment consent so most of the women who were going to test positive had already tested positive in the clinic.

rjflyn, ASN, RN

Specializes in Emergency. Has 23 years experience.

what would you do if they expressly forbid you from doing a tox screen?

In this case probably tell them they would be signing out AMA from our facility and that our doctors would not be caring for her. The she is not the physician and she does not tell them how to practice medicine.

Rj

From reading the post, it seems like you think the pt is a drug user just because her HR was 115-120. If I was scared and in pain, I think my heart rate would be slightly increased also.

babyktchr, BSN, RN

Specializes in Nurse Manager, Labor and Delivery.

:yeahthat: You know, when I first read this thread..I thought the same exact thing. Is an elevated HR the only reason to suspect drugs in this case? Certainly there are many explanations for an increases HR, as the above poster mentioned. I would probably investigate more before going to the drug screen...but that is just me.

I would HOPE a nurse would look for more obvious signs of drugs use before jumping to get a tox screen: jumping to that conclusion on hr ALONE is presumptous. What if the woman had a heart condition? Stress? Issues with BP? It could be alot of things. LOL

DutchgirlRN, ASN, RN

Specializes in OB, M/S, HH, Medical Imaging RN. Has 33 years experience.

www.allnurses.com is not as private as you think.

allnurses is private. every word is moderated and when a member posts their name, address, phone, or e-mail address it is removed from their post.

if a member chooses to devulge some bit of information about themselves such as where they work or where they currently are on vacation, etc...then they are solely to blame for that information being made public. it is no fault of the site or the moderators.

i was once referred to a different site. i went to check it out. they actually expected me to enter my state and license number to verify that i am a bonafide nurse. :no: i don't even let my employer have a copy of my license, they are only allowed to inspect it and make a note of the number.

but....what does any of this have to do with the op? just curious.

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

Just to clarify, before we get back to the regularly scheduled topic.

Allnurses is privately owned and operated. However, it IS on the world wide web for anyone who stumbles across it to read. For every registered poster, there are many many lurkers who can read anything anyone posts. We have no control over that.

On the topic of UDS - I tell my patients what I am collecting their urine for. I want them to trust me, and they won't if they feel I'm lying to them or trying to trick them. I tell them why as well.

Where I am, anyone with a hx drug use and anyone who got no prenatal care gets an automatic UDS. I tell them it's not meant to be a judgement on their character, nor are we picking on them. It's in the orders for us to do for everyone who meets those criteria. Most people are pretty forthcoming about their use.

We also bag the babies to do a UDS, and I tell mom what we are doing and why. I can only remember one instance where mom/family tried to pull any stunts, and she got caught pretty fast. She had some psych issues as well.

bagladyrn, RN

Specializes in OB.

Ok...this is pathetic...and funny as all get out at the same time.:rotfl::rotfl:

After I finished my list, she added a couple I hadn't had! Truly, when we were done, I did thank her for her honesty and told her that it would be very helpful in making sure her baby had appropriate treatment. (The broader issues could be saved for a later time).

shortstuff31117

Specializes in OB.

With our docs, the pts. sign a form saying they consent to any and all UDS so if they come in for a labor check, we can send one without telling them. I've only done it once without asking, actually was screening for a UTI but the pt. had really dilated pupils so I just added a UDS to it. Otherwise, any pt. being admitted with any history of drug is asked for a urine sample and I personally have never had anyone refuse.

Technically, the docs can drop a pt. from care if they had signed a consent before and are now refusing.

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