Pt treated bad

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I work for a Private Duty company and my supervisor is located in another state, The pt that I sit with recently got dehydrated and we obtained a order for IVF at 25cc/hr prn d/t h/o chf, the day shift nurses have been increasing his fluids during the day and now he has become overhydrated and has developed 2+ edema and crackles in his lungs, I contacted my supervisor concerning this and each night i chart the edema and lung sounds but then they come in during the day and chart that everything is wnl. the other night i came in to find him in fluid overload and called the supervisor again very angry at what they where doing to this pt, she said to stop his fluids, which i had already done, he had 2+edema from his knees down and rales/rhonchi in all lobes, the next morning i told the nurse he needed to be seen by his doctor that day so the Dr. would be able to see what they where doing to him, I even told the daughter he had to much fluid on him and needed to see the Dr. the day shift played it out to her that we just made it up but when i told him he needed to go to the Dr. one of them states "lets just give him one of his wife Lasix pills" that night when i got to work he had not been taken to the Dr. and for the first time since we have taken care of him voided huge amounts every hour during the night, he is not in his right mind enough to tell you if they gave him something or not but i believe they did. I feel like we are all just warm bodies taking care of them to the company and the supervisor does not want to hear about it, I dont know what to do, I feel like my pt is in danger, he is not strong enought to withstand being flooded with fluids one day and then getting dried out the next. What do I do? It does no good to talk to the supervisor.

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Document, document, document.

If you're supervisor won't listen, then go over her head. Also, contact the family and your local ombudsman. If they did, indeed give the pt someone else's lasix, they are so far outside the law, it's not funny.

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Specializes in Neuro/ Tele;home health; Neuro ICU.

hello ATNNurse,

i am nursing student but what i think maybe you could contact social worker , if this does not help department of public health... it is evident abuse. also document everything what is going on, this will help to protect you. you can also tape-record or keep some form of journal where you write what is going on during the day of your duties.

it seems there is no good leadership, managment, care about patient's well-being. i hope it will have good outcome. keep up on your good work and patient' advocacy, we need more people like you. :)

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Specializes in Utilization Management.

he had 2+edema from his knees down and rales/rhonchi in all lobes,

Is there some reason that this patient could not be sent to the Emergency Room with symptoms like these? I would've called 911 immediately and notified everyone later, frankly.

As you probably know, CHF is potentially fatal and is considered an emergency. Once at the hospital, labs would be done to determine what's going on as a result of the dehydration/overload--such as potential renal failure, electrolyte imbalances, and cardiac arrhythmias.

In other words, whoever's been just dosing this patient up could be severely compromising his what little health this fella has, :angryfire not to mention practicing medicine without a license.

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This is outrageous...

Are you working in this patients home or is he in some sort of hospital? Are you allowed to call the doctor & speak to him or her yourself? Or leave a message on an anwerphone asking the doc to visit the next day, preferably early on.

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Document, document, document.

If you're supervisor won't listen, then go over her head. Also, contact the family and your local ombudsman. If they did, indeed give the pt someone else's lasix, they are so far outside the law, it's not funny.

I do doccument my findings each day, but i have no proof he was given lasix. I dont feel I can contact the family because the day shift has her so snowed that she thinks they are just perfect and do no wrong, I did tell the daughter he seriously needed to see the Dr. but they talked her out of it because they knew the minute the Dr. laid eyes on him he would know what was going on, thats why I believe he was given Lasix to get rid of the evidence, without regard as to what they are doing to him.

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he had 2+edema from his knees down and rales/rhonchi in all lobes,

Is there some reason that this patient could not be sent to the Emergency Room with symptoms like these? I would've called 911 immediately and notified everyone later, frankly.

As you probably know, CHF is potentially fatal and is considered an emergency. Once at the hospital, labs would be done to determine what's going on as a result of the dehydration/overload--such as potential renal failure, electrolyte imbalances, and cardiac arrhythmias.

In other words, whoever's been just dosing this patient up could be severely compromising his what little health this fella has, :angryfire not to mention practicing medicine without a license.

The pt has made it clear that he is not to be taken back to the hospital, and the family supports this, he is suffering from lung ca and wants to die at home, but it should be from that, not from some stupid little know nothing trying to play god. I believe that is why he was given lasix because if he was taken to the Dr. as i requested the Dr. would have seen right off what was going on with all the edema, so they had to cover themselves. what do i do about her charting his lung sounds clear and no edema when it is there? Can I take a picture of the edema in his ankles? although i dont think it would even do any good, the supervisor has made it plain she does not want to hear it.

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This is outrageous...

Are you working in this patients home or is he in some sort of hospital? Are you allowed to call the doctor & speak to him or her yourself? Or leave a message on an anwerphone asking the doc to visit the next day, preferably early on.

This is in the pts home, i get there at 7pm and the Dr. is closed, the supervisor has said it is the day shifts place to call the Dr. They would have to take him to the MD office

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When you're off, maybe call the Dr's office and let them know of your concerns.

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if he has lung ca, perhaps he'd be eligible for hospice care.....the hospice nurses certainly would not be overloading this poor soul.

i agree about calling the doctor, and also get an order for a set of labs to be drawn; and ask the md about hospice eligibility.

these nurses sound scary.

leslie

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Wow! Since the patient won't go into the hospital, the family won't try to convince him to go, the day nurses are only further contributing, and you have no support from your supervisor, I would get out of Dodge. Let your supervisor know that you can't be part of this negligent care. I would also suggest that you make sure that the documentation is in the supervisor's hands so that you are covered.

Kris

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Specializes in Utilization Management.
The pt has made it clear that he is not to be taken back to the hospital, and the family supports this, he is suffering from lung ca and wants to die at home, but it should be from that, not from some stupid little know nothing trying to play god. I believe that is why he was given lasix because if he was taken to the Dr. as i requested the Dr. would have seen right off what was going on with all the edema, so they had to cover themselves. what do i do about her charting his lung sounds clear and no edema when it is there? Can I take a picture of the edema in his ankles? although i dont think it would even do any good, the supervisor has made it plain she does not want to hear it.

I would suggest that the family get Hospice care for the patient. Is the patient a DNR? Might be a good idea. Even so, the family and the patient certainly need education that DNR does not mean "Do Not Treat."

Since the patient is adamant about refusing hospitalization, I guess he has every right to die from CHF; it's quick enough, but it's just not the most pleasant way to go. Maybe some education about treatment options is in order here. Of course, if he's terminal, there might not be any sensible treatment options at this point, and the patient and family are just being realistic.

If you can't prove that the patient was given lasix, then you can't prove it. Likewise, the patient with lung cancer might or might not have CHF. Just document what you see and hear. I have had more than a few patients whose legs were swollen to 3+ pitting edema after a few hours of dangling, but then went back down to normal overnight. I've also had lung Ca patients who sounded very wet,but the sounds changed from one shift to another--to the point where I nearly questioned the last nurse's assessment skills. Then suddenly there were all these rhonchi and the patient's dyspneic. After a breathing treatment, would improve tremendously.

Given the cancer, there might be some CHF going on there, but only a BNP would really tell.

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