Rn

[runnernurse487]

I work in a Dr.'s office, one of our drs is out currently and the other dr is stressed taking on his job plus the other dr's pts., but handling it as well as he can. Yesterday one of our pts. had a mag of 0.5, yes 0.5. That went unnoticed by both offices . A nurse from the lab ordering dr reported this low mag to me, I told the dr..... The stressed dr did not order the lab and said the ordering physician ( another md in another ofc) needs to handle it. And he did, he ordered some ryders for the pt to recieve in the he was to go into the hospital to recieve them. Then home care calls saying the pt had leg pains....DVT?? Pt had a hx of them. Also the pt had such bad watery diarrhea from his abd. fistula that electrolyte balance maybe a problem.

I told stressed dr this and he said not to worry, the leg pain could be due to low mag. The pt. was going to the hospital for mag ryders that same night....I am worried, I like this pt. I was short with home care when they called at 4:55 to report all this. The stressed dr is on call (again) tonight...hopefully they will call him with any other problems??

This patient has had enough problems.... I feel bad, I shouldnt have been short with home care, but what did they expect at 4:55?? The stressed dr knew the patient was going in for the ryders. I don't know what I am asking....maybe some absolution for feeling like everything falls on me and then I get short with people and feel bad..Surely the nurse in the hospital will assess the pt. for DVT and they will order a follow up mag before he can leave?????

I am thinking of leaving nursing.....sometimes I feel so stressed.

Help.

[dream'n, BSN, RN]

Not sure I understand all of your post, but a few things stuck out to me. I know you were stressed and the covering Dr. was stressed, but that is no reason to be short with Home Health for calling at 4:55. Perhaps the patient just told them about the leg pains. What would you rather they have done, not called? Think of yourself in their position, issues can pop up at all hours and they have to call the Dr. for problems. As for the covering Dr., I'm sorry he is so stressed, but taking call and covering his partner's patients is his job. If it is too much to handle, then they should have worked out another system, contracted with other Drs., etc, prior to now. Patient's get sick, have problems, and they have the right to be able to contact their Dr. (or his covering agent) anytime.

Sounds like you work in Primary Care. It is a very stressful field, that's why I got out of it.

Personally I think a patient with such problems, and with the history you described, needed seen right away, not 'sometime tonight.'

[Kymmi]

I also had to read the OP three times before I totally understood the situation and Im also not sure what it is you are asking or saying. Sounds like the patient is going to go into the hospital to have the Mag replaced (Im assuming thats what you meant by Mag riders or ryders as you put it). What Im not understanding is if this patient had a Mag level of 0.5 and a history of DVT with current leg cramps and loose stools that have obviously caused a electrolyte imbalance is not being admitted to the hospital.

[mianders, RN]

I work in IV therapy and have patients with 0.5 and lower mag levels all the time, and do their mag infusions as an OP. With that low of a mag level the patients leg pain is probably related. If the pain does not improve after the mag infusion then a doppler to r/o dvt would be warranted. You did not say if his K or Na were low, so the diarrhea could or could not be the cause of the low mag. Sounds to me like the problem of the low mag was addressed. Is he taking anything for his diarrhea?