Ummm, I think the patient looks bad....

[SweetLemon]

So last night I had a patient who is normally very bright, pleasant and talkative get up in the middle of the night practically unable to walk. She was very lethargic with slurred speech and a dramatic overall general weakness. While sitting in a chair she slouched over and while she was oriented x 3 still appeared to be very generally confused. While her BP & Pulse were both a little low from here norm neither of which were alarming. Blood sugar was good temp normal, but she continued to complain about an intense headache and generalized body pain. So my dilemma, I had another nurse as well as my supervisor come down and take a look at the patient and we all three were in agreement that she probably was going to need some additional care, So I get on the phone with the doctor (who was incredibly gracious, especially for it being 3am and attempt to explain my pt). First of all I have to admit I was a little nervous I dont mind interacting with the doctors and find the majority of the staff come across to be very decent but I hate calling them in the middle of the night. With the vitals and the blood sugars being as they were I just felt as though it was impossible for me to convey the actual status of my patient. Coupled with my neves I found myself repeating the phrease, "ummm, well she just looks really bad". How do you convey that a patient looks bad without having things like vitals to back you up???

[BrnEyedGirl, BSN, MSN, RN, APRN]

There is nothing wrong with following that gut feeling,...it's saved me more than once. I've learned over the years that it helps me to think a bit before I call the doc....what doesn't look right? What do I think is wrong? What do I want from the doc when I call? That helps me have my ducks in a row when I get the doc on the phone.

[Coffee Nurse, BSN, RN]

"A patient who is normally very bright, pleasant and talkative...practically unable to walk."

"Very lethargic with slurred speech and a dramatic overall general weakness."

"While sitting in a chair she slouched over and while she was oriented x 3 still appeared to be very generally confused."

"She continued to complain about an intense headache and generalized body pain."

If all that was needed to describe a patient's status were her vital signs, there'd be no need for bedside nurses -- just monitors to send automatic alerts to doctors with any changes. Your assessment was thorough and plenty of reason for the doctor to be concerned, as long as you described your findings to him just as you did here.

[morte, LPN, LVN]

at least in this specific case, i would be emphasising that the patient was not at HER baseline.....and especially the H/A......

[AirforceRN, RN]

I've found that a lot of the docs understand or at least respect the nurse's "spidey senses". If I have to call a doc in the middle of the night (and I don't like to do it either) I make sure I have:

Brief history (it is 3am, just in case "Mrs Jones" isn't enough to trigger the memory)

Vitals

Current issue (and I think your story above was VERY appropriate)

Plan

I know its not really our place to tell the doc what to do but at least in my experience if I tell the doc "I would like to.....call an ambulance, give tylenol, insert foley etc" I usually get a better reception than "I know its 3am but what should I do?"

[CoffeeRTC, BSN, RN]

Sooooo What happend? Stroke?

[travel50]

In my experience, almost all doctors are good with a description like you gave us. At 3AM, I'd be a brief as possible. And I agree with airforceRN who said to tell the doctor you'd like to call an ambulance. Most doctors like to know that you have an opinion. I have called a doctor more than once and just said that I didn't know what was wrong, but I had a gut feeling there was a problem. I have even sent one of my nsg home residents to the hospital, not b/c I saw a problem, but b/c my aide did. Sometimes they see small things that I don't. My doctors listen to them as well.

[MoopleRN]

How do you convey that a patient looks bad without having things like vitals to back you up???

You simply describe what you saw/your assessment of her.

...normally very bright, pleasant and talkative get up in the middle of the night practically unable to walk. She was very lethargic with slurred speech and a dramatic overall general weakness. While sitting in a chair she slouched over and while she was oriented x 3 still appeared to be very generally confused...

Use your gut instinct but describe objectively to the doctor what you've assessed/observed.

[nurse grace RN, BSN]

You could use SBAR -- we use that at our hospital

S= situation: patient X is showing signs of possible stroke, MI etc

B= background: a brief hx and what you think is going on now

A= assessment: vitals. slurred speech, change in sensorium etc

R= recommendation: what you 'd like to do --- fluid bolus, foley, CT etc

And you could tell the doc ---my "gut" says .... or I just feel this patient is off and why

Most docs recognise and appreciate our "intuitions'

I think you did fine in getting your point across. :)

[Tait, MSN, RN]

"A patient who is normally very bright, pleasant and talkative...practically unable to walk."

"Very lethargic with slurred speech and a dramatic overall general weakness."

"While sitting in a chair she slouched over and while she was oriented x 3 still appeared to be very generally confused."

"She continued to complain about an intense headache and generalized body pain."

If all that was needed to describe a patient's status were her vital signs, there'd be no need for bedside nurses -- just monitors to send automatic alerts to doctors with any changes. Your assessment was thorough and plenty of reason for the doctor to be concerned, as long as you described your findings to him just as you did here.

Exactly.

[Aneroo, LPN]

You could use SBAR -- we use that at our hospital

S= situation: patient X is showing signs of possible stroke, MI etc

B= background: a brief hx and what you think is going on now

A= assessment: vitals. slurred speech, change in sensorium etc

R= recommendation: what you 'd like to do --- fluid bolus, foley, CT etc

And you could tell the doc ---my "gut" says .... or I just feel this patient is off and why

Most docs recognise and appreciate our "intuitions'

I think you did fine in getting your point across. :)

I was also going to suggest SBAR. It's a great resource for getting exactly to the point of what you want and need.

[talaxandra]

I think part of the problem is that you weren't acknowledging then that the information you provided here was factoring into your assessment that there was spmething going on.

Sometimes it won't be as clear as the changes you described - the patient's vitals are fine and there's nothing you can point to but something inside is quietly alarming. In those cases I usually say "She's fine on paper and there's nothing I can identify but I have a bad feeling and would like her reviewed." Experienced doctors tend to pay attention to those hinky feelings.