What would you do in this situation?

arelle68 · Aug 19, 2009

At my hospital we'd add it to the doctors list for the AM (if no other symptoms) and send it for culture and of course watch the pt closely. If we called the on call doc he would be like, "What the heck, seriously... that can't wait for the pt's own doc @ 0700hr..." I know you all are saying, "well he's on call..." but at our facility we don't call for everything like that... we use our judgement and something like that would wait for the doc in the am. However, we are not LTC we are acute and chronic medical floor.

Yeah. That was my thought process. I hate being yelled at by doctors. I thought it could probably wait. I thought maybe the chemstrip wasn't even reliable with no other symptoms presenting. I'm a new grad, and don't know quite what to do a lot of the time. I was dealing with actual, major problems that other residents were having, and just faxed this chemstrip to the doc for in the AM, documented, and reported it to the oncoming shift. I hope so much that I did well enough. I was so overwhelmed with the sheer volume of work I had to do, and by then I was so tired, and so hungry that I was in a daze. Of course, that won't keep me from getting in trouble if my manager doesn't agree with what I did.

arelle68 · Aug 19, 2009

When I worked in LTC that sort of thing would have waited until the am and then called in to that dr's office

Whew! I hope my manager sees it your way!

achot chavi · Aug 19, 2009

Check Vitals esp rectal temp, Send urine for C&S.

Why did the dr want this done? Routine or in response to a problem.

You didnt ,mention if the pt has a Foley Cath or other urinary related issues, It can probably wait for the am but if I am in the mood and feel on the cautious side I would call the doctor anyway- just to Cover my U-no-wat. If overworked with more important stuff, I would leave the pt for monitoring and exam in the am

CoffeeRTC, BSN, RN · Aug 26, 2009

Well, more often than not, the previous nurse prob missed it or just didn't do it. (at least in my building)

No s/s or complaints...I would wait till the am to call the doc.

NurseKitten, MSN, RN · Sep 27, 2009

Take this as a learning experience though...and remember that the elderly, especially women, will run low-grade infections, just as matter of course, and be completely asymptomatic.

These low-grade infections can bloom into full-blown sepsis at the blink of an eye. They also put them at increased risk for strokes and heart attacks.

This is why I said you can not know about something like this and sit on it...not because you're not a careful, competent nurse and you'd know to watch this resident a little closer throughout the night, but because should something stupid happen - and we all know it does, every day - your butt would be on the line for not reporting it sooner when you had knowledge of it.

This is what doctors/ARNP's/PA's are on-call for. This is why they collect their on-call money. You may get yelled at, yes, and that kind of unprofessional behavior needs to be reported to the DON, formally in writing. It won't get better until it is documented enough times they can address it with some authority.

Assess all your residents, figure out ALL the issues needing to be addressed, make ONE call, do it early enough that the person is probably not in bed already, and thank them for their time. I always close out my conversations with, "Thanks so much - I won't call you for anything else tonight short of a full-blown code." This lets them know you're mindful of their time and needs, as well.

And there is NOTHING wrong with calmly, respectfully, standing your ground.

"Dr. X, I *do* apologize for disturbing you, but I do not apologize for doing my job. Are there orders you wish to give on this patient?"

You get the idea. :)

Keep it up...you're thinking through things, and that's the key to developing strong judgement in these situations.

katr131313 · Oct 13, 2009

this probably is the best thing to do...

katr131313 · Oct 13, 2009

Take this as a learning experience though...and remember that the elderly, especially women, will run low-grade infections, just as matter of course, and be completely asymptomatic.
These low-grade infections can bloom into full-blown sepsis at the blink of an eye. They also put them at increased risk for strokes and heart attacks.
This is why I said you can not know about something like this and sit on it...not because you're not a careful, competent nurse and you'd know to watch this resident a little closer throughout the night, but because should something stupid happen - and we all know it does, every day - your butt would be on the line for not reporting it sooner when you had knowledge of it.
This is what doctors/ARNP's/PA's are on-call for. This is why they collect their on-call money. You may get yelled at, yes, and that kind of unprofessional behavior needs to be reported to the DON, formally in writing. It won't get better until it is documented enough times they can address it with some authority.
Assess all your residents, figure out ALL the issues needing to be addressed, make ONE call, do it early enough that the person is probably not in bed already, and thank them for their time. I always close out my conversations with, "Thanks so much - I won't call you for anything else tonight short of a full-blown code." This lets them know you're mindful of their time and needs, as well.
And there is NOTHING wrong with calmly, respectfully, standing your ground.
"Dr. X, I *do* apologize for disturbing you, but I do not apologize for doing my job. Are there orders you wish to give on this patient?"
You get the idea. :)
Keep it up...you're thinking through things, and that's the key to developing strong judgement in these situations.

NurseKitten you have the best answer here! bravo!

teeniebert, LPN · Oct 13, 2009

Is there a UTI protocol at your facility? If a resident where I work has signs/symptoms of possible UTI we start a flow sheet and they get increased fluids (if not on restriction), cranberry juice at each meal, vitals more often (I think q 4 instead of q shift), and toileted every 2 hours. Many times the symptoms go away after 48-72 hours on the protocol. Along with the protocol we get a sample, do a chemstrip, and if positive send it for C&S. ONLY if the C&S comes back with a specific organism does the resident get abx. Anyway, I hope things turn out well.

rapkeygurl · Oct 17, 2009

first assess the resident, check for any s/s , call that previous nurse and ask why he/she forgot to write the order, report to the doctor and find out if there was an order, needs to be an order written since it was just left on the report sheet, if the doc has no clue then call the Don. Sometimes it is like CSI- you have to play detective, communication works if you work it lol!! Why are some of the new nurses so darn afraid to notify the docs? all they want to do is get on the fax machine. I went to a training from our state surveyors a couple of weeks back and they say CMS says a faxed critical lab with no return call is not going to cut it. I use to as a charge nurse -GOD FORBID make rounds before taking report, then get report, nurse aide assignments, transports and do treatments, pass morning meds, ( did not have med aides back in the day) then had a list and called all the docs told them about things I needed for each of there people and wrote orders, called pharmacies and charted I was much skinnier then. lol is this unreasonable to expect charge nurses to be charge nurses?? I had one cry to me " how can I get all the things I have to do done and check to make sure the nurse aides do there charting.? She wanted to know if I just came up with this?? ok will stop ranting but you get the picture.. am I being unreasonable??

SuesquatchRN, BSN, RN · Oct 17, 2009

Is there a UTI protocol at your facility? If a resident where I work has signs/symptoms of possible UTI we start a flow sheet and they get increased fluids (if not on restriction), cranberry juice at each meal, vitals more often (I think q 4 instead of q shift), and toileted every 2 hours. Many times the symptoms go away after 48-72 hours on the protocol. Along with the protocol we get a sample, do a chemstrip, and if positive send it for C&S. ONLY if the C&S comes back with a specific organism does the resident get abx. Anyway, I hope things turn out well.

That's the same as ours. I wouldn't call someone for a UTI. It can wait until the morning.