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What would you think if you saw this patient?

Nurses   (13,105 Views 57 Comments)
by coffeemamaRN coffeemamaRN (New Member) New Member

1,288 Visitors; 11 Posts

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116 Visitors; 1 Post

Patient cant swallow - therefore cant protect airway- off to ER by EMS please

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KarenMS has 1 years experience.

2,012 Visitors; 112 Posts

Sounds a bit like homework!

It doesn't sound like a typical nursing school question to me.

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YoutubeTheNP has 9 years experience and works as a FNP-C.

3,628 Visitors; 221 Posts

Well, I'd go with option C and do an exam. Young patient. A retropharyngeal abscess can present this way, rare diphtheria also, +4 abscessed tonsils. So what was the exam findings? You're really leaving out important stuff

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1,288 Visitors; 11 Posts

Thank you to everyone for your responses, I really appreciate the different perspectives. To me, it seems like all around, the doctor should have referred the patient to ER immediately.

In this case, it was my youngest brother who went through this. The symptoms developed over a couple of weeks. His breathing was not compromised, just his ability to swallow and talk. I did not include the type of cancer he had, but it was a malignant brain tumor at the age of six. He was in remission for all this time until these symptoms occurred. The doctor was aware of his history, yet still prescribed Robinul and referred to GI. After almost two weeks, he went to the GI appointment, who was the one who told them to immediately go to ER.

As to why my parents would take him to the outpatient clinic instead of ER...I don't know. I can only think that maybe it was a certain level of denial in hoping that it was a temporary ailment that would resolve, rather than a return of his cancer. Unfortunately, it was a brain tumor even larger than the one before, and it is terminal. He is on hospice care now.

I guess I'm still trying to come to terms with the whole thing, especially trying to figure out why the doctor would advise my parents the way he did. He is also the same doctor who told them that he no longer needed follow-up CT scans, despite the high risk that his childhood cancer might return. So by the time he had his symptoms, the tumor was too large (plus there were other smaller tumors present). I know that if it were different, it doesn't necessarily mean that my brother would have survived. But I still do not understand the doctor's reasoning behind all this.

Anyway, thanks again for all the responses.

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1,427 Visitors; 94 Posts

hospital for sure, sounds like a stroke. even though he is in his 20s . stroke can strike at any time. if the pt is a juvenile diabetic this could happen. The me is a fool and should have his license under scrutiny by a panel of his peers

I hope you charted that you suggested to call an ambulance. cover your own behind because sh#t rolls down hill and falls on the nurse every time. let us start putting the responsibility back on the decision maker not th nurse

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1,136 Likes; 7 Followers; 21,307 Visitors; 2,696 Posts

coffeemama, I am so sorry.

Though your brain may know that the 2 weeks' delay from this clinic visit did not change anything, that is no consolation for the devastation of what you and your family are facing. And the follow-up recommendation is another matter entirely.

(((may your days with your brother be special))), there are really no other words.

JKL

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1,427 Visitors; 94 Posts

I am sorry for him and you. sounds like a lawsuit. you have one year from the incident. don't let this poor md get away with his poor dianosis

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Glycerine82 has 3 years experience as a LPN and works as a Licensed Practical Nurse.

10 Likes; 25,280 Visitors; 1,933 Posts

Go directly to the ER do not pass go, do not collect $200 dollars. I mean, I don't get it. I'd be curious to see how this case turned out. It's not like urgent care facilities typically have intubation equipment, monitors, radiology or stat labs.

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Glycerine82 has 3 years experience as a LPN and works as a Licensed Practical Nurse.

10 Likes; 25,280 Visitors; 1,933 Posts

Thank you to everyone for your responses, I really appreciate the different perspectives. To me, it seems like all around, the doctor should have referred the patient to ER immediately.

In this case, it was my youngest brother who went through this. The symptoms developed over a couple of weeks. His breathing was not compromised, just his ability to swallow and talk. I did not include the type of cancer he had, but it was a malignant brain tumor at the age of six. He was in remission for all this time until these symptoms occurred. The doctor was aware of his history, yet still prescribed Robinul and referred to GI. After almost two weeks, he went to the GI appointment, who was the one who told them to immediately go to ER.

As to why my parents would take him to the outpatient clinic instead of ER...I don't know. I can only think that maybe it was a certain level of denial in hoping that it was a temporary ailment that would resolve, rather than a return of his cancer. Unfortunately, it was a brain tumor even larger than the one before, and it is terminal. He is on hospice care now.

I guess I'm still trying to come to terms with the whole thing, especially trying to figure out why the doctor would advise my parents the way he did. He is also the same doctor who told them that he no longer needed follow-up CT scans, despite the high risk that his childhood cancer might return. So by the time he had his symptoms, the tumor was too large (plus there were other smaller tumors present). I know that if it were different, it doesn't necessarily mean that my brother would have survived. But I still do not understand the doctor's reasoning behind all this.

Anyway, thanks again for all the responses.

So sorry to hear this, OP. I don't think the delay in going to the ED would have changed is prognosis, but I know you're all heartbroken over this all.

I'm so sorry, i truly don't know why the doctor wouldn't have called the ambulance right then and there, but he didn't.

For now, be with your brother and when the time comes you can look into this all more deeply.

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Chaya has 15 years experience.

1 Like; 10,682 Visitors; 932 Posts

So sorry to hear the result. He and your folks are lucky to have your caring, insights and guidance at this time

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Marisette has 28 years experience.

13,443 Visitors; 353 Posts

Thank you for sharing your story. I'm sorry your family is going through this. We have a tendency to wonder what IF we had done something differently, perhaps sought different or better care, we could have prevented the present outcome. It's a heartbreaking and difficult position to be in. Sometimes, the outcome to disease is beyound anyone's control. I'm sure your family did everything they knew and felt they could do for this child. I wish you and your family peace and comfort in knowing this.

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209 Visitors; 18 Posts

Patient condition is critical and should be sent to Emergency room immediately for evaluation, adequate Data collection,neurological consult ordered immediately by ED doctor in case patient has CVA,also GI consult is needed,and other test CT SCAN,MRI,XRAY,and some Labwork.

When in doubt ask questions and take appropriate action.

Is the patient on drug?If yes what is he smoking,inhaling,or whatever?

Appropriate Data collection is essential .

Since patient has history of cancer.Is there any indication that the cancer is back?

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