Just curious to know what other nurses think. To me it sounds obvious, but maybe I'm missing something...
Let's say you have a patient in an outpatient clinic with the following symptoms: he cannot swallow, cannot talk, and is drooling because he cannot swallow properly. He never had problems with swallowing or talking before this. He is in his 20s, and has a history of cancer when he was a child. No facial drooping or other symptoms present. As a nurse, would you recommend:
A)the patient should go to ER immediately for further evaluation, and it is most likely neurological rather than a GI issue
Or
B)the patient should be prescribed robinul and referred to a GI specialist.
To me, A seems obvious. But in this case, the doctor went with B, and I still don't really understand why. Any insights?
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?
Please read post #39 above.
OP, so sorry to hear of the outcome. Our thoughts and prayers are with you, your brother, and your family.
Nothing is said about his other means of communication. Is he DD? If not, can he nod yes or no? Can he write? Use 2 minutes to establish communication. You then can give your supervisor amo for a different course of action.
This is tough. Do your hugs and "I Love You's" as often as you can. Your cared for by a great and faithful group.
I am sorry to hear about the sad outcome.I will encourage patients and their families to be their own advocate and not to relie completely on their doctor. If quacks like a duct,walks like a duck.It is a duck .
I am so sorry. I think the other posters and I all agree that this physician perhaps was too lax in his care and perhaps some accountability needs to occur. Hugs to you and your family as you get through this tough time.
As an ICU/ER nurse, my foremost concern would be the patient's airway. It would increase my concern even more that the patient has at least TWO symptoms that individually could cause severe airway compromise. My thinking is also supported by experience providing triage to hundreds of patients that arrive to the local ER. A patient presenting this way would be required to be taken straight back to an ER bed (no waiting), ER MD called to the bedside (if not attending a greater emergency), THEN vital signs, more complete history, etc could be obtained in a more stable environment, as well as the patient being made more comfortable ASAP (if possible). It might take quite awhile to fully sort things out, esp with the patient's past history. This is a patient that should be transported from the clinic by ACLS trained ambulance ONLY, unless the patient (adult) refuses.
In reference to who brings this type of patient to a clinic... After having worked at the walk-in clinic while on light duty d/t injury (very tiny and isolated rural community, 22 bed hospital, etc), LOTS of people. Having newly arrived from a level ! trauma facility in an urban area, I too, was stunned by this phenomenon. I had to remind myself on a daily basis that I was literally privy to an abundance of knowledge that only other healthcare providers would know. It has been 17 years since I witnessed this for the first time, and have seen this happen many times since. I was reminded of it once again, while i was picking up a prescription from MY local clinic. A patient arrived (having driven himself and was alone) that was VERY short of breath WHILE using O2, dusky,etc and asked the receptionist if the clinic had time to see him without an appointment...
Thank you for the presentation of this very ill, but interesting patient!
I would need more assessment data to decide. How are his vital signs? What is his PMH? What you are describing could be a stroke, or it could be bells palsy or any number of other things. My gut leans toward sending him to ED for further assessment, but I don't have the entire picture here from your post.
EDITED TO ADD: Now that I read through some more of your postings and see the hx of brain cancer I would have opted for sending the patient to the ED via ambulance.
caliotter3
38,333 Posts
Please read post #39 above.
OP, so sorry to hear of the outcome. Our thoughts and prayers are with you, your brother, and your family.