When to call the doctor

[NurseLoveJoy88, ASN, RN]

My rule for when to call the MD has always been "when in doubt call the MD". However, every once in a while I go back in forth with myself whether or not to call. Today was one of the days.

I work in LTC and a GNA reported that Miss Jane has a small amt. of blood in brief. I observed a very small amt. of blood mixed with a little bit of clear cervical mucus that came from the residents' lady parts. I patted some tissue at the lady partsl opening and only a scant amt. was on the tissue. Vitals were stable. Labs were great. No hx bleeding. NO ASA. No coumadin. No sign of rectal bleeding. No reports of trama. No other s/s of UTI. So I did a concurrent review for the other nurses to monitor.

Now I wonder if I should have called the doc. She had no other sx, first time ever doing this. Sometimes elderly women have a little breakthrough bleeding due to hormonal changes.

What do you all think ?

[leslie :-D]

vss, labs good, stable at present...

no, i wouldn't have called either.

but, i would make sure someone calls first thing monday a.m.

in the meantime, continue to monitor, including assigned cna in plan.

leslie

[lusa]

Hi NurseLoveJoy88,

I am a new grad in LTC and I would love to know what the experienced nurses have to say, once in a while I find myself in similar situations.

[NurseLoveJoy88, ASN, RN]

Thanks Leslie. I did ask the nurse to call if it continues.

[lilhealer]

Did she have an indwelling catheter?

[Daliadreamer]

I almost had the same thing happen to me once in LTC:

I received report from the NOC RN that a patient had one episode of blood in her urine when she went to the bathroom. She said that the toilet bowl was red. The patient herself was fine, VS stable, no change in status. The episode happened only once. During the day, her family was telling me to call the doctor. It was a weekend, and I told the family that I would monitor her, and if I saw blood in her urine a second time, I would notify the MD. I examined the patient's lady partsl area, no tears were noted. The patient voided several more times and no blood was seen.

The family still wanted me to call the doctor. I didn't because the patient was stable and I didn't want to bother this particular doctor. Well, the family called the doc for me and he actually came in to see the patient. Needless to say I was terrified when he walked in the door ( I was a brand new grad at the time) but he wasn't upset with me and was a pretty cool guy. Maybe he had nothing to do on the weekend!

Anyway, it's so hard to judge. Now I don't care; I always call the doc if I have to question something.

[rkitty198, BSN, RN]

Is it normal for anyone to have blood in their underwear, other than a menstrual period? No.

I would notify the MD when he comes in, not necessarily call. What can he do over the phone that he can't do in person? Not much.

I would for sure at least tell him, CYA

It is not up to us to diagnose whether it is due to hormonal changes.

[NurseLoveJoy88, ASN, RN]

Is it normal for anyone to have blood in their underwear, other than a menstrual period? No.

I would notify the MD when he comes in, not necessarily call. What can he do over the phone that he can't do in person? Not much.

I would for sure at least tell him, CYA

It is not up to us to diagnose whether it is due to hormonal changes.

:o:o:o:o. Learning lesson for me...

[Orange Tree]

I've gotten into the habit of leaving notes in charts about things that are important, but not urgent. Letting the oncoming nurse know and take over doesn't always work out as well. I had a diabetic patient a while back with no accucheck or sliding scale orders. Since it was a new admit and I didn't want to disturb anyone at 4AM, I passed it along to the next shift (verbally and in writing on a report sheet). Three days later, I came back and the patient had not been checked or covered once. I checked her then and she was about 400.

[OldNurseEducator]

Is it normal for anyone to have blood in their underwear, other than a menstrual period? No.

I would notify the MD when he comes in, not necessarily call. What can he do over the phone that he can't do in person? Not much.

I would for sure at least tell him, CYA

It is not up to us to diagnose whether it is due to hormonal changes.

Great answer...:nurse:!!

[okielpn75, ASN, RN]

I would have notified MD via fax. Not a phone call. I would sticker the chart for monitoring, pass it on the following shifts and DOCUMENT well!

[OldNurseEducator]

I would have notified MD via fax. Not a phone call. I would sticker the chart for monitoring, pass it on the following shifts and DOCUMENT well!

FAX?????????????????????????????? Geesh....times are a changin'. :nurse: