When you're the pt or family member

[All_Smiles_RN]

I'm used to calling docs for orders and asking for certain things, etc etc. Being in the family member role is challenging for me. My toddler is being referred for a CT head with contrast as an outpatient. I inquired about a baseline creatinine level. I'm sure we've all seen patients develop renal problems after contrast.... Well anyways, she just kind of smiled and said she has no reason to suspect anything is wrong with his kidneys and if she did, she would have ordered some labs. Because of his age and uncooperativeness (can you really see a squirmy, very mobile 18 month old lying still on the table? lol), he will have mild sedation for the procedure which is scheduled in 2 weeks. I've been thinking maybe an MRI is more appropriate. His dx is developmental delay. In my experience, CT heads are not that great on picking up on things. I see normal CT heads all the time and then an acute stroke picked up on the MRI. Also, I'm not really in favor of sedating him twice should she decide to refer him to a neurologist or order the MRI herself. I haven't said this to her though. I think I need to sit back and let her manage his care, she's his pediatrician after all and knows what she's doing. Or should I be vocalizing more? I don't want to seem like the know it all parent, but this is my baby. Shouldn't he be the most important person for me to advocate for? As I said, the role of parent and not the nurse is difficult for me. Any advice on accepting the change of roles? How is your relationship with your personal doctor or children's doctors? Thanks in advance for any pointers.

[NYnurseatheart]

Hi All Smiles,

I think that many of the nurses here can easily put themselves in your shoes. I know that it is sometimes hard to "switch hats" from nurse to mom. How good of a rapport do you have with your son's pediatrician? I think it would be wise of you to call her and ask to talk with her about this issue. I wouldn't worry about a creatnine level - unless he has had renal problems in the past. I would, however ask her why the CT instead of the MRI? Has she told you what they are looking for (or looking to rule out) with the CT? Have you done any research on developmental delay's and CT's?

I wish you, and your son the best of luck. In my experience, it never hurts to tell the doctor what you are thinking, and ask them what their rationale for a test is.

NY Nurseatheart

[Zookeeper3]

Let me see if I can help;

I have worked radiology and did the sedation for the kids both CT and MRI. For routine outpatient with kids and healthy adults we do not screen kidney function, it's a standard for sick hospitalized patients, not healthy ones. An RN will give the sedation, stay with your child, monitor them after and have specialized training (ACLS and others). The sedation starts to wear off in 30 minutes.

To be honest, it makes no sense to do either scan at 18 months without sedation as you won't get any pictures with movement and have to reschedule, or worse, pay for an inconclusive test "with motion" and have to go again and now sedate.

It's not uncommon for a primary doc to start with a CT scan and THEN do an MRI next with abnormal results, and only with abnormal results a neurologist is called.

Now do I think, like you, that the MRI is better... yep. You may be required through insurance purposes to do a CT first and the doc knows this, or it may be an MD preference based on experience and standards of care.

Me, I'd definately call the MD, ask WHY not an MRI, and although it's easy for me to say, I'd personally have no problem with the sedation, but I'm unfairly familiar and comfortable with the safety. Your child will only be without you for the 5 minute head scan... and if you want, you can down on a ton of lead protective barrier and go into the scan too. My facility allowed it, but discouraged in your child bearing years.

After, you'll be in a recovery room with him and the RN that has your child as a 1:1 and you'll participate in keeping him stimulated and awake, he'll have to drink and be well awake before you can be discharged.

I hope everything turns out for the best for you

[muffinrn99]

I would definitely ask about the MRI. Does the Dr. know you are a nurse? My kids pediatrician knows that I am an RN and is very open to my input, as a nurse and as a mom. I think most good pediatricians would, and should, be open to all questions and input from parents, you know your child better than anyone.

[TheCommuter, BSN, RN]

I was in a similar predicament last month. I had visited my OB/GYN with the desire to have a pelvic MRI (I have fibroids which will need medical intervention because they are interfering with my quality of life). He said, "An MRI is way too high-tech at this time, so we'll set you up for a sonogram."

Of course, the sonogram was very rudimentary in the information it revealed, and it even missed several fibroids. I ended up having a pelvic MRI 2 weeks later, which revealed an enlarged uterus with grapefruit-sized fibroids that were compressing my bowel and bladder. I am somewhat annoyed that money was wasted on the sonogram when the MRI could have told my healthcare providers everything they needed to know the first time around. In addition, I wouldn't have had to waste time preparing and attending appointments for 2 different types of imaging.

My OB/GYN said, "You're in control of the decisions here," but his actions revealed otherwise.

[kgmiller1]

I have a great relationship with our family doctor who sees both of my young children. I often write down my questions before going into an appointment and sometimes I like to do a little research online to share with my doctor. I think it lets the doctor know that you are not just a nurse asking questions but a concerned parent who is seeking more information.