treaux Posted January 8, 2010 Posted January 8, 2010 I'm with P_Instructor on this. Def perform a complete abd assessment. Possibility of GI bleed, decreased motility (possibly due to the MS) or constipation? If it's an acute onset it may be something treatable so recommend transport if the symptoms are different than her usual for hospice. You don't have the resources to just write it off as a DNR pt and leave them there.
itku2er Posted January 8, 2010 Author Posted January 8, 2010 Sorry about the delay in answering but I had a few technical difficulties: P_I you may palpate the abd. There is nothing there to palpate nothing out of the normal. (I was not hijacking the thread!) Fire: She does have a DNR but she is requesting to go to the ER. She is her own responsible party she makes all the decisions on her health care. 4c6: GOOD ANSWER!
fireflymedic Posted January 8, 2010 Posted January 8, 2010 Thanks terri, Since she does want to be transported, I'm going to treat for pain (as long as she is maintaining her airway and doesn't become unstable) - if pain is controlled by my measures, I'll transport without L and S, if not, then I'll transport with - however, I don't want to jostle this lady around too much as there could be other things going on. Where is she saying her pain is - and with thorough assessment, I'm going to treat as needed. Another thing to note is if there are multiple hospitals to choose from, I'm going to ask her choice of hospital and make sure DNR accompanies. Chances are she has been dealing with a specific hospital and they are aware of her condition and wishes. Again, DNR is not do not treat - treat what you can as it may not be related and if not, you stand to miss something that could have easily been fixed. She may have something as simple as a UTI (those can be darn painful !), or even just be constipated from the pain meds. Either of which could be a fairly simple fix. Don't just automatically assume that because it's pain and she has a terminal issue it's related to that. Very well may be, may not be. She's chosen to go to the ER, so get her there as comfortably as possible, do a good assessment, and let the docs give her the option of treating/not treating. That's how I'd do my job !
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