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Old 05-05-2011, 12:12 PM   #1
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The ER

Hi My FIL went to the ER this morning to get his lower back checked for his fall Monday. Somehow the ER also gave him a catheter again because the bladder has urine. But he has that for 9 months and last checkup last month showed less urine held there.
Maybe this is the ER protocol or they worry about UTI? He has some pain at his lower back but they are not sure what is wrong. It may be ok.
I was surprised they put the catheter back as it was not the issue today.

Will have to see if he will go back to his residential home today. If he has no broken bone, he should be home, with or without the catheter??? He had really bad reaction toward the catheter last year and he has to have the short one, not the long one. Also if he has this again this time, they need to do the bladder dripper for long-term use because they did the catheter here and there already last year.

Is it the ER protocol or he really has the issue for the urine in the bladder?
The urologist was OK with it last month.

Nina

Last edited by ninamarc; 05-05-2011 at 12:13 PM.

 
Old 05-05-2011, 03:39 PM   #2
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Re: The ER

Well my FIL is going home. There is nothing wrong. It may be gas or diarrhea due to the diet.

Now I began to wonder: An elder with ALzheimer's complains he has pain. He does not know what is going on. Does this mean the home should send him to the ER to check? They should know the elder does not understand pain or where the pain may come from... He may not know it is gas... It is not the bone (he fell and nothing was broken.)
This is the second time at the ER and he has nothing wrong.
Amazing. Back home before he moved last summer, he always had something wrong in the ER.

Now I wonder if it is possible to realize the pain he was talking about may be about something mild? Maybe the home is trying to be cautious. My husband could say wait and watch.... Now we also spent money for one-on-one caregiver in the hospital in the day...

Nina

 
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Old 05-05-2011, 07:43 PM   #3
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Re: The ER

Nina...My mom is now under Hospice care..mostly because I said no more hospitals!! If something comes up they call hospice to come and check. She would have to have a bone sticking out of her somewhere before they could take her anywhere. We also have the ability to have her xrayed right there where she lives...there is a traveling xray they can bring in to check for breaks.

Talk to his doctor and find out if it is necessary to insert a catheter...if it isn't then refuse to let it be done. The last time my mom was hospitalized I made them take out the I V needle they put in as standard operating procedure. They didn't like it but it wasn't their choice.

I'm glad he's is back and everything is as fine as can be....is the catheter still in?

Love, Meg

 
Old 05-05-2011, 09:22 PM   #4
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Re: The ER

Quote:
Originally Posted by meg1230 View Post
Nina...My mom is now under Hospice care..mostly because I said no more hospitals!! If something comes up they call hospice to come and check. She would have to have a bone sticking out of her somewhere before they could take her anywhere. We also have the ability to have her xrayed right there where she lives...there is a traveling xray they can bring in to check for breaks.

Talk to his doctor and find out if it is necessary to insert a catheter...if it isn't then refuse to let it be done. The last time my mom was hospitalized I made them take out the I V needle they put in as standard operating procedure. They didn't like it but it wasn't their choice.

I'm glad he's is back and everything is as fine as can be....is the catheter still in?

Love, Meg
No, nothing at all. He is back to his old self. The urine was fine, I think.
The ER just did what they thought they should. At least they cleared it away. But strangely he was not fuzzy at all.

Nina

 
Old 05-05-2011, 09:34 PM   #5
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Re: The ER

I did the same thing Meg has done with my Dad... put him under the care of Hospice so there would be no more ER visits.

If the resident complains of pain anywhere withing a week of a fall they ship them off to the ER for just what you said... they have no way of knowing if there is anything wrong. Of all the trips to the ER there was only once they found anything wrong and it was a minor brain bleed which resolved itself in a few hours. But the ER created more problems than it resolved. Dad had degenerative joint disease and back problem. He always hurt in that waist to lower hip area. If they would point to that area he would say it hurt... but that was not fall related it was an all the time thing. It resulted in way too many trips to the ER for him. Because of the fear of law suits, facilities are over reactive when it comes to falls and pain... especially in dementia patients.

As for the catheter... it's standard procedure in ERs. If they want a urine sample they do a catheter. I have fought with the ER staff more than one time over this practice. Catheters are one of the quickest ways to get a UTI.. or sepsis, or any other number of complications. It was a catheter that was actually unnecessary that resulted in my grandmother contracting sepsis. I completely and totally refused to let them use a catheter with my Dad. I demanded a bed pan and a glass of water... they had their urine sample within a few minutes. It is quick and easy for them to just do the procedure instead of waiting a few minutes.

I am just glad your Dad is back and there is nothing physically wrong

Love, deb

 
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Old 05-06-2011, 08:23 AM   #6
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Re: The ER

My FIL still knows that he wants to get treated but it certainly is up to the nurse to decide if it is something that should be checked. However, they did ask if my husband the POA approved it. So he has the power to tell them to wait and see. But we would not know in case there was something wrong and we don't want to be the bad guys...
However I do know the ER has certain protocol that is not friendly to an elder with dementia. But my FIL as a physician in Europe, wants to get treated although he does not want to be hospitalized. He would play the trick so people think he is right or something. I am sure they know he is incompetent.

Next time we may want to wait a little bit. Maybe he got diarrhea from the ER! Some other elders in the home also had diarrhea.

He is not ready for hospice at all. Far from that.

Nina

Last edited by ninamarc; 05-06-2011 at 08:25 AM.

 
Old 05-06-2011, 08:51 AM   #7
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Re: The ER

It is because our loved ones can not accurately communicate their needs that nobody wants to be the "bad guy" as you put it. Your hubby was in the same position as the care facility. Who want to say that pain complaint is not legitimate without checking it out. I have made the opposite call. Mom fell. They called me and I could hear her laughing in the back ground. She was sitting up on the floor and saying "get up". They wanted an ER visit just because she fell and I said no. Even with a non-verbal resident recently that fell from her wheel chair, there are checks you can do to determine the severity of the injuries. A trained eye should know but many times because of that illusive "pain complaint" we doubt.

ERs are definitely not dementia friendly. They have procedure and protocol that is based on dealing with cognitively aware individuals and they don't get it. Dad fell and was shipped off to the ER. When I arrived only minutes after he did I informed the little intern that Dad had "Advanced Vascular Dementia". I said it several times. He HAD to talk to Dad and did. He came back to me and ask if Dad had hit his head and I said no.... the same thing Dad had said. But he must have.... because he is so confused said the intern. DUH He wanted yet another CT scan to find the source of the confusion. I just looked at him and ask...."What part of Advanced Vascular Dementia do you not understand?" I suggested he go back and pull the last four CT scans they did on Dad. They would explain the confusion. I never saw that intern again That is why I always try to be present and advocating for my parents in an ER. It is difficult when you are pulling against those that are supposed to be helping!

Love, deb

 
Old 05-06-2011, 04:02 PM   #8
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Re: The ER

Reminded me of DH's psychiatric admission. They processed him through the ER. We got there as quickly as possible. We were amazed by the nurse slowly shouting at him, as if he was hard of hearing instead of in stage 6 Alzheimers... "Mr. ___, When was your last tetanus shot?"

One kid was recently in a hospital ER. As we waited, we observed many things like the nurses snacking and chatting instead of responding to call buttons, workers with scrubs dragging on the floor from room to room, and a patient just laying alone on a gurney in a hall for over 1/2 hour. And this is supposedly a good hospital in an upscale community. Geez.

Two of my kids are now in college/grad school pursuing careers in health care. I don't think I necessarily would have noticed the scrubs dragging on the floor, for example, if they hadn't pointed it out to me. I can't wait until I can turn medical issues completely over to them. The battle to get an appropriate level of health care for an Alzheimers patient is exhausting.

 
Old 05-06-2011, 05:11 PM   #9
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Re: The ER

Bless both of your children!! They know and understand the struggle with dementia and they will be able to take that knowledge into the medical field with them. It will make the day of caregivers they come in contact with!!!!

I have had ONE ER doctor that got it!! He was wonderful.... compassionate and understood! As he was helping me check Dad out of Observation after a horrible night, I ask him who he knew that had dementia. He was an ER doctor and not Dad's doctor but he expedited Dad's discharge because he knew it was the right thing to do for Dad. He finally told me as we looked at Dad's CT scan together that he had actually cared for his grandfather for a while and that is what propelled him into Med School. I can see your children doing that for somebody someday and it thrills me

Love, deb

 
Old 05-07-2011, 02:56 AM   #10
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Re: The ER

Thank you, Deb. And another kid is in law school...together, they're going to be quite a team of patient advocates!

 
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Old 05-07-2011, 11:30 AM   #11
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Re: The ER

The tricky part is my FIL still wants to know what is wrong like a child thinking he wants to know what is going on. If you don't do certain tests, how do you make sure he is OK? He is not bedridden or anything. He walks with a cane and is a role model in the home. He has the best behaviors in the home. He has fallen more lately so the home is trying to be cautious in the ER. He is 90! So it is a danger if nothing is checked out fine.

My husband wishes to find out why with the tests. My FIL used to be the one that loved to do tests to find out what is wrong for prevention purpose.
Now he is not dying or anything, so my husband wants to let him do the best in the ER.

The argument is that the ER does unnecessary tests but my husband said how do you know? What if something is wrong?

However, if he falls every week and goes to the ER every week, then it would be a joke.
I mentioned some idea of this to the residential care director so I hope he gets the idea and will be more prudent to call for the ER.

Nina

Last edited by ninamarc; 05-07-2011 at 11:31 AM.

 
Old 05-07-2011, 11:28 PM   #12
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Re: The ER

Yes, it is a catch 22. If they fall, it is difficult to tell what is going on because they can not tell you with accuracy what is truly wrong with them. If you ask my Dad if he hurt there, and pointed to any part of his body between his lower hips and his waist he would say yes. But I know he had chronic back pain much of his life. Yes, it hurt but it was not because of the fall. So off to the ER for hip x-rays. Repeatedly they were negative. Once there he was confused so they wanted to check for head injury. We know the confusion was due to the dementia but they had to be sure. Scan him in, x-ray, scan him out. After so many repeated trips to the ER I thought he might just be a bar code.

At some point YOU have to set the priorities. I never send my parents to the ER alone. I am always there. I make the calls. There is a right of refusal of any medical treatment as long as you have the proper authority in the form of a Medical POA. I refused catheters and ask for a bed pan to get a urinalysis. I refused CT scans when I knew there was no head injury, only dementia confusion. After a disastrous night in the ER observation unit I would check Dad out if necessary with a promise to watch neurological signs... even if I had to spend the night at the facility with him. I have even talked the facility out of sending Dad to the ER twice and so far Mom twice. If they didn't know how Mom got on the floor and she was sitting up laughing... why send her? It usually entailed me going to the facility myself but that sure beats a day in the ER.

I also think about... "what would I do if they found something major?" When Mom broke her hand, I decline surgery to pin the bone. It has healed well with only limited loss of mobility and flexibility. I also took her to urgent care rather than let them transport her to the ER. She has had episodes of blood in her urine which we suspect is because of cystitis due to dehydration. We don't know this for sure but I refused the extensive testing it would take to prove it was not something else. If it were cancer would I put her through chemo or surgery... NO! So there are calls that can be made based on what you would do if....

It's something that you have to decide for yourself what is right. You say your FIL is not dying or anything... but he does have a terminal disease for which there is no cure and no way to significantly change the course of the disease. I do let that fact play in my decisions. I make decisions that are based on quality of life rather than quantity of life. I know that medical procedures, hospital stays, and especially anesthesia can cause a cognitive decline. I seek treatment if it is something that will improve the short term quality of life. I do not seek treatment for anything else. If Dad fell and had a sever brain bleed... he would not survive the surgery with his cognition in tact... so why even consider the possibility?

When I called in Hospice it was not because I thought Dad was going to die soon. I called Hospice because they had a nurse and a doctor that would visit the facility if Dad fell.

But as I said... these are all decisions your hubby will have to make. Each has to do what is right for them. I just believe there is a time to let go....

Love, deb

 
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