Unable to answer family questions about DVT.

1 I'm an RN with 2 1/2 months experience in Med/Surg following 11 months in LTC. I work 7p to 7a. Recently I had an elderly female pt. admitted for DVT - my first DVT pt.

She had arrived on the floor shortly before shift change. She had 3 family members in the room who had questions for me as soon as report was finished. They were curious what the plan of action was, how long a DVT usually takes to resolve, how did the Dr. know she had a DVT, and how was he treating it? Seems to me this should have been addressed by someone already, but it wasn't, so they asked me, the nurse.

Of course. It's my job to answer questions right? Except, I didn't know the answers. I responded initially by stating that I needed to review the pt's chart before I could answer their questions. I did so and found that an abdominal/pelvic CT had been ordered but not done bc the pt was uncooperative (pt had dementia). I don't even know what it was ordered for.

The DVT was in the lower extremity. Were they trying to rule out others or was this test unrelated? There were no other procedures ordered. There were some labs but I can't remember what they were now, and the pt's leg was warm and swollen.

I felt at a loss trying to answer the family's questions for several reasons.

1) I wasn't sure of the diagnostic criteria for DVT and because I'm an RN not an MD I didn't want to get into how the pt was diagnosed because that's not my job.

2) I have no idea the average length of time a DVT takes to resolve and couldn't just call the Dr. to ask.

3) I don't know how they monitor progress in a DVT pt. Basically, I need a refresher on DVT's I guess. But I seem to be in this situation a lot where I just don't have the answers and I feel like I should. Any advice?

I just feel like there is so much I don't know! I did well in school but feel I have forgotten everything. Probably the 11 months in LTC prior to Med/Surg. Last edit by Joe V on Aug 22, '12 : Reason: spacing
Ah yes... it's been a long time since I worked in Med/Surge/Acute Care, but I remember moments like what you described, quite well. When the family isfiring off all of those questions at you, it's hard to know how to respond. Youcan't really say "The doctor is the best one to answer all of those questions foryou", whether it's true or not. Reason being, the doctor MAY NOT actuallysit down with the patient and family and discuss/explain everything. They may orderall of the treatments, meds, procedures, etc.. but will they actually do any ofthe in depth explaining of what is going on? The MD may do that, or theymay not.One thing that you can do with families is give them a starting point. You cango over with them what is being done right NOW. "We're going to start withIV fluids, IV Heparin, labs, and we'll go from there. I want to assure you thatyour loved one is in very good hands and we are doing everything possible. Wewill keep you updated." So, you don't really HAVE to go into a full legnth explanationof a condition that you are not quite familiar with yet. Orient the family towhat is being done now for their loved one, and keep them reassured.THEN, on your own time, spare time, whatever, educate yourself aboutthe various conditions such AS DVT, that you will come across.

Sorry, I've been a RN too many years to count, and I would still would be kind of guessing, stumbling, at answers to the families questions along with you. But of course you don't want to look like an inept idiot in front of the family!It is okay to say '"I don''t know the answers to all your questions.......the doctor has ordered all the appropriate tests and treatments.' Offer them paper and pen to write down their questions so they can remember to ask the doctor when they see him. Check with a co-worker or charge nurse (or a computer with Internet access) to see if you can get some quick answers to the questions.The longer I have been a nurse the more comfortable I am with saying to patients or their family, "I don't know about that.....or.....I don't know what that drug is." Given the situation you can add......"but I will find out".....or....."your doctor will be here soon we will ask him.'

Every place I've been to has access to printable educational materials, as well... this is stuff that you can just print out and hand to the patient/family and they can read at their leisure.

I love education material for just this. We can't know everything about everything but we should know where to find the answers I love pt guided material on things such as DVT's, basic procedures etc.. It really helps, also don't be afraid to ask your charge nurse, if she doesn't know, she/he can guide you in the right direction. I have called the MD for families before or arranged a meeting to answer all their questions.

Personally, I hate hate hate it when a nurse says, "You'll have to ask the doctor about that," because it just makes the point that only the doctor knows anything and we poor benighted nurses are dumb as boxes of bricks and can only "follow doctor's orders." If that's what you want people to think about you and your chosen profession, be my guest...... but maybe you could have said, "I am new here and I don't know, but I will find out for you," and get someone-- a nurse-- on the floor who is experienced enough to answer those questions. BTW, it is perfectly appropriate for a nurse to answer all of them." They were curious what the plan of action was," "A DVT is a clot in a big vein, in this case in your mother's leg. You can tell because it has a characteristic appearance, her leg is swollen and tender, and they did an ultrasound examination in the ER to look at the vein and saw the clot in there.""... how long a DVT usually takes to resolve," "All clots eventually dissolve, and that can take different amounts of time for different people. What is important now is to do what we can to see that it doesn't get bigger, by giving her medications that make her blood clot less well. These are called "anticoagulants," because "coagulation" is the medical word for clotting. We will monitor her clotting by a blood test every day and adjust the medicine dose accordingly.""... how did the Dr. know she had a DVT, and how was he treating it?" (See, we covered that already.)For next time. Since you asked for advice, here's mine: every day at the end of your shift, pull out your textbook(s) and read something about at least one of the diagnoses and nursing care of something you saw that shift. You will have a better way to remember it than you ever did as a student. You should do this for the rest of your professional life. I have been out of school for smumblemumble years, and I still find there are things to learn. Different ones, but always something. Never stop learning.Note: to get full impact of this message, it should display in Comic Sans, green. Thank you.

Typically the MD will write in the H&P or progress note the pt's problems and the plan. I always check that b/c in nursing report we tend to miss a lot of the important things unfortunetely. A lot of times they will number it like 1.DVT 2. Hypertension 3. etc... and they will write a plan like start heparin, CT of abd to rule out ...., and etc.. That will give you a better picture of the patient and the plan going forward. I've been a nurse for awhile and have been stumped. Worse is when the families come in the morning and start firing off questions when I haven't had a chance to review the chart or really get to know the patient. You'll find w/experience that a lot of the patients come in with similar things, DVT, PNA, etc.. and you will become more knowledgeable about these things. Next time you will be prepared to educate the pt and family on what a DVT is and the treatment I bet. Hang in there

Quote from GrnTeaPersonally, I hate hate hate it when a nurse says, "You'll have to ask the doctor about that," because it just makes the point that only the doctor knows anything and we poor benighted nurses are dumb as boxes of bricks and can only "follow doctor's orders." If that's what you want people to think about you and your chosen profession, be my guest...... but maybe you could have said, "I am new here and I don't know, but I will find out for you," and get someone-- a nurse-- on the floor who is experienced enough to answer those questions. BTW, it is perfectly appropriate for a nurse to answer all of them." They were curious what the plan of action was," "A DVT is a clot in a big vein, in this case in your mother's leg. You can tell because it has a characteristic appearance, her leg is swollen and tender, and they did an ultrasound examination in the ER to look at the vein and saw the clot in there.""... how long a DVT usually takes to resolve," "All clots eventually dissolve, and that can take different amounts of time for different people. What is important now is to do what we can to see that it doesn't get bigger, by giving her medications that make her blood clot less well. These are called "anticoagulants," because "coagulation" is the medical word for clotting. We will monitor her clotting by a blood test every day and adjust the medicine dose accordingly.""... how did the Dr. know she had a DVT, and how was he treating it?" (See, we covered that already.)For next time. Since you asked for advice, here's mine: every day at the end of your shift, pull out your textbook(s) and read something about at least one of the diagnoses and nursing care of something you saw that shift. You will have a better way to remember it than you ever did as a student. You should do this for the rest of your professional life. I have been out of school for smumblemumble years, and I still find there are things to learn. Different ones, but always something. Never stop learning.Note: to get full impact of this message, it should display in Comic Sans, green. Thank you.

I agree "You will have to ask your doctor about that." Can be really annoying for a nurse to say. But there are certainly situations where it must be used.What would you say to a patient who just had hernia surgery and asked you when he could ride his motorcycle? I wouldn't want to hazard a guess, I do know about driving a car instructions, and said, "You will have to ask your surgeon about that." Actually the surgeon was still in house so I called him. I don't want the original poster to think that phrase should never be used. But I agree it grates on my ears when I hear nurses use it in many other situations.

@brownbook: Perhaps in time you'll learn to say things like, "Since your foot will not have full range of motion until you've had several weeks of physical therapy, you won't be able to shift your bike safely. And those other fractures won't be healed enough to withstand any dumps, so you'll need to wait at least until your 6-week xray check to see if they're OK." Or, "I am pretty sure Dr. Green won't want you to put any strain on that abdominal incision after he took such great care to sew it up so neatly. ::with a smile:: I would plan on leaving the bike in the garage until he clears you for full activity, and that will probably be about six to eight weeks (or whatever)." And I would be good and sure the GF or parent hears that too. (This would NOT be a HIPAA violation !!)Note: for full impact of this message, it should display in Comic Sans, green. Thank you.

Quote from arallenrn11I'm an RN with 2 1/2 months experience in Med/Surg following 11 months in LTC. I work 7p to 7a. Recently I had an elderly female pt. admitted for DVT - my first DVT pt. 1) I wasn't sure of the diagnostic criteria for DVT and because I'm an RN not an MD I didn't want to get into how the pt was diagnosed because that's not my job.

Christy1019 - I think it came across wrong when I said it wasn't my job to explain the process of diagnosing DVT. What I meant by that is that I didn't want to overstep my bounds professionally, and, as I stated, I wasn't 100% clear on the diagnostic criteria. I was confused upon reviewing the chart bc no ultrasound was performed and lab values are my weakness, so while I assumed the diagnosis was based on the lab findings and the clinical s/s, I wasn't sure which lab values were relevant. Interestingly, the next day I did research and found many articles which recommended the use of a rapid result d-dimer in combo with clinical s/s as a more cost-effective and slightly more accurate way to diagnose DVT vs ultrasound. I'm glad I looked it up. Thank you for all your responses. They were all very helpful

Quote from GrnTeaFor next time. Since you asked for advice, here's mine: every day at the end of your shift, pull out your textbook(s) and read something about at least one of the diagnoses and nursing care of something you saw that shift. You will have a better way to remember it than you ever did as a student. You should do this for the rest of your professional life. I have been out of school for smumblemumble years, and I still find there are things to learn. Different ones, but always something. Never stop learning.Note: to get full impact of this message, it should display in Comic Sans, green. Thank you.