Hi, and welcome back to the course vigilance during hospital stay of loved ones. In this last part of the course, I provide quite a few practical examples of requests made to hospital staff, some of which were honored while others were brought based on clinical reasons hospital policy, routine or administrative reasons. The first set of examples is focused mainly on requests made to medical staff. requests can be made to several types of doctors such as the ER doctors, the meeting, hospital doctor, the on call doctors, as well as surgical specialists and ICU doctors. requests can also be made to nurse managers and nurses First, let us look at a request to an ER doctor. Here's a case scenario of a patient presenting with seizures at the emergency room.

And so the patient is presenting signs and symptoms of seizure or at least has a history of it and the year staff generally do not tend to get an eg test done on an emergency basis. This request for an immediate eg is not fulfilled mainly because of a lack of availability of an EKG technician at the time of the ER admission of the patient. A second reason is that the eg tests are usually known to be non sensitive. This means that even with a seizure activity or sooner After the EKG may show a general slowing of the brain activity, and nothing more specific to identify the type of seizure the patient has. This diagnosis is therefore, based more on clinical aspects and history rather than the eg test, however, it is still incumbent on the patient and his or her family members to make that request in order to find out the type of seizure that's occurring, that may in turn help with more specific therapy in the future with the clinical neurologist.

Test Surely, if the clinical signs are not specific, so the timing of an EKG may actually be helpful from the patient's point of view. know an example of a request to a hospital doctor, a patient is presenting with unitary infection and has a need for repeated catheterizations. If the patient has kidney infection and the catheter is placed, and has to be removed and placed back due to the possibility of infection in the hospital, we can do research on how to avoid such infections. And find out through some research that there are some new types of catheters that are antimicrobial in nature that might prevent any re infections. When asked for it, the request may be denied first because of lack of availability of such catheters in the hospital or The time it takes for the order to be placed and by the time the catheter comes, it is too late for the procedure to be done and the doctor may not see a need for it.

However, if there is a clinical reason that is on the patient's relatives or friends or patient himself or herself to see that such a request can be fulfilled. Now I request further on call doctor. Again a patient with a kidney infection. And in this case, the patient may not have had enough fluid intake through the saline water and yet the urine output may be fine at this point a request can be made on the nurse who can call the on call doctor for an increase in the sale. Line fluids to be made. In this case, the staff would have thought that the patient is taking enough water by mouth.

However, when relatives or friends notice that the patient is not taking enough fluids by mouth, due to whatever reasons it is on them, to mention it to the hospital staff who are actually unaware of this fact. And so it is on us who are concerned for the patient that we place that request and then the CNA may check the charts to make sure that's what is happening. Now a request for an ICU doctor. A patient in the hospital is experiencing difficulties in consciousness. The oxygen supply line is that it through the nose From the oxygen tank when asked for admission to the ICU for a closer monitoring of the symptoms, the doctor argues that he or she does not see enough evidence or indication for it as there should be considerable deterioration of the patient such as needing tracheotomy or having to open airways for the patient to be admitted to the ICU.

Then the request is for the patient to have oxygen supply increased and vital signs to be monitored more closely which request is then granted. The vital signs in this case would of course include oxygen levels. Now I request to a nurse manager. This is still Regarding the patient with unconsciousness for whom a request is made, and then that request is passed on to the on call doctor. A patient is not conscious. But breathing well.

The nurse manager does not give an indication to call an on call doctor. The patient's relatives insist on it the request is granted the ICU doctor comes in and gives his reason for not admitting a patient thus an agreement is reached. And that is the request is that at least oxygen be maintained in good supply and more frequent monitoring of the vital signs. Although this example is same as the previous one, the nurse manager is the one who was the intermediate or between the doctor and the ICU doctor Now it is regarding nurses and verification of list of medications. nurses have duty at the very beginning of a hospital room admission to ask for an up to date and accurate list of medications the patient normally takes at home. As now, new medicines need to be used for treatment of the current condition of the patient along with the routine medicines that the patient had already been taking.

At times, the records that they pull up off a list of medications are all thus the read. The patient needs to update the records. Even then, while administering the medicines one has to be careful and take a close look at the medicines being given by the nurse. Why aspect of the nurses duties to have an accurate list of medicines. So the administration of these medications would be correct while in the hospital. So these changes have to be verified very closely.

And this concludes the first set of examples of requests made to medical staff.