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What Causes Nausea And Appetite Loss?
Question: Hello, I am a nurse and this question is about a patient I had recently, admitted for nausea and failure to thrive. He was admitted from a nursing home after being nauseous for days with no appetite. He was found to have severe protein-calorie malnutrition but refused a PEG tube and frequently had no appetite or had nausea/vomiting after eating. Past medical history: R leg amputation, stage 4 sacral pressure ulcer (surgically debrided during his hospitalization), urostomy, and ileostomy. On my shift he was on a clear liquid diet but still was not able to keep much down. His abdomen was slightly distended with normal bowel sounds and no abdominal pain. By the end of my shift (12 hours) his ileostomy had not put out much, only about 100ml. I didn't report this to the MD because the MD had just been in to see the patient and patient was not in acute distress. I did chart it and report to next nurse. She said he remained the same over night but the next day his abdomen became more distended and painful and the nurse called the doctor for an NG tube but he refused and ordered a KUB to be done the next morning. That night around 3 am the pt complained of severe bloating and pain, and night nurse called for NG tube again but MD refused and said stop all narcotics and he would see the pt in the AM. The pt ended up vomiting, aspirating, and coding, then passing away in the ICU after his BP dropped and he coded again. I am wondering if I should have reported the low ostomy output and vomiting to the MD and if this would have caused earlier intervention and saved the pt. I didn't feel the pt's condition had changed drastically as he was admitted for nausea and vomiting, but I would like a second opinion for peace of mind; I am hoping I didn't miss an obstruction developing. Thank you!
Brief Answer:
Should do our job decently....
Detailed Answer:
Hi,
I have gone through your query carefully and understood your concerns.
The situation of the patient with history of nausea, failure to thrive and no appetite should have been taken more seriously by all of your medical staff, especially the MDs.
Although you have not reported the quantity of ileostomy content, however, you have written it down to the pt's records and pass to the other nurse. So, the MD should have evaluated his medical condition after reading the medical records.
The most important part is that the MD "DID NOT CONSIDER PAIN AND DISTENSION" that the patient reported. This was the crucial time where proper assistance should have given after re-evaluating his health condition.
Unfortunately, this patient has a sad ending. I would only remind to :
- check your patient's status correctly (although you might be tired or frustrated)
- report always to the MD everything you see unusual
- if the MD won't listen to you, be patient and insist in giving all the medical records of your patient to the MD, especially in acute situations
for future patients.
At the end, as health-care providers, we are facing a variety of patients with happy or sad ending. The most important thing is to do our job properly and to take good care of our patients. At least, we should try to do our job; the rest depends on God's Willing.
Let me know if you have further queries!
Dr.Klerida
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you for your help. I agree that the MD should have taken the change in condition more seriously, and I wish there had been a better outcome. I am just curious what could cause a patient to have nausea/poor appetite for such a long time, and if there is anything I should have done differently in this situation. I was not on shift when the patient died but the nurses felt they wasted precious time trying to convince the MD to let them put down an NG tube. Is there anything nurses can do if MD will not give the orders we think are needed?
Brief Answer:
Following suggestions...
Detailed Answer:
Hi,
From the moment the patient has been sent to the ward, further tests and exams should have run to diagnose the right cause for nausea and loss of appetite for such long time.
You have done the best of you as a nurse. Putting NG tube might not be a solution, but to insert a catheter for intravenous perfusion.
Only a doctor-assistant can insert the NG tube straight away without having permission of the MD when is necessary.
As you are not a doctor-assistant, you have done the best you can.
Dr.Klerida
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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