Update on my client's patient

"Ignoramus7651" wrote in message
...
they are probably all mental...

i

Your assessment skills are obviously finely honed. Please tell me, Dr.
Iggy, exactly what do you mean by mental? Is there a particular DSM axis
that you would care to share with us?

Do you believe that if someone is 'mental' (which, incidentally loosely
means of or pertaining to the brain or chin) that they are not worthy of
health care? Do you believe that anyone who is 'mental' is not as sick as
anyone who has high blood sugars or a positive culture?

What good, pray tell, and what did you add to the discussion by calling my
patient's family 'mental'? How does this help my patient and the other
patients who come along? Or just it just make you feel superior to call
other people names?

j

In article , Jayjay wrote:
God, how sad - and inferiating at the same time.

Unfortunately the family is probably to ignorant to realize that they
killed their family member

On Mon, 22 Sep 2003 22:20:07 -0500, "Julianne"
wrote:

I went to visit my client who had the extremely obese patient today and
learned that she had died.

For those of you who do not remember, this was a 40ish year old patient
who
weighed close to 500 pounds. She was physically unable to feed herself
and
her family seemed to mistake food for love. I spent an afternoon with
the
agency trying to come up with a decent plan of care. We even went as
far as
having the family sign a contract that they would abide by the written
dietary guidelines we provided. About two days later they called asking
if
perhaps we could approach the MD about having a feeding tube inserted
because they were afraid she wasn't getting enough protein. Don't go
there.

The food diary mirrored the dietary guidelines and no one ever knew how
the
fast food wrappers got into her bed. The patient was extremely
compromised
and needed to be up in the chair to breath. When the family got adamant
that she stay up in the chair, she activated her emergency alarm and
summoned 911 to put her back to bed.

It is tragic. It is not the story of those of us on ASD but it made me
sad,
all the same. She has teenage kids. Thanks to everyone who responded
with
good advice on how to motivate this patient.

For what it is worth, we did have elderly protective services involved.
I
likened the patient to an alcoholic who's family poured vodka down their
throat until they passed out and as soon as the patient stirred, they
poured
even more never giving the patient a sober moment to consider their
choices.

j

Owen,

Obliviously, it is impossible to chart every little thing about this patient
but one factor that I did omit was that the staff of the home health agency
aggressively pursued having the patient admitted as an inpatient to a rehab
facility that specialized in wound care. Although, this admission would not
have addressed the problem head on, it would have put a barrier between the
patient and the family. Alas, the patient was in and out of the hospital in
intensive care due to respiratory distress that the plan was never
implemented.

Whenever a patient dies unexpectedly, a root cause analysis is done.
Although the agency might not have violated any state standards or regs, it
is a good exercise into what could have been done differently or better.

Meanwhile, patients have the right to make decisions. Who am I to force a
patient to receive treatment?

j

ee, here is the thing. You have a patient who is alert, awake and oriented
and refusing care at an inpatient facililty.
"Owen Lowe" wrote in message
...
In article IZObb.2201$k74.675@lakeread05,
"Julianne" wrote:

I went to visit my client who had the extremely obese patient today and
learned that she had died.

I've followed your posts about her the past few weeks - what a sad and
disturbing story. I wonder if it would be possible to have a meeting
with those medical professionals involved to try to hash out a program
for any future patients in similar situations. Is there any sort of
mandatory hospitalization or commitment to a secure facility that the
patient could have been placed?

Maybe there's nothing any of you could have done differently... she and
her family were your strongest opposition and it appears they won the
battle.

Thanks. I hope we learn something as well. Although there is a pathology
within the family, it seems that the more experience we get, the more
capable we will be as an industry to make changes.

j
"janice" wrote in message
...
What a very sad story Julianne. I just hope that something good may
come out of the lessons that should have been learned. It seems
ironic that people who exercise their own free will to eat in fast
food outlets can then decide to sue them for feeing them unhealthy
foods, whereas no one could take action to prevent this happening
within a family.

janice
233/161/133

On Mon, 22 Sep 2003 22:20:07 -0500, "Julianne"
wrote:

I went to visit my client who had the extremely obese patient today and
learned that she had died.

For those of you who do not remember, this was a 40ish year old patient
who
weighed close to 500 pounds. She was physically unable to feed herself
and
her family seemed to mistake food for love. I spent an afternoon with
the
agency trying to come up with a decent plan of care. We even went as far
as
having the family sign a contract that they would abide by the written
dietary guidelines we provided. About two days later they called asking
if
perhaps we could approach the MD about having a feeding tube inserted
because they were afraid she wasn't getting enough protein. Don't go
there.

The food diary mirrored the dietary guidelines and no one ever knew how
the
fast food wrappers got into her bed. The patient was extremely
compromised
and needed to be up in the chair to breath. When the family got adamant
that she stay up in the chair, she activated her emergency alarm and
summoned 911 to put her back to bed.

It is tragic. It is not the story of those of us on ASD but it made me
sad,
all the same. She has teenage kids. Thanks to everyone who responded
with
good advice on how to motivate this patient.

For what it is worth, we did have elderly protective services involved.
I
likened the patient to an alcoholic who's family poured vodka down their
throat until they passed out and as soon as the patient stirred, they
poured
even more never giving the patient a sober moment to consider their
choices.

j

Alas, Bev,

What do you do when a grown woman with no documented psychiatric illness
refuses treatment? Yes, the agencies and myself can all learn realms but
adult folks, up and until they are declared incompetent by a court are
allowed to make their own decisions. It is painful.

j
"Beverly" wrote in message
...
This is so sad. I know how frustrating this situation was to you. I only
hope this puts into motion some changes within the involved agencies to
change their procedures for future patients in a similar situation.

Beverly

"Julianne" wrote in message
news:IZObb.2201$k74.675@lakeread05...
I went to visit my client who had the extremely obese patient today and
learned that she had died.

For those of you who do not remember, this was a 40ish year old patient
who
weighed close to 500 pounds. She was physically unable to feed herself
and
her family seemed to mistake food for love. I spent an afternoon with
the
agency trying to come up with a decent plan of care. We even went as
far
as
having the family sign a contract that they would abide by the written
dietary guidelines we provided. About two days later they called asking
if
perhaps we could approach the MD about having a feeding tube inserted
because they were afraid she wasn't getting enough protein. Don't go
there.

The food diary mirrored the dietary guidelines and no one ever knew how
the
fast food wrappers got into her bed. The patient was extremely
compromised
and needed to be up in the chair to breath. When the family got adamant
that she stay up in the chair, she activated her emergency alarm and
summoned 911 to put her back to bed.

It is tragic. It is not the story of those of us on ASD but it made me
sad,
all the same. She has teenage kids. Thanks to everyone who responded
with
good advice on how to motivate this patient.

For what it is worth, we did have elderly protective services involved.
I
likened the patient to an alcoholic who's family poured vodka down their
throat until they passed out and as soon as the patient stirred, they
poured
even more never giving the patient a sober moment to consider their
choices.

j

It is a waste. On the same day, I learned that a second patient had died.
His blood pressure had been steadily climbing. The nurses repeatedly told
him to go to the doc, go to the ER, find another doc, etc. He stroked and
died after about a month of this.

It is tragic but the law says that we cannot hold a patient down and do what
is good for them without informed consent. Being a nurse really sucks
sometimes.

j
"Chris Braun" wrote in message
...
I'm sorry about this woman's death, Julianne. It's distressing to
think that things like that happen despite the attempts to help. It
seems like such a waste.

Chris