Dialogue Volume 13 Issue 2 2017 - Page 48

practice partner woman’s potassium was significantly elevated and that Kayexalate was administered and spironolactone was discontinued. There was no evidence that an electrocardiogram was ordered or that a physician as- sessed the woman. There was a nursing note indicat- ing that β€œthe resident had significant abnormality in the lab results, especially elevated K and CBC. Resi- dent is on Kayexalate. Fax the results to [hospital] ER MD on call for further evaluation.” The advice given was for the facility’s physician to review the results on July 2, 2014. That same day, there was documenta- tion that the woman had been complaining of severe back pain and was continuing to be administered as needed hydromorphone. On June 29, 2014, nursing notes indicated that the woman was receiving 1 mg of hydromorphone for pain on an as needed basis as well as hydromorphone 3 mg every 24 hours for breakthrough pain. The physician in the emergency department was again contacted and narcotic medications were ‘…Ή•ΡΌ)!ε‘Ι½΅½ΙΑ  ½ΉΡ₯Έ€Δȁ΅œΡέ₯”„‘…䰁…±½Ήœέ₯Ρ )‘ε‘Ι½΅½ΙΑ‘½Ή”™½Θ‰Ι•…­Ρ‘ɽ՝ Α…₯ΈΈ)=Έ)Υ±δ€Δ°€ΘΐΔΠ°Ρ‘”έ½΅…Έέ…́չɕΝΑ½ΉΝ₯Ω”ΡΌ)Ω•Ι‰…°ΝΡ₯΅Υ±…Ρ₯½Έ…Ήέ…́Ή½ΠΙ•ΝΑ½Ή‘₯ΉœΡΌ„Ρ…ΐ½Έ)Ν‘½Υ±‘•Θ°ΝΡ•ΙΉ…°ΙՈ½ΘΩ•Ι‰…°½΅΅…ΉΈ!•ΘΝ­₯Έέ…Μ)±…΅΅δ…ΉΝ‘”έ…́ͱ₯‘Ρ±δΑ…±”ΈY₯Ρ…°Ν₯ΉΜέ•Ι”θ @(ΰΜΌΤΤ°ΑΥ±Ν”€δά°Ι•ΝΑ₯Ι…Ρ½ΙδΙ…Ρ”€δέ₯Ρ €Δԁ͕½Ή‘Μ)½˜…ΑΉ•„…Ή€ΐȁͅΡΥΙ…Ρ₯½Έ½˜€ΰΠ”½ΈΙ½½΄…₯ΘΈQ‘”)έ½΅…Έέ…́ΡΙ…ΉΝΑ½ΙΡ•ΡΌ‘½ΝΑ₯Ρ…°Έ)UΑ½ΈΙ•Ω₯•ά½˜Ρ‘”Ι•½Ι‘Μ°₯Ё½Υ±Ή½Π‰”‘•Ρ•Θ΄)΅₯Ή•₯˜Ρ‘”Α…Ρ₯•ΉΠ‘……ΡΥ…±±δ‰••ΈΝ••Έ‰δ„Α‘δ΄)Ν₯₯…Έ™Ι½΄Ρ‘”Ρ₯΅”½˜‘•Θ…‘΅₯ΝΝ₯½ΈΡΌΡ‘”1Q )½Έ)ΥΉ”€ΘΤ°€ΘΐΔΠ°ΥΉΡ₯°‘•ΘΡΙ…ΉΝ™•ΘΡΌ‘½ΝΑ₯Ρ…°‘Υ”)ΡΌΥΉΙ•ΝΑ½ΉΝ₯Ω•Ή•Ν́½Έ)Υ±δ€Δ°€ΘΐΔΠΈQ‘”‘½ΝΑ₯Ρ…°)…‘΅₯ΝΝ₯½ΈΉ½Ρ”½˜)Υ±δ€Δ°€ΘΐΔΠ°½΅Α±•Ρ•‰δΡ‘”)…‘΅₯ΡΡ₯ΉœΑ‘εΝ₯₯…Έ€‘έ‘Όέ…́…±ΝΌΡ‘”Α‘εΝ₯₯…Έέ‘Ό)…‘©ΥΝΡ•Ρ‘”΅•‘₯…Ρ₯½Έ‘½Ν”€°₯Ή‘₯…Ρ•ƒŠqΡ‘₯́ɕΝΥ±Π΄)•₯Έ„Ν₯Ή₯™₯…ΉΠΉ…ɍ½Ρ₯Œ½Ω•Ι‘½Ν”Ρ‘…ЁΥ±΅₯Ή…Ρ•)Ρ½‘…δέ₯Ρ „Α•Ι₯½½˜ΥΉΙ•ΝΑ½ΉΝ₯Ω•Ή•ΝΜ»Št)]‘₯±”₯ΈΡ‘”•΅•Ι•Ήδ‘•Α…ΙΡ΅•ΉΠ°Ρ‘”έ½΅…Έ)݅́ΡΙ•…Ρ•έ₯Ρ ΡέΌ‘½Ν•Μ½˜Ή…±½α½Ή”έ₯Ρ Ν½΅”)ΝΑ½ΉΡ…Ή•½Ύ₯΅ΑΙ½Ω•΅•ΉΠΈ%Ё݅́…±ΝΌΉ½Ρ•Ρ‘…Π)Ν‘”‘…Ή½Π‰••ΈΙ••₯Ω₯Ήœ‘•Θ±…ΡΥ±½Ν”έ‘₯±”₯ΈΡ‘”)1Q ΈQ‘”έ½΅…ΈΙ•΅…₯Ή•ΥΉΙ•ΝΑ½ΉΝ₯Ω”₯ΈΡ‘”)‘½ΝΑ₯Ρ…°…ΉΡ‘”‘•₯Ν₯½Έέ…́΅…‘”ΡΌ‘••΄‘•ΘΑ…°΄(Πΰ)₯…±½Υ”%ΝΝΥ”€Θ°€ΘΐΔά)±₯…Ρ₯Ω”…ΉΡΙ…ΉΝ™•Θ‘•Θ‰…¬ΡΌΡ‘”1Q Έ)Q‘”έ½΅…ΈΝΥ‰Ν•ΕΥ•ΉΡ±δ‘₯•½Έ)Υ±δ€Μ°€ΘΐΔΠΈ)₯͍ΥΝΝ₯½Έ)Ι½΄Ρ‘”Ι•½Ι‘́ΑΙ½Ω₯‘•™½ΘΙ•Ω₯•ά°₯Ё݅́‘₯™™₯Υ±Π)ΡΌ‘•Ρ•Ι΅₯Ή”Ρ‘”΅½ΙΑ‘₯Ή”•ΕΥ₯Ω…±•ΉΠ‘½Ν”ΑΙ₯½ΘΡΌ)Ρ‘”‘…Ή”ΡΌ±½Ήœ΅…Ρ₯Ήœ‘ε‘Ι½΅½ΙΑ‘½Ή”Έ%Ёݽձ)…ΑΑ•…ȁё…Ёё”‘½Ν”½˜Ή…ɍ½Ρ₯Œέ…́‘½Υ‰±•…ΉΡ‘…Π)Ρ‘”±½Ήœ΅…Ρ₯Ήœ‘ε‘Ι½΅½ΙΑ‘½Ή”έ…́±₯­•±δΙΥΝ‘•)…ΉΑΥЁ₯ΉΡΌ…ΑΑ±•Ν…Ս”Έ%˜°₯Έ™…Π°Ρ‘”‘ε‘Ι½΅½Θ΄)Α‘½Ή”έ…́ΙΥΝ‘•…ΉΡ‘•ΈΑΥЁ₯Έ…ΑΑ±•Ν…Ս”°₯Ё݅Μ)½ΉΡΙ…ΙδΡΌΡ‘”ΑΙ½‘ՍЁ΅½Ή½Ι…Α έ‘₯ ΝΡ…Ρ•Μθ+Šq!eI=5=IA  =9Q%8…ΑΝΥ±•ΜΝ‘½Υ±Ή½Π‰”)‰Ι½­•Έ°‘•έ•°‘₯ΝΝ½±Ω•½ΘΙΥΝ‘•°‘Υ”ΡΌΡ‘”Ι₯Ν¬)½˜™…Ρ…°!eI=΅½ΙΑ‘½Ή”½Ω•Ι‘½Ν”Έ)!eI=5=IA  =9Q%8Ν‘½Υ±‰”Νέ…±±½έ•)έ‘½±”½Θ½Α•Ή•…ΉΡ‘”½ΉΡ•ΉΡ́ΝΑΙ₯Ή­±•½ΉΡΌ„)Ρ…‰±•ΝΑ½½Ή™Υ°½˜έ…Ι΄½Θ½±€ Π΄ΠΓ ι €…ΑΑ±•Ν…Ս”½Θ)Ι½½΄Ρ•΅Α•Ι…ΡΥΙ”ΥΝхɐΈQ‘”•ΉΡ₯Ι”½ΉΡ•ΉΡ́½˜Ρ‘”)Ρ…‰±•ΝΑ½½Έ½˜™½½…Ή!eI=΅½ΙΑ‘½Ή”΅₯αΡΥΙ”)Ν‘½Υ±‰”Νέ…±±½έ•…́ͽ½Έ…́Α½ΝΝ₯‰±”…™Ρ•ΘΝΑΙ₯Ή­±₯Ήœ)…ΉΝ‘½Υ±‰”‘₯͍…Ι‘•₯˜Ή½Π½ΉΝΥ΅•ΈQ‘”™½½Ό)‘Ι՜΅₯αΡΥΙ”Ν‘½Υ±Ή½Π‰”‘•έ•°…ΉΡ‘”₯Ή•ΝΡ₯½Έ)Ν‘½Υ±‰”™½±±½έ•‰δΙ₯ΉΝ₯ΉœΡ‘”΅½ΥΡ έ₯Ρ ™±Υ₯‘́Ѽ)•ΉΝΥΙ”Ρ‘…Ёё”•ΉΡ₯Ι”½ΉΡ•ΉΡ́…Ι”Νέ…±±½έ•»Št)%Ё…ΑΑ•…Ίё…Ёё•Ι”έ…́…Έ•Ιɽȁ₯ΈΡ‘”…±Υ±…Ρ₯½Έ)½˜Ρ‘”‘…₯±δ΅½ΙΑ‘₯Ή”•ΕΥ₯Ω…±•ΉΠ‘½Ν”έ‘•Έ½ΉΩ•ΙΠ΄)₯ΉœΡ‘”έ½΅…Έ™Ι½΄Ρ‘”Ν‘½ΙΠ΅…Ρ₯Ήœ‘ε‘Ι½΅½Θ΄)Α‘½Ή”ΡΌΡ‘”±½Ήœ΅…Ρ₯Ήœ‘ε‘Ι½΅½ΙΑ‘½Ή”Έ)Q‘” ½΅΅₯ΡΡ•”…±ΝΌΉ½Ρ•Ρ‘”±…¬½˜½΅΅ΥΉ₯„΄)Ρ₯½Έ‰•Ρέ••ΈΡ‘”ΉΥΙΝ₯Ήœ‘½΅”ΝΡ…™˜…Ή…ΡΡ•Ή‘₯Ήœ)Α‘εΝ₯₯…ΉΜ₯ΈΡ‘”•΅•Ι•Ήδ‘•Α…ΙΡ΅•ΉΠΈQ‘”…‰Ν•Ή”)½˜Ρ‘”΅•‘₯…°‘₯Ι•Ρ½Θ½΅Α½ΥΉ‘•Ρ‘₯́ΑΙ½‰±•΄…Ή)Ρ‘”±…¬½˜Α‘εΝ₯₯…Έ…ΡΡ•Ή‘…Ή”ΡΌΡ‘”Α…Ρ₯•ΉΠέ‘₯±”₯Έ)Ρ‘”1Q ±₯­•±δ‘……Έ₯΅Α…Π½ΈΡ‘”…Ι”ΑΙ½Ω₯‘•Έ)Q‘” ½΅΅₯ΡΡ•”Ι•½΅΅•Ή‘•Ρ‘…Ёё”±½Ήœ΅Ρ•Ι΄)…Ι”‘½΅”₯ΉΩ½±Ω•Ι•Ω₯•άΡ‘”₯ɍաΝΡ…Ή•Μ½˜Ρ‘₯Μ)…Ν”έ₯Ρ Α…ΙΡ₯Υ±…ȁ…ΡΡ•ΉΡ₯½ΈΡΌ₯΅ΑΙ½Ω•½΅΅Τ΄)Ή₯…Ρ₯½Έ…ΉΑ…₯Έ…ΝΝ•ΝΝ΅•ΉΡ́‰δΡ‘”ΉΥΙΝ₯ΉœΝΡ…™˜)…Ή₯΅ΑΙ½Ω•½΅΅ΥΉ₯…Ρ₯½Έ‰•Ρέ••ΈΡ‘”…ΡΡ•Ή΄)₯ΉœΑ‘εΝ₯₯…ΉΜ…ΉΡ‘”ΉΥΙΝ₯ΉœΝΡ…™˜°•ΝΑ•₯…±±δέ‘•Έ)Αɕ͍Ι₯‰₯Ήœ½Α₯½₯‘ΜΈ)5