As a nurse, what is arguably one of the most important things I can say in the course of my everyday job?
"This doesn't look/feel/seem quite right!!!"
Two days ago, still on orientation on a busy floor, I had a patient who had come in after Very Bad Things had happened to his esophagus. He was two weeks or so PAST the Very Bad Thing, but he was still "a little out of it" and his cough sounded...funky. It was my first day of two with this patient, and I was reassured on day one that his coughing was related to the Very Bad Thing he had come in for. His diet was ordered as Full Liquids, so when his wife asked for a milkshake in the afternoon, I went and made one (i am fully in favor of making food for patients. They get calories, I get brownie points.)
The problem was, after his wife started feeding him, he started coughing milkshake colored sputum. This was especially worrying, as immediately BEFORE the milkshake, his sputum was NOT that color. "But he's had a swallowing test done!!!" insisted his wife.
So I paged my Favorite Resident (he's not only REALLY good at his job, and highly personable and respectful, he's HOT!) and he came over yesterday morning. "Swallow study? well he's had a test to see if there's a MECHANICAL problem (tumor, obstruction, etc)!"
Me: "Um...you mean nobody has done a Speech and Swallow Consult?" (Speech Language Pathology...they RULE- they can evaluate anyone to determine how they can communicate, and if they're safe to be fed)
Favorite Resident: "well damn...I'll order one for first thing tomorrow then...yeah...you're right...if this is a result of his Other Medical Problems, this could be something where he's going to need help..."
Me: "So...no more milkshake then???"