Tales from the ER: The Curious Case of "Betty" and Her Jar of Black Sludge

Have you ever been handed a Tupperware container of evidence by a patient? Sounds bizarre, right? Well, let me take you through an ER shift that was anything but ordinary, featuring our memorable patient, "Betty." She waltzed in with abdominal pain and a very direct approach to communicating her symptoms. Betty's self-diagnosed treatment plan, rooted in decades-old research assistant experience, leads us on an eye-opening journey about the crucial role of medical knowledge and patient education.

Join us as we unravel Betty's story, which is as colorful as it is instructive. We'll explore the detective work nurses undertake in the ER, the common misconceptions around managing gastrointestinal issues, and why reaching for Advil and milk might not be the best course of action for suspected peptic ulcer disease. You're in for an episode that's not only filled with interesting medical twists but also laced with humor and the importance of accurate patient information for better health outcomes. Buckle up for a narrative that's as engaging as it is informative, and remember, the next time you're in Betty's shoes, leave the Tupperware at home.

Episode Transcript

Speaker 1 (00:00):
Is the nursing student coach giving you the
strategies you need the most.
Hi everybody, welcome toNursing Student Coach.
Today I want to tell you abouta patient that I had recently.
Let's call her Betty that's nother real name but we're going

(00:21):
to call her Betty for the sakeof her privacy.
Betty was quite a character.
I came in I knew her chiefcomplaint was abdominal pain.
So one of our roles as a nursein the emergency department is
we are playing detective.
We have to assess our patientin such a way and ask the right

(00:44):
questions to kind of get to thebottom of what is going on.
So our assessment is veryimportant.
So I walk into this room andBetty she's in her 60s.
She has this giant blanket thatshe's knitting and she's got
her you know tote with her shebrought in, instead of a purse,

(01:06):
she has this big shopping bag,this recyclable shopping bag.
So I say hi, my name is Lauren,I'm one of the nurses here.
What brings you to theemergency department today?
She reaches into her bag andshe plops down on the table a
container, a Tuberware container, sealed in a Ziploc bag of poop

(01:30):
.
It was black, sludgy poop andshe plopped it right in front of
me and I believe my reactionwas oh, what's this?
Because nobody had ever broughtin a stool sample before.
So she puts it up and I say, oh, all right, it looks like
you're having some black stool,all right.

(01:52):
So we know that she very likelyhas some sort of GI bleed going
on.
So I start asking my questions.
I say how long has this beengoing on?
And she says a few days.
Where is your pain?
It's, you know, epigastric pain, basically just stomach pain.
And I ask her what makes itworse, what makes it better,

(02:15):
what does it feel like?
And she says it really hurtswhen she eats anything, and
pretty much within 30 minutesafter she's just in agony.
That's a big clue because thatis a very likely sign of a
gastric ulcer, which led us tothink probably PUD, peptic Ulcer

(02:39):
Disease.
And what this is is tiny littlesores, tiny little ulcers,
either in your esophagus, yourstomach, or, it can happen, in
your duodenum, that get veryirritated when you eat and cause
extreme pain and they can bleedand lead to black tarry stool,

(02:59):
which was boom, right in frontof me.
Thank you so much, betty.
That was just a fabulous gift,little treat at the end of my
shift there, this jar of poojust being presented to me.
But listen, I love talking toall the different people that
come in.
I love hearing their storiesand one of the things I love

(03:20):
about ER nursing is being thatfirst point of contact when
somebody comes in in crisis.
And she was in pain and she wasgoing through something and she
was also quite a character.
So she was a huge opportunityfor patient education.
And I'll tell you why.
Because I asked her.

(03:41):
I said what have you been doingto make it feel better, like,
have you taken anything to treatthis?
And this is when she saysLauren, I am a medical
professional, I know how totreat this.
And so I think, oh, all right,maybe she's a nurse.
Turns out she worked in a lab asa research assistant 40 years

(04:04):
ago for a few months.
So she says I know how to treatthis.
I'm in pain, I've been takingAdvil and it has not been
helping.
And then she says I've alsobeen drinking milk and that has
not been helping at all.
So here's the thing N said use,that's ibuprofen, aspirin any N

(04:31):
, said they.
That is one of the causes ofPeptic ulcer disease.
The other cause is H pyloribacteria.
So she was actually making herproblem worse by taking NSAIDs.
Nsaids can cause gastricirritation and bleeding.
It is one of the last thingsyou want to take if you have

(04:55):
Peptic Ulcer disease.
And milk is a myth.
It used to be thought that milkhelps with the pain and
relieves gastric ulcer disease,but it actually makes it worse.
So she was not doing herselfany favors.
So Betty was very likely goingto get admitted.
She was very likely going toget an endoscopy, an exploratory

(05:20):
endoscopy, to see if there wereulcers going on.
But we were going to start theinitial treatment for PUD and
then she was going to beadmitted upstairs.
So that's sort of how the EDworks.
You, the patient, comes in,they're either going to get
admitted, they're going to stayfor observation for less than 24

(05:41):
hours on a separate floor, orthey're going to go home, or
they might get transferred outto another facility.
If it's something we can'ttreat something very critical.
So in Betty's case she wasgoing to get admitted either for
observation or inpatient.
I'm not sure she was such acharacter, let me tell you,

(06:02):
because we had to get some bloodwork on her, we had to start an
IV we gave her.
I'll tell you about the initialtreatment for PUD.
We gave her a PPI, a protonpump inhibitor my hospital uses
protonics or pentoprasol IV andwe also gave her some IV

(06:23):
antibiotics.
Generally you would give twoantibiotics like an.
Amoxicillin and chlorothromycinare two of the choices that are
commonly used to start thetreatment of Peptic ulcer
disease.
Let's talk real quick aboutPPI's proton pump inhibitors and

(06:44):
their risk, their side effects.
Now, most of these side effectsare if you take this medication
long term, it can lead to boneloss and osteoporosis and which
puts you at risk for fractures.
That's one of the risks.
Another risk is it puts you atgreater risk of infection
because it decreases theresponse of your immune system.

(07:07):
And PPI's can also beassociated with C diff,
associated diarrhea which, ifyou've never smelled it before,
is quite pungent.
So you don't want to take a PPI, a proton pump inhibitor, for
too long.
You want to give the lowestdose for the shortest amount of

(07:29):
time possible.
So that was the treatment forBetty.
She had a PPI, she had twoantibiotics and she was going to
get sent upstairs for anendoscopy.
Let me just tell you a littlebit more about Betty and our
interaction and just kind ofwhat I learned about patient
communication.

(07:50):
So we had to start an IV on herand she said you get one chance
.
And let me tell you that when Iwas a medical professional,
they used to use me for practicebecause I have wonderful veins,
ha ha.

(08:10):
So I Put the tourniquet on her,I look at her arm.
There are no veins to be felt.
Seen anything, I don't.
I don't know it.
Maybe she used to have goodveins, but she definitely does
not, if that makes any sense.
So I gave it the good oldcollege try.
I tried to start her IV and Imissed.

(08:31):
So she said I had one shot.
So then I said alright, well,what do you want to do?
I said I can call in our teamthat can do an ultrasound IV.
So that's what they ended updoing.
She also Learned that she wasgoing to be admitted to the
hospital and had some questions.
So she says Well, will they bewaking me up to take my vital

(08:56):
signs?
And I said well, betty, you arebleeding.
So yes, they are going to beMonitoring your vital signs at
least every four hours.
Once you go upstairs and shelooks at me, she says do you
know what it means to leaveagainst medical advice.
I said yeah, I know what thatmeans.
She said well, that is exactlywhat I will be doing if anybody

(09:21):
wakes me up.
I said listen, betty, you got alook at the risk versus the
benefit.
If you are bleeding and, godforbid, you start hemorrhaging,
then we need to know if yourblood pressure is dropping.
They have to monitor your vitalsigns.
That's just part of the deal.
Sleeping in the hospital, youknow, one of the things you can
do is get some earplugs, maybeget a sleep mask, but

(09:44):
unfortunately you won't be herefor long.
But unfortunately that is partof the deal of, you know,
getting admitted to the hospital.
Well, she didn't care for thattoo much, but that's the tale of
Betty with her jar of poo andher peptic ulcer disease.
I hope that that helps you incase and a question comes up on
your next exam.
But that's all I got for youtoday, guys, I hope you have an

(10:06):
amazing day.
Stay well, bye, bye.
Thanks for tuning in To thenursing student coach podcast.