Lorena Velasquez
July 2023
Lorena
Velasquez
,
BSN, RN
5 East
VA Southern Nevada Healthcare System
Las Vegas
,
NV
United States
Ms. Velasquez advocated for the patient, treating him with respect and compassion and preserving his dignity by allowing him to explain things in his primary language.
On Monday, an ICU RN, assisting the 5East, expressed some concerns about the Veteran she was caring for to Ms. Lorena Velasquez, 5E Charge Nurse. The Veteran was admitted for chest pain and failure to thrive and was dropped off by friends who stated they could no longer care for him. The Veteran was alert and orientated but had intermittent confusion and memory lapses, missing his medications at home and repeatedly asking to go home while in the hospital. The Veteran also reverted to his primary language (Spanish). The patient was also a poor historian, and two psych consultations had already been placed in April to determine his competency. The nurse spoke with the doctor about this case, and both recognized the need for another psych assessment using the Veteran’s primary language.
Ms. Velasquez discussed the concern with the doctor, the Psychiatrist. She inquired if a mini cog (a fast and simple screening test to help detect dementia in its early stages) is a typical test during the evaluation for competency. She was informed that this test was not necessarily done during the assessment. However, she was told she could perform it and would pass the information to another doctor.
Ms. Velasquez is familiar with the St. Louis University Mental Status Examination (SLUMS) from her outpatient experience. She suggested performing the test, and the doctor asked her to complete this assessment. Ms. Velasquez reviewed the SLUMS assessment on TMS and clinical skills before completing the test to ensure it has not changed since she left the ambulatory care. She also confirmed that SLUMS and speaking the Veteran’s native language is within her scope of practice. Ms. Velasquez completed the test in Spanish. The Veteran scored 8/30, which is indicative of dementia. She notified the MDs and documented the findings.
Ms. Velasquez advocated for the patient, treating him with respect and compassion and preserving his dignity by allowing him to explain things in his primary language. Ms. Velasquez’s cultural awareness, excellent assessment skills, inquiries, and nurse’s instincts (gut feeling) led to a diagnosis that the two previous psyche evaluations didn’t catch. This result is crucial to the Veteran’s plan of care, treatment, and intervention, such as referral, guardianship, and appropriate placement after discharge from the hospital. This event is a remarkable display of a front-line RN upholding the VA ICARE values.
Ms. Velasquez discussed the concern with the doctor, the Psychiatrist. She inquired if a mini cog (a fast and simple screening test to help detect dementia in its early stages) is a typical test during the evaluation for competency. She was informed that this test was not necessarily done during the assessment. However, she was told she could perform it and would pass the information to another doctor.
Ms. Velasquez is familiar with the St. Louis University Mental Status Examination (SLUMS) from her outpatient experience. She suggested performing the test, and the doctor asked her to complete this assessment. Ms. Velasquez reviewed the SLUMS assessment on TMS and clinical skills before completing the test to ensure it has not changed since she left the ambulatory care. She also confirmed that SLUMS and speaking the Veteran’s native language is within her scope of practice. Ms. Velasquez completed the test in Spanish. The Veteran scored 8/30, which is indicative of dementia. She notified the MDs and documented the findings.
Ms. Velasquez advocated for the patient, treating him with respect and compassion and preserving his dignity by allowing him to explain things in his primary language. Ms. Velasquez’s cultural awareness, excellent assessment skills, inquiries, and nurse’s instincts (gut feeling) led to a diagnosis that the two previous psyche evaluations didn’t catch. This result is crucial to the Veteran’s plan of care, treatment, and intervention, such as referral, guardianship, and appropriate placement after discharge from the hospital. This event is a remarkable display of a front-line RN upholding the VA ICARE values.