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Friday, May 18, 2012

What is a slug patient?

Have you seen this patient?
Slug:  These are patients who are originally bedridden because they are lazy and unwilling to care for themselves.  Yet ultimately they become dependent on the bed due to muscle fatigue.

Many are depressed, and most are obese and have a variety of maladies due to poor self care during their active years. They can be very demanding initially, yet as their body fades they will become completely dependent on you for all their needs, including butt wiping, rolling over in bed, scratching their faces, eating, drinking, and scratching their cheeks when they itch.

In the later stages you can do anything you want to them and they won't care, including putting the patient on a BiPAP mask or even ventilator.  Most will even become deconditioned to the pain of needles, and you can put IVs in them without as much as a wince.  You can draw labs and ABGs without much trouble from the patient, even though you'll often have trouble obtaining blood on the first poke due to poor circulation.

These patients are quite often full codes so you have to do everything possible to save them.  Yet even if they have DNR orders the doctor will insist that you get an ABG even if it's physiologically impossible to feel a pulse and you've already missed 22 times.

They most frequently come from nursing homes.  They can be very friendly early on, yet as their disease progresses they will only open their eyes and look at you and smile.  It's sad in a way as ultimately you watch as a nice patient fades away due to her own laziness.  However, most will not call her on it, not even her own doctor.

Most will also be ordered on aerosolized breathing treatments even though there is no evidence of bronchospasm and the patient never complains of dyspnea.  The reason for the treatment is of one of the following reasons:

  • Doctors don't know what else to do and have to do something, so they order treatments
  • Audible annoying wheeze due to dehydration 
  • Audible annoying wheeze due to over hydration 
  • Audible annoying wheeze due to secretions in throat
  • Diminished lungsounds must be due to bronchospasm
  • In order for the patient to meet criteria for admission and reimbursement
  • To cover their bases (order sets)
  • The patient was diagnosed with pneumonia even though the patient doesn't have pneumonia because pneumonia is a reimbursable diagnosis.  If patient has a lung diagnosis a bronchodilator must be ordered at all times at a minimum of every six hours.  
  • The doctor wants the RT to assess the patient so he doesn't have to

As their body's slowly wade off they cease even watching TV, and simply spend their time either staring off into space or sleeping.  However, they do cheer up and become quite loquacious whenever one of their friends or family members enters the room.

Synonym:  A sluggish patient

Antonym:  The Spirited patient

Note:  This post is a generalization and not a description of any one particular patient.  If you work in a hospital or nursing home you will meet many patients who fit this vague description.  

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