Advice please...

[Pyracant]

My 87 year old dad has been in AandE 3 times over the last week with oedema that comes on at night with delerium linked to heart failure. But seems to be no improvement when he comes out of Aand E They've taken him off furosemide and put in a urinary catheter. His bloods and urine come back as unremarkable. But it's taking its toll on him and my mum. What should I ask of the doctors, please?

[Handel]

My dad suffered exactly the same. Swollen ankles/legs and delerium. He was in hospital for 2 weeks (before COVID) and tests came back as 'normal'. It wasn't until I asked whether it could be an undetected UTI that they retested! After a course of antibiotics, he recovered. Good luck xxxx

[Pyracant in reply to Handel]

Thanks for that, I'll ask the question of the doctors. The problem is that my dad is taken to a and e and comes back home the same day just for the cycle to repeat within a couple of days and he's back in a and e again. As a lay person I have a feeling that he needs at least an overnight in hospital for a bit more of an investigation, but I understand that resources are stretched at the moment. I'm glad that they sorted your dad out.

Thanks

[Qualipop in reply to Handel]

That's just what happened to my mother in law. Her GP immemorial said UTI. It's easy to think of complicated reason but also very easy to miss the simple and obvious. Mum in law was hearing babies, the man on teh TV was talking to her and the police had told her to let in a group of fighting teenagers. Delirium with a UTI is very common in the elderly.

[Handel in reply to Qualipop]

My dad thought he was being kidnapped by aliens and pulled the urine catheter out 5 times. At that time he was 87 (he's in a care home now aged 98!). Once the infection was detected and treated, he was able to get out of bed and walk to the loo. I think a catheter was an easier option for busy nurses but sometimes they can be the cause of an infection. xxx

[Pyracant]

Thank you very much for the chart. Its a lot to digest but it gives me a good place to start and may even help me to understand what its actually going on behind the scenes wrt what the doctors are doing.Thanks once again.

[Milkfairy Heart Star]

Hello,

I sorry that your dad is facing such difficulties.

Who is managing your dad's heart problems?

I suggest you ask for your dad to be reviewed by a specialist in heart failure either a Heart Failure nurse or Cardiologist.

Most hospitals should have a Frailty care pathway for older patients ask has your dad been assessed and treated according to this care pathway.

Perhaps request that your dad be seen by a specialist in caring for the elderly.

Covid has had a huge impact on the care of many non Covid patients.

I hope your dad can access the care he needs soon.

rcn.org.uk/clinical-topics/...

[Pyracant in reply to Milkfairy]

Thanks Milkfairy, great advice that I knew nothing about, hopefully he won't need to be bounced in and out of A and E so much.

From being at a loss yesterday as to what I should do to help my dad, I've had three varied but great responses that have pointed to a way forward. What a fantastic website...thanks once again.

[Milkfairy Heart Star in reply to Pyracant]

Do come back and tell us all how your dad gets on.

Good luck !

[Pyracant in reply to Milkfairy]

Hi again...just a quick update... my dad's still in the hospital and was sort of ok but before he could be discharged he had a repeat of an episode which happened for the first time last week when his penis swelled up to an unbelievable extent which I think is water retention but I really don't know what the cause or technical term for it is. Also I believe that his blood presure shot up (I dont know the figures) but he has never had a blood pressure problem in the past. I'm glad that this has happened to him whilst he is still in hospital. Also, as Handel suggested, he did have an infection and has been put on antibiotics for thrush. Also I think that there are things going on behind the scenes for there to be care when he gets home.

[Milkfairy Heart Star]

Thank you for the update.

Oh my goodness your poor dad having to go through this experience. Certainly a possible cause for raised blood pressure.

He must have been feeling uncomfortable which can be missed by staff in a patient with delirium especially on a busy ward.

Thrush is a fungal infection and can be a result of being on antibiotics rather than the urinary tract being infected. It can be painful and itchy.

I expect your dad has been prescribed an anti fungal medication.

Do you feel any happier about the care your dad is receiving?

[Pyracant]

Hi Milkfairy, I think that the doctors are doing as much as they can, it's just the underlying pressure that seems to exist to discharge him that is a bit of a worry. I was able to speak to a doctor yesterday who was okaying his discharge if things were in place for him at home, and yet, within a couple of hours, his condition deteriorated such that he was unable to be discharged. I am very much in awe of the work that all the hospital staff do, its just my concern that there may be a tendency to discharge too early, although if they have done as much as they can in the hospital then I can understand their position.