Often, you may get calls where the caller does not really understand the medical terminology they use. Many times, this is a lack of education or fear of what is really wrong with the patient. It is the telephone triage nurse's job to interpret and clarify what the caller is really trying to say. The nurse many times cannot take the caller's description verbatim and should document the difference between the caller's words, and what they are really trying to say. Let's look at some of the terms the caller may say, and what they may actually mean.
Lethargic means a serious change in activity where a patient is too weak or exhausted to move or interact, but to the caller, this may just mean a decrease in activity level. Ask what the patient has been specifically doing. Have they been been getting up to the bathroom, eating, walking or watching television? If so, they are not lethargic. The term lethargic should not appear in the nurse's documentation unless the disposition is call 911. If the patient is not getting up as often, or the child is not getting up and playing with toys but may be lying on the couch watching TV, then an alternate description would be decreased activity.
Limp means a loss of tone, and can be serious. Many times this means decreased activity and lying down most of the day, when the caller uses this term. Again, decreased activity would be an alternate description.
When a caller uses the term "coughing nonstop", they may mean the cough has been occurring hourly or daily. However, a continuous cough is one that prevents the patient from eating, drinking, sleeping, or participating in normal activities. If possible, the nurse needs to listen to the patient to determine if it is occurring frequently enough to interfere with activities. An alternative description would be frequent cough, but able to perform normal activities.
Never accept the caller's diagnosis of a rash unless their description is consistent with that of the definition in the guideline or the patient has already been diagnosed by a healthcare professional who has seen the patient. Often patients or parents will diagnose insect bites, impetigo, viral rashes and contact dermatitis as chickenpox, measles, welts, or hives. The best thing to do is describe the rash than using a diagnosis as a label.
It is important to differentiate between decreased urine output and no output. If the caller says no urine output, they may mean the output is greatly decreased or they have not witnessed any output by the patient. For patients who wear diapers, it is important to ask if the diaper is completely dry or slightly damp. Any urine in the diaper is reassuring. It is best to ask how often the patient is voiding and when was the last time, and note output is decreased.
It is obviously a red flag if the caller says the patient is having trouble breathing. Assessment is based on the patient's age. If an infant, the ability to drink a bottle normally and breathing through the nose is reassuring. If older children are able to sing, play and talk, then their respiratory distress is not severe. Often, callers will use trouble breathing to say their children are congested or breathing fast. A better term to use would be nasal congestion or upper airway congestion.
Constant abdominal pain, if significant, will leave the patient with impairment in activities. Most likely, the patient will not be active, probably not have an appetite, and have trouble sleeping. Intermittent pain is different and often represents pain associated with intestinal motility. A better description would be to use intermittent abdominal pain.
Diarrhea is often used to describe loose stools. One or two stools does not indicate diarrhea. Diarrhea refers to increased frequency, amount, and looseness of bowel movements. The best description to use is loose stools.
Constipation does not necessarily mean the patient is having trouble having a bowel movement. Constipation refers to infrequent stools that are usually hard and, in infants, pellet-like. If the feces are soft and the bowel movements are regular then it is not constipation. Regular bowel movements could range from several a day to one every 2 to 3 days. An alternative description would be trouble having bowel movement, but soft and regular.
Vomiting must be distinguished from spitting up to normal reflux of gastric contents. The difference is spitting up is usually not forceful and dribbles out of the mouth without effort. Spitting up is usually consistent of formula and not bile. Both can come out of the nose. Vomiting requires contraction of the abdominal muscles and takes effort. Spitting up is effortless. An alternate description would be spitting up.