Wednesday, July 11, 2012

When a headache is just a headache

I took care of a patient this week who was 13 and came in with altered mental status that started with a headache while playing basketball, and was severely hyponatremic (very low sodium levels).

I took care of him a few days after he was admitted, and other than being weaned off his 3% sodium drip, he was back to baseline.

Until he got a headache again in the afternoon.  The bedside nurse paged me and told me that mom was very adamant that I come immediately.

I went to examine him, and the nurse was right: the mother was just shy of freaking out.  And I guess I can't blame was a headache that started his whole initial downward spiral that led him to going unconscious and getting intubated for a day.  She was telling me "The doctor at the other hospital ER told me that with him, a headache will never just be a headache" to which I had to think, why do people say these things sometimes!?

I get that in that circumstance, the headache was an initial indicator of other serious underlying issues, but sometimes a headache is just that...a headache!

And to prove my point, the patient kept rolling his eyes the more his mom was talking.  When I asked how bad his head hurt, he said 3/10.  And then he proceeded to tell me that his head only started hurting after he was wrestling with his 8 year old brother, his 3 year old sister was running around the room screaming for 15 minutes, and his 9 month old brother "made the biggest stinky ever"..."That would make anyone's head hurt!"

I completed his exam and told the mom that it was completely reassuring.  I told her all the things that made me not concerned with this headache, and things that I thought would help alleviate it completely, including some tylenol, no more wrestling, quieting the screaming toddler, and yes, that diaper STUNK...get it out of the room! Not that a stinky diaper alone would make a head hurt necessarily, but no reason to keep something so vile in a sick patient's room!

Before I left, I asked the patient if he had any more questions.  His answer:  "Yeah...can you please tell my mom to stop freaking out!? I told her it was just a little headache, and if my brothers and sisters would just leave, it would go away.  But she went crazy and had you running over!"

To which I answered, nope, I can't do's a Mama's job to be worried like that.  

And it's my job, as the APN, to help the worried Mama understand that in this circumstance, his headache was just a headache.

I left the room with a much more calm, reassured mother.  Job well done to the both of us!  

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