Discerning the Caller

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Discerning the Caller

​Parents and patients often do not fully understand the medical significance of the terms they use to describe the condition of themselves or their children. This is due to numerous factors including misunderstanding of medical terms, conscious or unconscious fears of what may be wrong, the need to justify calling the doctor, and simple lack of education. It is the job of the telephone triage nurse to ​clarify and interpret exactly what the caller is trying to convey. The nurse often cannot take a caller's words verbatim and should document the difference between the caller's words and the nurse's understanding of the patient's condition.

The following is a list of what callers may say, what the terms indicate in a medical record and what the caller may actually mean. This list ​​is not exhaustive, but provides examples for consideration.

​ ​Lethargic o​r Slug​gish

Lethargic connotes a serious change in activity level where a patient is too weak or exhausted to move or interact. Callers may mean decreased activity level. The nurse should ask developmentally appropriate ques​​tions to assess the child's status. Ask if the patient has been playing, eating, walking to the bathroom, texting, and watching television. Ask the caller to describe how the child looks and explain what they mean by lethargic.

  • Alternate description: Decreased activity. ​

Lim​​p

Limp indicates a loss of tone (when not referring to an abnormal gait) and also connotes a level of seriousness. Callers may mean decreased activity and lying down most of the day.

  • Alternate description: Decreased activity.
Additional AAP Telephone Care Resources

Pediatric Telephone Protocols, 15th Edition​
A go-to resource for telephone care triage, which covers a broad spectrum of caller concerns. 

Pediatric Nurse Telephone Triage
A decision-support tool that is a companion to Pediatric Telephone Protocols, and helps office staff deliver superior telephone advice. 

Breastfeeding Telephone Triage and Advice​​
​Resource to help nurses, lactation professionals, and other medical staff confidently advise breastfeeding mothers by phone.​​​​​

Advertising Disclaimer

​Cough​ing Non​​-Stop​​

​​A continuous cough is one that prevents the patient from eating, drinking, sleeping or normal activities. To interfere with these activities the cough does not have to be continuous but certainly would be occurring at least every couple minutes. Callers may mean that the cough has been occurring hourly or daily. Instruct the parent to hold the phone to the child to assess the character of the cough. If possible, talk or listen to the patient to determine if the cough actually is occurring frequently enough to interfere with routine daily activities.

  • Alternate description: Patient with annoying cough, able to perform normal activities. ​

Chicken Pox, Measles, or Hi​​ves

Many rashes are often interpreted by callers to be chicken pox, measles, or hives. Never accept the caller's diagnosis unless their description is consistent with that of the definition in the guideline or they have already received the diagnosis by a health professional that has seen the patient. Parents often interpret insect bites, impetigo, viral rashes, and contact dermatitis as chicken pox, measles, or hives. Eczema and ringworm are often confused, even when seen in person.

  • Alternate description: Describe the rash unless it meets description in guideline. ​

Not Uri​​​​n​ating

No urine output is an obvious sign of dehydration and needs to be addressed. Callers may mean that urine output is greatly decreased or that they have not witnessed any voiding by the patient. It is important to clarify decreased urine output and no urine output. Similarly, was the diaper completely dry or slightly damp (ask if they can feel anything like jelly when they squeeze the diaper). Any urine in the diaper is reassuring.

  • Alternate description: Decreased urine output, still voiding regularly. ​

Trouble ​Breathin​g, Wheezing

It is obviously a red flag when a caller says the patient is having trouble breathing. Clarifying questions are based on the patient's age. In infants, nose breathing is reassuring, as is the ability to drink a bottle normally. Similarly, if older children are able to talk, sing the ABCs, and play, their respiratory distress is not severe. Parents may mean their infants are congested or their children are breathing fast. Nasal congestion in infants often creates a musical sound and upper airway congestion can cause vibrations referred to the lungs described as rattling in the chest or wheezing.

  • Alternate description: Nasal congestion interfering with breathing, upper airway congestion. ​

Constant A​bdo​minal Pain

As with a continuous cough, constant abdominal pain, if significant, should lead to some impairment in a patient's activities. The patient likely will not be active, probably not have an appetite, and have trouble sleeping. Intermittent abdominal pain is different and often represents pain associated with intestinal motility.

  • Alternate description: Intermittent abdominal pain that does not interfere with activities. ​

Dia​​r​r​hea

Callers often use the term diarrhea when they mean loose stools. One or two loose stools do not indicate diarrhea. Diarrhea actually refers to an increased frequency of bowel movements that usually happen to be loose.

  • Alternate description: Loose stools. ​

Consti​​p​ation

The term constipation refers to infrequent stools that are usually hard and in infants pellet-like. Constipation does not mean that the infant or child is having trouble having the bowel movement. If the feces are soft and the bowel movements are regular (ranging from several a day to one every 1-2 days) then it is not constipation. Many infants grunt, turn red, and seem to be in pain with bowel movements, especially if breast-fed. This is normal.

  • Alternate description: Trouble having bowel movement but soft and regular ​

Vo​m​i​ting

Especially in the infants, vomiting must be distinguished from spitting up or normal reflux of gastric contents. Spitting is usually not forceful and dribbles out of the mouth. Spits usually consist of formula and not bile (green discoloration).

  • Alternate description: Spits or spitting.​

The recommendations in this publication do not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate. This content is for informational purposes only. It is not intended to constitute financial or legal advice. A financial advisor or attorney should be consulted if financial or legal advice is desired.​

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