In November, Juliet saw a patient who is a chronic complainer. The patient had been seen almost daily for numerous complaints. The patient was also observed gagging herself and throwing herself down to "gain attention". She was seen numerous times in the ER and standard lab work was competed and fluids were administered.
In November when Juliet saw the patient, she was complaining that she was unable to see out of her right eye. Juliet did an assessment of the patient and noticed that her right pupil was nonreactive. Juliet immediately called the NP and the patient was transferred to the local ER. A CT scan and MRI were done with abnormal results. The patient was then transferred to a larger hospital where more studies were done. After an extensive workup, the patient was found to have a rare disorder called Neuromyelitis Optica (NMO) or Devic's Disease.
NMO affects the optic nerve, the spinal cord, and the brain by the immune system reacting against its own cells. NMO can cause blindness, paralysis of legs and arms, loss of sensation, uncontrollable vomiting and bowel and bladder dysfunction. The patient spent an extended time hospitalized undergoing multiple plasma exchange treatments.
If Juliet had not been meticulous in her assessment and had just chalked it up to "another complaint" the patient may have lost her vision, become paralyzed, or even died. Because of Juliet, the patient received the treatment she needed to keep NMO from progressing.