Tuesday, April 27, 2010

Two g-tube tales

Yesterday, around 7:45 a.m., an aide came into the hallway shouting for help, that a resident had removed her own g-tube. The day shift nurses were already in and had taken over the unit. I was present, but doing my charting and documenting for the night. I don't mind helping in an emergency. This was a manageable, yet urgent situation that the day nurses could easily cover. But: an evil nurse was working- the nurse that wrote bad things about me (never do that to another nurse) for a wound on another resident.

My fear was: how am I going to convince administration that the tube was intact at the end of my shift?

So I hurried to the room and found a nurse already inserting a tube to keep the opening patent. The aide was distracting the resident from tearing out the new tube. I knew the g-tube was in place when I flushed it after the feeding ended at 6:30 a.m. I hid the g-tube from the resident under two pillows. She is confused and picks and pulls at anything she finds, so her plan of treatment involves burying the g-tube and feeding line so she can't find it and remove it. I asked the aid if she knew how the tube came out. The aid answered, "I was washing her and she just reached down and pulled it all the way out before I could stop her."

I was relieved- they couldn't blame me. But they would try, just for the hell of it. So I returned to the nursing station, grabbed her chart, and documented for the night that the g-tube feeding was well tolerated and the tube was in the correct position. My last time entry was for 7:15 a.m., so a future entry of "Received resident with tube removed" will look suspicious. It still may happen.

The other g-tube story is that the resident for this morning has a g-tube in her, but eats entirely by mouth. Each shift is supposed to flush the tube and does indeed sign for it. Day shift is supposed to clean the g-tube site daily and signs for it. Night shift replaces the flush kit. I know that the day and evening shifts aren't flushing the tube because the previous night's new flush is always in the sealed package, untouched. I took care of this resident three nights ago. I assessed her g-tube and the site and found a slight bloody drainage. I cleansed the area and applied a dressing because she was going out for an appointment and I didn't want her to leak or bleed through her clothing. This morning, which is three days later, I had the resident again and of course, my dressing is still on the site. It was filthy. I removed it and don't know how I did not dry heave in that room. That means that it was really bad because, as a nurse, I have pretty much lost most of the ability to feel disgusted, or even gag at anything. I think that I did not reveal my disgust to the resident. Never do that. It is entirely not her fault that this area of her body has turned so yucky. The nurses were supposed to maintain the site and they failed.

The nurse who relieved me was a per diem floater, so I did not mention the situation to her. I will tell the regular day and evening nurses. They should receive the information well. Other nurses would not like to hear such a thing, especially from me, but I'm not doing it to feel superior. I'm doing it so that the resident receives better care. Each aid who took care of her should have seen the (glaring) date on the dressing and told the nurse. Each nurse should have assessed the area on their own accord and found the dressing and removed it. What is truly sad about this particular resident is that she has already lost a leg while living at the nursing home because she developed a foot wound (from not being positioned and turned properly), the wound went unnoticed and then was not treated regularly, became infected, not noticed, until an amputation was necessary. That's not the end. Same process played out on her sacrum, though you can't amputate somebody's butt.

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