A pt of mine (diabetic, elderly, recently in the hospital for a CVA and urosepsis) had an NG tube (cont feed) and was NPO (except meds in applesauce). She had pulled it out on the 3-11 shift around 9pm so when I got there for my 11-7 shift, she had no NG tube.
Anyway, the 3-11 nurse called the doc and the doc said to leave the NG tube out and send her out to the hosp for a video swallow test in the am to see if she can resume eating by mouth. I set everything up during the night for her to go out first thing. Well, this was on a Sat night so that means she was going to the hospital on a Sun for this test.
I leave at the end of my shift and come back Sun night to find out the hospital did nothing because that dept isn't open on a Sun and the ER sent her back without anything done. The 7-3 and 3-11 nurse called the doc and he said "oh I meant to send her out on Mon" but still leave the NG tube out and give her nothing except meds by mouth and we won't start an IV unless she shows signs on hypoglycemia and give me a call if she is hypoglycemic.
So it's been more than 24 hrs without food/water for this diabetic patient by the time I got there Sun night. I kept a close watch on her and her blood sugars and made sure I sat her up and gave her heaping spoonfuls of applesauce with her crushed meds. The poor lady reached for her flush cup and started to eat the lid because she was so hungry and she kept saying "why won't you feed me"?
Anyway, the point of this was that I'm really irked that a doctor would hold food and water from someone to wait on a video swallow test. Isn't that neglect of some form? He didn't want the NG tube put back in for a day.. I don't see why NOT but I'm not a doctor.. I just think letting someone starve and have no fluids is rotten and I didn't like to be put in that position. If she can take the applecause with no problem then why not try pudding thick liquids or food for the day/ night?There were other alternatives he could have done but refused them. He is known as Dr. Death because of his rep with older people. Other nurses had encounters with him and it seems like he has the 'they are old and will die soon anyway' mentality.
Nov 27, '07
I'm sorry, but I fail to see how this is an ethical dilemma. I actually think the MD did a good thing by leaving out the NG tube and having the pt go for the swallow study. It shows that he at least is on the track of thinking the lady CAN have food PO.
An ethical dilemma to me would have been if the MD had authorized you feeding this lady by mouth before the swallow study had been done, and then she aspirated. That would have been much worse than her tummy growling for a day or so.
So, did she pass the swallow yesterday?
Nov 27, '07
I think ChangeofPace's ethical dilemma is having to stand by while a coherent elderly diabetic patient got neither fluid nor nutrition for close to 48 hours. I'm not sure I wouldn't have just dropped another NG when she pulled out the first one, since she had an order for continuous NG feeds... which incidentally provide a much greater risk for aspiration than feeding thick semi-solids like applesauce and pudding. She's lucky she didn't apsirate when she pulled the NG out in the first place.
Nov 27, '07
i agree this is not a ethical dilemma, but it is a irritating position to be in. do you not have a speech therapy dept? me personally i would have got speech in there to re-eval her and get a mobile mbs on sunday. if he would not have agreed to this i would have been on the phone with the don.
Nov 27, '07
this is true....
Quote from janfrn
i think changeofpace's ethical dilemma is having to stand by while a coherent elderly diabetic patient got neither fluid nor nutrition for close to 48 hours. i'm not sure i wouldn't have just dropped another ng when she pulled out the first one, since she had an order for continuous ng feeds... which incidentally provide a much greater risk for aspiration than feeding thick semi-solids like applesauce and pudding. she's lucky she didn't apsirate when she pulled the ng out in the first place.
Nov 27, '07
What janfrn said "I think ChangeofPace's ethical dilemma is having to stand by while a coherent elderly diabetic patient got neither fluid nor nutrition for close to 48 hours. "
This is why I thought it was an ethical dilemma. Not because she needed to be NPO for a swallow study but for the amount of time he had her NPO before the study was done. A few hours ok.. a few days= not ok in my opinion. He was confident enough for her to have meds PO with applesauce for the last week with no problem so that irked me too- why nothing else during the day? It was hard to sit back and watch her beg for food.
We do have a speech dept but they are not there on weekends. By the time she went out and came back, it was 41 hrs no food/ no water. She was able to resume eating after the test and looks much better now.
Dec 1, '07
Why did not one person just start an IV and give her some D5 1/2NS or D5NS to keep her hydrated and her sugars up?
Why were they giving her meds orally and not through the NG tube to begin with?
I could see why the MD would keep her NPO. If she were to aspirate then it would have been a bigger problem. We have a nursing swallow eval to do before speech therapy can do their official one or the video swallow done.
Dec 1, '07
'Patient Advocate' we are.
All kinds of hindsight, all I can say is what I would have done. Pudding, thickened fluids and blood sugar checks to make sure parameters were good. 'Patient Requested' on the MAR and no way am I going to let a patient of mine jeapordize their health because the Doc didn't think something through.
Some of these 80lb geriatric bed-ridden types cannot go 24 hours without fluids and some form of nutrition.
grrr.. I can feel myself getting angry thinkin of just how bad it has to be for a Doc to earn a nickname of 'Dr. Death' .. I hope I never meet someone like that.
Chain of command, documentation, legal recourse, ..next thing yanno 'Dr. Death' is lucky to get a job workin at Mcdonalds ..if not in jail.
I can only hope he doesn't kill someone's mom 'accidently' and that he ends up in the care of a 'Dr. Death' of his very own.
Dec 2, '07
yeah, i think that's a bit weird (i.e. outrageous!). if she's diabetic i cannot for the life of me figure out how leaving her with no food and no NG tube for TWENTY FOUR HOURS could be for the best??!! even a simple sliding scale for the 24hrs that she was denied any real sustanace would've been the decent thing to do! no?? shame ChangeofPace, i can just imagine how stressful that must've been for you and the poor patient
and I agree with GrayEagle about patients suffering cos docs havent thought it through! makes me MAD!!!
Must Read Topics