Advice Please Ruptured Appy

[flowerchild]

Hi everybody! I am in need of some allnurses BB advice. My best freind is in the hospital, presented in ER after 2 days of excrutiating abd pain and fever. Didn't call me :-( The did an emergency appy and he looked good to me on day one. Now we are heading into day three and my best freind is running a slight temp. Has only gotten up twice, asst. by freinds, to the BR. Has not yet to touch any of the clear liq. diet. Is in alot of pain and is so doped up is now hallucinating. I just heard they are backing off the pain meds now. No NGT, came from OR without one. They left the wound open to heal and drain. Has one drain w/ ss dng. When they first did the surgery they said home on Monday. But it is Sunday night and now he's not going home tommorow. I'm concerned that he may need to go back to OR. I have so many questions like are the nurses turning Q2h, is anyone going to ambulate and when, is the wound being packed correctly, why is there so much pain and on so much medication???? Brother said was there 3 hours and never saw a nurse. I'm worried that the hospital is short staffed and cannot provide the outcomes that my own nursing care could. But, I don't work there and don't think the nurses would welcome my "interference" and I'm not sure that my best freind would care much for me if I force ambulation, eating, turning, etc. esp at this point in recovery. Although I am not seeing recovery happening at this point. My best freind is in middle 40's, which also concerns me. I have lost freinds before due to post op recoveries that went bad and I'm very worried now. Is this recovery normal so far? It's been awhile since I did M/S but I thought I'd definatly see an NGT. And I thought we should be ambulating by now. I'm worried that there may be pockets of infection in the abd that are causing the pain. Should I go to the hospital and get involved in the care? The SO is so out of it and is not a good advocate at this time. There are also way too many visitors/freinds in the room and I think this is causing problems too. Being a tough guy and all, he'd just as soon be druged up than let any of us see him in pain. I say if he was able to handle the pain for the two days prior to going to the OR that he can handle the discomforts of proper nursing care and get better! HELP! Any thoughts and all prayers are appreciated.

[sjoe]

What I have done when my friends are in the hospital and experiencing problems (and I have doubts about the care they are receiving) is track down their daytime nurse and have a chat--to see if there is anything I can to do to help, what the nurse thinks regarding perhaps a change in MD orders, medications, treatments, etc. That might, at least, give you some support and ideas and a plan, rather than just worrying. And it gives the nurse a chance to have some input into the situation.

Then I usually do the simpler chores, if needed, like feeding, turning, shaving, whatever, to take some of the load off the nurse. This can be much appreciated.

(Fortunately, this situation has happened only a few times--so far, at least.)

Good luck.

[frankie]

hi flowerchild, frankie here. I am sorry your friend is sick. It is difficult when you do not work in the hospital. I have a patient now - mid 30s - posterior appy rupture - he is at home on IV ATB - new on Invanz - while he was in hospital, he did not have NGT, but did have quite the infection and illeus. He had his appy 1 day after his wedding - vomited X 2 days and thought he had prewedding jitters. Anyway, he was in about 6 days. Now he is home on IVs for 1-2 weeks. Maybe you friend needs ID consult. frankie

[Youda]

Seems I always agree with sjoe. Talking with the day nurse or NM is a good idea. You'd get info instead of just worrying.

Like sjoe, I take over things like making the beds, running for ice, keeping track of intake, turning, bed bath, etc. If needed, I chase friends/family out of the room so I can "work."

[oldgirl, RN]

All of the above sound like good ideas. Do be aware that your friend will have to make it clear to the staff that you can have access to any medical info-this new privacy stuff means staff is not to dicuss ANYTHING with you without his consent-at least that is the way our place is doing it.

[K O'Malley]

I'm sorry to hear that your friend is having such a bad time. I don't have much experience in surgical nursing but I do have personal experience with a ruptured appy, two years ago. I had surgery at 1:30 AM but was OOB independently, on liq. diet and oral pain meds that morning. I was pretty groggy, had an open incision with packing. Day #2 I spiked a temp and my WBC went up. They gave me some extra antibiotics. On day #4 I was discharged and was well enough to do some light housework. Sounds to me like your friend might be having some complications.

[shodobe]

It's not unusual to leave wound open and packed, especially if it is ruptured. If it was a bad appy to begin with then perontonitis is probably the cause of the cont pain. I know of patients having pain for 3-5 days post-op until the antibiotics kick in. All the surgeons I work with always leave the wound partially opened and packed. The floor nurses have to have a good, clear understanding of aseptic technique in changing the packing and dressings. The info you are giving is probably your friend was sick longer than he let on. The times that a NGT was placed is always in kids and sometimes, but not always in adults depending on how bad the ruptured appy was. I think patience is the word here and let the nurses do their job, but keep an eye on things anyway. Good luck, Mike