NG Tube Yields 2000 ml Immediately - page 2
I walked into one of my patient's rooms yesterday and I see this 70 something year old woman who has been on the floor for 2 DAYS who is extremely nauseated. She has a history of cancer and she's... Read More
Apr 17, '08Quote from crb613silverdragon trained in the UK and our training has changed quite a bit since 1986. Many of the qualified nurses coming out of thier training may not have ever put in an NG so don't have the confidence. But I do agree if your unsure ask for helpWas part of my training in 2006....I don't know what the big deal is about putting in an NG...you have orders, your pt needs it....for heavens sake put it in! If you are unsure/scared....ask for help!
Apr 17, '08Quote from ERTraumaJunkieThe RN that I work with in the ER actually runs and hides if she sees an order for NGT to be dropped. She will stay hidden until I have it done. What's the big deal? We do a lot worse things without as much benefit in return....
I'm great at putting in IV's but for some reason I have a hard time with NG tubes. Thank goodness, our unit NG Tube Queen has been on duty whenever I've had to put one down. (I try it first, but if I cannot get it, I go ask Queenie.)
So based on my experience, it's pretty much an art to getting one down right the first time.
However, you should tell her that it's OK for her to ask you, rather than run and hide. Maybe observing you would help her develop that skill.
That said, I've been amazed at some of the outputs we've had with SBO's. But nothing like the poor OP's patient had!!
Apr 17, '08HOLY COW! You guys!
I knew you could relate but it really, really gets hairy when you hear about doctors ignoring nurses' multiple calls to them on behalf of these patients who are throwing up with huge bellies and patients dying! That's horrible!
The very first thing I said to the night nurse after I got report was, "Did you put the NG tube in?" and then she started her song and dance about nausea, only small emesis and meds. (And she's a relief charge nurse!) BUT remember it wasn't just her who was ignoring the obvious, there were doctors and other nurses too!
I suppose walking rounds are part of the solution but our unit is so crazy at change of shift I guarantee you we'd all be getting out 1 hour late on a daily basis!!! Not sure if that's do-able. (they are doing a pilot on it on a different floor at my hospital, however, yikes! I'll keep you posted)
Again, I repeat, if you're not confident in something (for me it's IV's - I confess!) - then ask for help...no shame in that...ever!
You guys are awesome. Much appreciated.
Apr 17, '08Quote from NurseCherloveThere are a few residents on our floor that does not visit some of the patients, but rather asks the nurse about the patient and writes their progress notes and orders based on that.I hate to say it but I would probably from there on out be somewhat judgemental of that last nurse - you know, going over EVERYTHING with a fine-tooth comb after getting report from her b/c you know things have not gotten done.
Nurses like that are the reason I love the concept of walking report - you have the chance to at least get a cursory glance of the patient and get to hold that nurse responsible for at least the immediately obvious things that need to be taken care of (empty IV bags, pain needs, etc.).
One thing I do wonder about is, why did the MD not just go ahead and order for the NGT to be placed (non-elective) when he saw her on his rounds. A patient does not just suddenly develop massive abdominal distension. Did he not do a patient assessment? Sadly, I have seen docs come in and write a progress note without ever even laying a hand on their patient. Heck, I've even seen one write a note and not even go in to talk with the patient!
Nurses like that give the term "nursing judgement" a bad rap. I guess that MD had more confidence than he should have in those nurses.
Apr 17, '08Kind of like the day I went into work and found my young resident (40+ yrs) sitting up in bed rocking. She doesn't really talk, so I asked her to lay down and what do you know, she looked 4-5 months pregnant with urine. Her bladder was so distended it was awful. She had a foley in, but for some reason noone had notice little to no output for appx. 24 hours. Her BP was 210/140 something, her pulse was 160+ and she was as pale as could be. I immediately pulled her Foley and straight cathed her and got 1700cc's out and her B/P and pulse went down within about 15 minutes. She has neurogenic bladder so she has to be either straight cathed or have a foley in or you know what happens. I guess noone wanted to deal with it for 24 hours prior to my shift. I know we all make mistakes and miss little things, but if I do something like that I give the nurse who catches my neglectfulness permission to kick my butt.
Apr 17, '08Wow, I've never heard of 2000mL straight away from an NG. The poor pt! Are you guys allowed to insert one without a doctors order? Or can you place one based on your judgement. Unfortunately we have to have an order. We try three times, and if unsuccessful, call the resident medical officer. Generally speaking, nurses are better at it. Doctors seem to love putting down hosepipes...
Apr 21, '08Quote from sistermikeTo their credit, in general, the doctors at our hospital ALWAYS actually lay eyes on their patients (even if it's just from the doorway???). It's pretty rare that they will not look in on the patient before writing their progress note.There are a few residents on our floor that does not visit some of the patients, but rather asks the nurse about the patient and writes their progress notes and orders based on that.
And also to their credit, they seek out the nurse (we carry RN cell phones at all times) to ask how the patient has been doing that day. I LOVE when the doctors do that. That way I get to clarify their chicken scratch orders too before they leave.
That's just wrong to think that doctors aren't even looking at their patients at all...that's just wrong
Apr 21, '08Isn't it amazing how much better a person can BREATHE when the stomach isn't distended into the chest cavity anymore? I've seen high peak pressures in ventilated patients drop almost as soon as an NG is inserted and put to suction. I swear with one guy I saw an entire pepperoni pizza aspirated in a couple of minutes!
BTW, I once knew a nurse who told me he had put an NG in himself once - try it and see how far you get!Last edit by aeauooo on Apr 21, '08
Apr 21, '08Quote from nyapaYes. We absolutely need an order to place an NG tube...and in this case there was an order on the chart for 2 days but it HAD A LOOPHOLE...it said, "Place NG tube if patient continues to have nausea and vomiting"...unfortunately the nurses kept medicating her with just enough anti-nausea meds to keep very large emesis at bay so she was just having small throw ups here and there (and those don't count I guess?).Wow, I've never heard of 2000mL straight away from an NG. The poor pt! Are you guys allowed to insert one without a doctors order? Or can you place one based on your judgment. Unfortunately we have to have an order. We try three times, and if unsuccessful, call the resident medical officer. Generally speaking, nurses are better at it. Doctors seem to love putting down hosepipes...
When things like this happen, I remind myself that I have choices in my life. I can make whatever I want happen in my life if I'm willing to do the daily baby steps required...it's my sincerest wish to inspire other nurses to create their ideal lives too!:typing
Apr 21, '08Quote from Nurse_Advocateno matter how the order read, ng tubes are excellent for decompression.Yes. We absolutely need an order to place an NG tube...and in this case there was an order on the chart for 2 days but it HAD A LOOPHOLE...it said, "Place NG tube if patient continues to have nausea and vomiting"...unfortunately the nurses kept medicating her with just enough anti-nausea meds to keep very large emesis at bay so she was just having small throw ups here and there (and those don't count I guess?).
this pt's abd was grossly distended.
even in the absence of n/v, it should have been placed.
shabby nsg for those who avoided it.
Apr 21, '08Quote from ERTraumaJunkieI work with a nurse who does that too.The RN that I work with in the ER actually runs and hides if she sees an order for NGT to be dropped. She will stay hidden until I have it done. What's the big deal? We do a lot worse things without as much benefit in return....
I'm the opposite. I'll seek out those skills I think I need to master. I'll grab whoever is the 'master' at that skill on shift and have her/him in the room with me. It benefits the patients and it benefits my comfort with certain skills that we don't get to perform everyday, which in turn, again benefits patients.
There's nothing wrong about asking for help or guidance.