NG Tube Yields 2000 ml Immediately

  1. 27 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 admitted for small bowel obstruction...her stomach was so distended that she looked 8 months pregnant.

    The orders on her chart were to insert NG tube for increased nausea and vomiting. The night nurse reported some "small emesis" last night and having to medicate her with anti-nausea meds a couple of times.

    I immediately explained to her all about an NG tube and that it would take away her nausea and that the doctor had ordered it for her IF she continued to throw up and feel nauseated.

    NO ONE HAD DONE THIS YET. She was actually very receptive and agreeable to it. I put the NG tube in and IMMEDIATELY got 2000 ml output. (by the way, I always bring another RN with me in the room during NG tubes and we work as a team to educate, help and encourage the patient through the procedure!!! In this case I had my 2nd semester nursing student in the room too!!! good experience for her to have!)

    Her husband was in the room and got "treated" to a show also. It actually couldn't have gone smoother and she tolerated it very well...and the relief for her...oh the relief!

    Anyway!!!! Seriously Folks!!!! This lady suffered for 2 days because, FOR WHATEVER REASONS, no one wanted to put the NG tube down...come on nurses, when something is so obvious, do the right thing...and if you don't feel confident in your skills OR YOU JUST WANT BACK UP get some help doing the right thing...that's how to advocate for your patients.

    Needless to say, we had a great rest of the day and she even was able to take a peaceful nap in the afternoon. We got another 800 out the rest of the shift!

    Even when things aren't so obvious to you, if you have a hunch or an intuition or things aren't adding up to you or you have a feeling or concern about something for your patients, RUN it by someone...this is what advocating is all about. We are the chosen ones who have stepped up to the plate to nurse our fellow human beings...I believe we are given hunches for a reason!

    Lots of love to you all.
  2. Visit  Nurse_Advocate profile page

    About Nurse_Advocate

    From 'Newport Beach, CA'; 48 Years Old; Joined Mar '08; Posts: 31; Likes: 123.

    23 Comments so far...

  3. Visit  hypocaffeinemia profile page
    0
    I'm a second-semester student. We actually had a lecture on the importance of the NG tube as a treatment for SBO from one of the local general surgeons. I can't believe she waited two days which such obvious and worsening symptoms before anyone elected to place the NG. Good on you.
  4. Visit  Silverdragon102 profile page
    0
    I had something similar when I first qualified in 1988 and it was the day staff that was reluctant to do anything. Patient admitted medical and everyone said she was a hypochondriac and there was nothing wrong with her. Initially gave her phosphate enema as prescribed by doctor but eventually had to pass NG tube and I must have received well over 3 litres and was worried may go into shock. Doctor wouldn't believe me until I said well come and check it out. She settled for the night but was in surgery next day and transferred to care of surgeons.
  5. Visit  nrsang97 profile page
    0
    OMG I had the same thing happen. Pt received as transfer from the ICU at near end of my shift. I thought "this guy dosen't look good". His belly made him look pregnant. I passed NGT and got half a wash basin full or about 2L. Plus what we got out by suction. Pt was there the next day, and Dr had nurse pull NGT. I again come on shift and pt again distended belly. Hard time inserting NGT call house MD again tons of drainage. They were trying meds to stimulate peristaltis. Not working. NO BM. Pt still distended. Sent back to ICU at one point. Sent back to our floor. Same room. I had a day off and called the nurse on pm shift and told her to watch him. He ended up coding that night and dying, why necrotic bowel and septic. WHY WHY WHY did that nurse keep listening to the doc and pull the NGT??? I kept telling them something was wrong and NO ONE except the house MD and MD on call would listen to me.

    I am sorry that your pt had to suffer. I am glad you are the patient advocate that you are. Good for you.
  6. Visit  MikeyJ profile page
    0
    I would report the nurse that preceded your shift because it was obviously an MD order that was not followed through.
  7. Visit  XB9S profile page
    1
    I bet your patient felt loads better without 2 litres in her belly.

    As for the previous shift, I know here in the UK I occasionally struggle to get ward nurses placing NG tubes as it is not something that is covered in thier training now so when they qualfiy them may never have put one in. When I trained it was something a 2nd year student would have been expected to do. In an patient with a distended abdomen and vomiting it would have been something that we would do without a doctors order but then passing an NG is not something that we need to get a doctors order for in the UK, it can and often is a nursing decision.

    I spend lots of time supervising and teaching rather than putting them in myself. Could it have been the previous shift wasnt confident to do it, obviously they should have sought help but just a thought.
    Silverdragon102 likes this.
  8. Visit  Silverdragon102 profile page
    0
    Quote from sharrie
    I bet your patient felt loads better without 2 litres in her belly.

    As for the previous shift, I know here in the UK I occasionally struggle to get ward nurses placing NG tubes as it is not something that is covered in thier training now so when they qualfiy them may never have put one in. When I trained it was something a 2nd year student would have been expected to do. In an patient with a distended abdomen and vomiting it would have been something that we would do without a doctors order but then passing an NG is not something that we need to get a doctors order for in the UK, it can and often is a nursing decision.

    I spend lots of time supervising and teaching rather than putting them in myself. Could it have been the previous shift wasnt confident to do it, obviously they should have sought help but just a thought.
    Was part of my training but that was back in 1986
  9. Visit  NurseCherlove profile page
    1
    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.
    Nurse_Advocate likes this.
  10. Visit  nightmare profile page
    0
    Quote from Silverdragon102
    Was part of my training but that was back in 1986
    Yes me too! As SD said ,part of our training,and we were better at it than the junior doctors!
  11. Visit  leslie :-D profile page
    0
    gawd, that poor lady.
    it's a no-brainer that a pt w/sbo & distended abd, needs relief...
    and immediately.
    shame on the dr. for not mandating it:
    and those nurses whose judgment, sucked.

    leslie
  12. Visit  SDS_RN profile page
    0
    Not quite the same circumstance but similar situation. I had a pt that had hip surg and pretty soon he's distended nauseated then started w/ the emesis. Called the doc x3 that noc finally on call #3 I had to request the NG as soon as I got that puppy in there bam 1L out immediatly. The guy ended up going to the unit that day and died r/t free air in the abd because this pompus doc refused to return 7 phone calls from the ICU staff. Unsure of how the entire situation went down but it wasn't good.
    This man was in his 80's but come on something could have been done for this man so he did not have to suffer that way. He got a good chewing from the surgeon which he deserved but too little too late.
  13. Visit  HopeItWorksDNP profile page
    0
    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....
  14. Visit  crb613 profile page
    1
    Quote from Silverdragon102
    Was part of my training but that was back in 1986
    Was 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!
    XB9S likes this.


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