The Dreaded Death Bath and a Moral/Ethical Dilemma? - page 4

by Be_Moore 9,024 Views | 33 Comments

So my coworkers and I were discussing a patient who had died recently during bathing. Well, let me clarify..patient didn't actually die during bathing, but the stress of bathing caused a chain of decompensating events that we... Read More


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    Quote from yesdog
    Great post. I am a new grad. I will be starting in the SICU on monday. I did my capstone in the MICU. My preceptor ALWAYS bathed and turned the patient....even when there were 9 drugs going in, vent, CRRT, multiple organ failure. Was she wrong?

    She wasn't necessarily wrong, I hope she just used good judgement. I mean when an oscillator patient starts dropping sats simply when you're screwing with their ted hose to check pulses then she needs to have sense enough to say hey let me stop and no this patient isn't gonna be bathed or turned until they can tolerate some stimulation.

    Just because someone is on every drip and has crappy lungs doesn't mean they can't be turned. You get a feel for what people can and what they can't tolerate. And honestly sometimes you turn them, they tank and you know not to do it again until they stabilize.

    Interesting thing though, I was in a skin meeting a few months ago and the WOC nurse was leading it for a new skin initiative on our unit. She was admit that ALL patients can and WILL be turned. Right. I say come on up and you can join in on a round of compressions when we follow the initiative on that patient. We turn unless we have an order not too. Our physicians are more than willing to write an order and physicians note stating that the patient is currently too unstable to turn and to list the reasons why.
    WindwardOahuRN and NurseKitten like this.
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    Quote from whooha
    She wasn't necessarily wrong, I hope she just used good judgement. I mean when an oscillator patient starts dropping sats simply when you're screwing with their ted hose to check pulses then she needs to have sense enough to say hey let me stop and no this patient isn't gonna be bathed or turned until they can tolerate some stimulation.

    Just because someone is on every drip and has crappy lungs doesn't mean they can't be turned. You get a feel for what people can and what they can't tolerate. And honestly sometimes you turn them, they tank and you know not to do it again until they stabilize.

    Interesting thing though, I was in a skin meeting a few months ago and the WOC nurse was leading it for a new skin initiative on our unit. She was admit that ALL patients can and WILL be turned. Right. I say come on up and you can join in on a round of compressions when we follow the initiative on that patient. We turn unless we have an order not too. Our physicians are more than willing to write an order and physicians note stating that the patient is currently too unstable to turn and to list the reasons why.
    I do so love the non-bedside (or, to be more accurate, the "occasionally at the bedside to evaluate the totally avoidable [sigh] decubiti") nurses who evaluate and walk away. Nice to be in the position to evaluate and be judge and jury regarding nursing care or the lack thereof. I fume at the flack we've gotten from them at times.
    As one who has had to choose lungs and heart over butt recently---we chose the first two. As expected, the butt suffered. But the butt's owner will live to fight another day, thanks to excellent nursing care and nursing judgement. Yes, we got the "Do Not Turn" orders that covered our nursey butts.
    It's not all textbook crap here, gang. Instinct, experience, and gut...they all play a part in saving the lives of our often extremely unstable patients. If we're lucky our docs trust our judgement and write the CYA orders. If not...:::SHRUG:::we're just gonna go with our gut.
    NurseKitten likes this.
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    Quote from yesdog
    Great post. I am a new grad. I will be starting in the SICU on monday. I did my capstone in the MICU. My preceptor ALWAYS bathed and turned the patient....even when there were 9 drugs going in, vent, CRRT, multiple organ failure. Was she wrong?
    Did the patient crump when he was turned? If not, nope. She was fine.
    No doubt your preceptor had instincts which she had developed over the years regarding patient stability and tolerance. Nine gtts and CRRT and MOF is often the norm in ICU. No biggie. You clean up these guys on a routine basis.
    Might I add that these patients do not benefit by what I fondly refer to as the "bonding bath." Skip the soothing back rub, the comforting applications of lotions.
    Jeez----scrub 'em down, dry them, have a bedroll ready for the very quick turn and linen change. Slap some heavy duty cream on their butts---QUICKLY--- and call it a day.
    IME you draw the line when the patient has serious decompensation, in any area, when they're turned. This happens with patients who are at death's door and have absolutely no reserve. They crash quickly and take a long time to get back to their very tenuous baseline, often necessitating extreme vent changes and gtt adjustments. And yep---sometimes they go beyond that and code.
    NurseKitten likes this.
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    We also get the fancy mattress for any patient that is hemodynamically unstable. We still bathe em, its a PTA bath if they can't tolerate more, and realistically if you've got a patient that sick, you are too busy with other priorities than about getting them bathed. Luckily they usually either get better or worse pretty quickly and they can be bathed later, no reason not to keep heels up though.
    NurseKitten likes this.


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