Private duty rant...

[smurfynursey]

Hi all...

I am sorry to rant...but this bothers me.

I worked a private duty case last night with a child that I have been with for about 2 months. When I got report from mom she said she hadnt had a bm in 3 days and gave her miralax in apple juice shortly after I got there. (of note, this is a fragile cardiac kid). About 1/2 hr after the miralax she was straining, sweaty flushed and crying. Mom consoled her and changed her. Her poop was baseball sized (big, round and hard) and had blood on the surface. I called her pcp and he was not concerned, as she was constipated. I called the day nurse and she was like, that happens.

At this time it is important to note that a)said event was NEVER documented b) Mom was NOT aware and c) Caseworker/DON was NOT aware.

Since when is bloody poop (small though it may be) not reportable to parents?!!!!

We ended up going to the ER with her in the middle of the night for various reasons and she was dx'd with an anal fissure. So....who knows how long this has been going on and no one has known about it? She has pooped for me and mom and we never noticed it before.

Like I said...Just a rant. and....Moms like to know these things. If it were my kid I would not be a happy mommy!

Thanks for listening :)

[ventmommy]

Kyasi, You and a couple of other nurses on here sound like perfect additions to our nursing roster!

If I say I am going to do something, I do it. In all these years, I don't think that a nurse has ever alerted me to something that I did not already know about.

Obviously, if there is a med change, I have the nurse call the office so that her paperwork is squared away.

[Kyasi]

Thanks Ventmommy....

In my state, if we can get a RX number on a med, we can accept that as a MD order. So if a child had increased congestion, the nurse calls the office and reports the problem. If she says that Mom is going to call the MD or will be taking the child in for an appt later, I give her time to do that. Usually the parent will call to report that an antibiotic or new medication was started, give us the RX number and details. We can then write an order to fax to the MD to sign. The nurse can give that med prior to the MD signing that order though. The key is 'follow up' with the parent. Obviously, how we handle it depends on the severity or how critical the situation is. But this is for the parents who are on top of the situation and who like Ventmommy, know what is going on.

Some parents, sadly, don't give a rip and won't follow through. We know who they are and in those cases, we always make the call. They are usually the ones who don't want to be bothered and would rather someone else take the responsibility. Either way, our charting shows the problem was handled by either the parent or our office and was properly followed up on, which ultimately is what any auditor wants to see.

Kyasi

[mb1949]

I agree, I am stuck in a case now with a very demanding mother, with a wicked control streak. Yesterday the little guy was vomiting his NGT feed out of his nose and mouth, I stopped the feed, informed the mom and wanted to call the MD, because he just upped the rate/hour, mom would not call and turned the feed back on about 1 hour later, I could just hear the congestion building up in the baby's nose and throat, patient is vented, anyway, she goes out at 3 o'clock to run to the store and comes home at 8pm, i have been on this case for 1 week and this happened 4 times already, I am very uncomfortable at this place, Yesterday she ranted at me for about 20min because I couldn't find the shirt she wanted him to wear, this woman is nuts, I am calling my agency at 9 o'clock to inform them of the situation. I am new to home care and am afraid for my license.

[Kyasi]

I'd be afraid too! Leave if you feel your license would be in jeopardy. Don't let this first case turn you off to home care entirely though. My first case (25yrs ago) was awful but I've had many wonderful cases since.

Kyasi

[mb1949]

I'd be afraid too! Leave if you feel your license would be in jeopardy. Don't let this first case turn you off to home care entirely though. My first case (25yrs ago) was awful but I've had many wonderful cases since.

Kyasi

Thanks so much, thats exactly what I did this morning, this was too scary,