Should I leave this case? Worried.

[dirtyhippiegirl]

Mom has some odd ideas about trach care. Kiddo is on a vent but we're weaning her. I guess about six months ago the kid pulled her trach out and mom didn't notice because the trach dressing was covering it. It was pretty traumatic to mom -- the kid turned blue, etc. When I do trach care, I do put the dressing on but mom comes home and immediately pulls it off. She's had some pretty nasty purulent drainage from the stoma site the last few days. I've been cleaning the site and putting a dressing on it but I'm pretty sure that mom takes it off the minute she gets home.

So, yeah. I come in today and the stoma site is obviously infected. On top of that, I'm helping mom do trach care and the kiddo has a ******* abscess just to the right of her stoma site. (Mom swears it wasn't there yesterday.) Mom flips out -- calls the doc who precedes to ***** out mom and me about the poor trach care. It was so awkward. Doc ******* me out and I couldn't say anything because mom was right there.

Anyway, doc gave orders for medicine BID. Mom comes home with the medicine and is like "I think we should do this four times a day at least." I'm like ---) "No." I'm okay with cleaning and changing the dressing 4 times. But if the doc says to apply the medicine twice a day, that's what we should do.

I'm just worried. I don't want this to come back on me. Didn't get to call my nurse manager today because mom was home all day. I plan on calling her tomorrow.

Any other ideas/halp?

[caliotter3]

Please be careful about the info you post concerning your clients. Although the story about her driving or not driving is certainly interesting, it makes the situation easily identifiable. Would not like to find out that you got in deep trouble because the wrong person read this thread and figured out who was who. Most of the stories posted on this site are generic enough that they could fit scores of people, but this one is kind of on the specific side.

[SDALPN]

I would get out and stay out. There are other cases out there. This is just asking for trouble. Too many red flags. If you must stay on it for financial reasons. Start easing yourself on to another case or float as much as possible. When the time is right, pull off completely.

[dirtyhippiegirl, BSN, RN]

Please be careful about the info you post concerning your clients. Although the story about her driving or not driving is certainly interesting, it makes the situation easily identifiable. Would not like to find out that you got in deep trouble because the wrong person read this thread and figured out who was who. Most of the stories posted on this site are generic enough that they could fit scores of people, but this one is kind of on the specific side.

I've changed enough things in the story to make her not easily identifiable. Trust me. :> But you get the jist of the story without me actually revealing specifics that are true.

txredheadnurse - I hadn't thought about that at all! Thank you for bringing it up.

tothepointeLVN - have you also run into clients who use the ER as their PCP? It's funny because I actually used to work in the ER so I'm pretty familiar with the mindset.

[ventmommy]

Just curious why any trach/vent parent would use the ER as a PCP? They never have supplies, a lot of ERs freak out when you walk in with a vent, you never see the same nurses/docs twice, they can't help you with supplies, they won't change vent settings, they hate replacing g-tubes, etc.

[dirtyhippiegirl, BSN, RN]

Just curious why any trach/vent parent would use the ER as a PCP? They never have supplies, a lot of ERs freak out when you walk in with a vent, you never see the same nurses/docs twice, they can't help you with supplies, they won't change vent settings, they hate replacing g-tubes, etc.

Let me preface this by pointing out that I work with a very, very good vent patient program. We have 24/7 access to a direct patient line. And not "just the office nurse" -- most of my families have the attending's cellphone number and we have someone on call for all after-hours questions. As a new grad nurse, this sort of open communication has been vital to my learning.

But there are a lot of socio-economic factors involved. Many of my parents do not have insurance for themselves. They cannot afford to see a PCP. So, for them, any health problem equals a trip to the ER because it's "free" or at least fairly quick/easy compared to having to wait six weeks to see a doc at one of our safety net clinics. So they extend this belief to their kid.

On top of that, you might have a parent who is slowly losing hours for the first time. So they're having to parent their vent kid over the weekend without a nurse. The kid gets a cold, needs increased suctioning and maybe some oxygen to keep their sa02s up. Parents freak out because that's a new thing to them because they simply aren't used to having to take care of their kid alone for more than a few hours.

/shrug

//I know nothing

[mb1949]

It is sad they are put in this position, my client just had hours cut, I have to find another day somewhere cause this isn't cutting it, anyway I just left another case for much of the same reasons, and because mom thought I was nannny for her other two kids, use to leave to run to store and get milk for 3 hours