Should I leave this case? Worried.

  1. 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?
  2. Visit dirtyhippiegirl profile page

    About dirtyhippiegirl, BSN, RN

    Joined: Jul '11; Posts: 1,581; Likes: 4,670
    from KS , US
    Specialty: 4 year(s) of experience in PDN; Burn; Phone triage


  3. by   caliotter3
    Easy. Best to waste no time in leaving the case unless you want to frazzle yourself with teaching and extra documentation. I would leave. You should have been able to speak up to the doctor but Mom is interfering too much and in the wrong way.
  4. by   systoly
    The pt. is on a vent, but no alarm went off with extubation ???
    The doc got inappropriate with mom ???
    A topical bid ???
    I know you cannot give details (and you shouldn't), but I don't see where mom is a problem. I'd be much more concerned about the time frame of reporting the drainage to the doc and then the docs response.
    Last edit by systoly on Oct 20, '11
  5. by   ventmommy
    If mom doesn't want the 2x2 or 4x4 under the trach flanges, why put them there? Nothing says they have to be used. We haven't put anything under my son's trach or g-tube for years and he never gets infections. If for some reason that is written into the 485, tell mom she can get the order changed.

    If there is seriously nasty drainage coming out of the stoma, I don't think a topical med BID is the right way to treat it (just my opinion).

    If the trach tube remains attached to the vent tubing and the trach is accidentally removed, the vent won't alarm (low pressure or low peep) because there is still sufficient resistance of air from the narrow diameter of the trach tube. If the LMV alarm is not disabled, it would have alarmed. I use an old (clean) trach to keep on the end when I am starting up the second vent to switch over because it won't trigger an alarm.

    I agree with Systoly, that it seems like there was a delay in reporting the infection. If you're not allowed to call the doctor per mom, she should have made the call when you first noticed it.

    I would call your DON or whomever the nurse manager is for this child and talk to her/him asap. It seems like there is some tension between mom and the nurses, mom and the doctor, nurses and the doctor.
  6. by   systoly
    I bet you keep the oximeter on when the LMV is off.
  7. by   ventmommy
    Heck yeah. The oximeter is on 24/7. My son can go from 99% to blue and convulsing in 30 seconds.
  8. by   dirtyhippiegirl

    Yes, there is a huge amount of tension between everyone involved in this case. I think the doc finally went off on mom because mom uses the ER like it's her pcp and was going off on the doc because she wanted to rush the kid to the ER and the doctor was And I agree because she didn't have a temp. Seriously, I went home, came back the next day (mom's doing all the proper trach care now) and everything was significantly better. So the topical BID and the dressings are actually doing something.

    ventmommy - I'm assuming what you said happened is what happened in this case. I wasn't there but mom keeps talking about it. I believe the kiddo had a huge granuloma at the time as well, which might have complicated things? I really have no idea. The kiddo is super stable right now. She's pretty much on target to remove the trach by July of next year.


    I actually called in the other day and said that I won't be working this case anymore. Mom is not being completely open with me about certain things. I guess she ends up having to spend a few nights in jail every couple of months due to her driving record. Apparently, she's driving to work on both expired tags and a suspended license. She got pulled over a few months ago but they let her go because the kid was in the car with her. She was supposed to go to court the other day but I later learned that she hadn't. So she now has a bench warrant out for her arrest.
  9. by   ventmommy
    Didn't your agency ask the mom if she had a clean driving record? Ours did because I transport nurses with us to medical appointments if my husband isn't available.
  10. by   dirtyhippiegirl
    I'm assuming that they didn't unless she lied (she lies a lot) about it.

    Or maybe she's the reason that the company recently changed policy and we (nurses) are allowed to transport kids in our cars to medical appointments if deemed necessary by the parent.
  11. by   sharpeimom
    dhg, all i can say is "yikes!!"

    ventmommy, you sound like a great mommy to me!! a fantastic role model for dhg's idiot mother.
    hugs to you both.
  12. by   tothepointeLVN
    Quote from dirtyhippiegirl
    I'm assuming that they didn't unless she lied (she lies a lot) about it.

    Or maybe she's the reason that the company recently changed policy and we (nurses) are allowed to transport kids in our cars to medical appointments if deemed necessary by the parent.
    I would not be cool with that at all.

    Using the ER like a Dr's office instead of utilizing the resources already available ( skilled nurse, dr on call, pcp, case manger etc ) seems to be a common theme. Often times they get VERY upset when the ER won't do anything for them.

    I don't think I have the temperament for dealing with the families anymore. I find hospice a little more straightforward.
  13. by   txredheadnurse
    I would suggest you check with your auto insurance carrier and see if you are covered for transporting a patient as part of your work assignment. It has been my experience that if I didn't have a specific rider (at additional cost of course) covering the use of my car to transport patients then I was placing myself at risk of having any claims denied. I was also advised by my insurance agent that no matter what an employer claims about carrying auto insurance on employees using their own vehicles to carry patients the reality is that a claim will be submitted on your personal auto policy first and, if they deny the claim, then the employers insurance will almost always deny it too. That is, if the employer in reality does extend their insurance coverage to the use of employees private vehicles to transport patients.
  14. by   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.

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