Am I crazy?

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I have a 41 year old male family member that had a laminoplasty on C3, 4, 5 6 ON 2/14 for spinal stenosis that presented aas gate disturbance BLE weakness and L thumb numbness. He was under anesthesia for over 3 hours, and needed 2 hours in the PACU to recover until going to his room at a big heart hospital, he went to a "heart and lung floor". The frist thing I asked the nurse is if he should have an incentive spiramoeter, she said nah, we dont give them to our lami pts, just heat and lung pts. Uhm , correct me if Im wrong , but its to prevernt atelectesis, from anesthia, it doesnt matter what kind of surgery. The fact that he was under for a while is what is relevent, correct? Ok so I taught him some deep breath and cough after the nurse wouldnt give me one. Then (he is overweight and dont forget hasnt been walking that much pre-op due to gate disturbance) he has the sleeves for the SCD'd on his calfs , but no machine! The nurse said she would get it, I go home an dwhen i come back in the morning, guess what? He has been sitting in the sleeves all night, with no machine! the day nurse gets one for him. I have been polite, freindly, even bought the staff choclates. Now he has only walked once today with PT. , he has a lot of pain and gets IV Morphine and PO Norco, he sleeps most of the day. They havent given him fluids since right after post -op, so I have been pushing fluids on him, as much as he can. Im getting ready to leave and they come to do his VS, BP was good, P-114, T-37.2 (it has been 36.4 all day). I tell the nurse (since the tech did not inform her) and she says , oh thats normal! I told her I was worried about atelectesis creeping up and I would like for him to get up and walk. she does take him for a walk (Iwas polite, but I did not want to be). I left shortly after that and told him to make sure to do deep breath and cough and to keep drinking as much as he can. Am I crazy to be worried about leaving him there??? Am i over-reacting? I realize its not time to go grab the defibulator, but to do nothing? and say its normal? Am i wrong to expect them to try and avoid illness, and I was there 10 hours yesterday and 12 today and not ONCE have I seen anyone listen to his lungs or heart or BS. only one nurse looked at his bandage. He did not urinate for 12 hours and they didnt even know! they dont do I' and O's, they dont even ask him if hes gone. Please be nice and gentle if you think Im acting crazy, but please tell me. thanks

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your concerns are most definitely valid and reasonable.

this is nsg 101.

shame on them.

leslie

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Specializes in medical surgical.

i agree with you. these are standards of care and best practice is not being followed. I sure that there are care plans for this pt and I would ask the charge nurse or nurse manager what they consist of and why he was not being treated as he should be.

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blu1073,

You are not crazy! SCD's, IS, ambulation, I&O,listening to heart and lungs....all reasons why nursing is there in the first place and are all necessary after surgery.

I have had pt's say, oh.."nobody has listened to my lungs before" or have found dirty original dressings on post op day 3 stll there.

The thing is, nurses in the hospital have too many pts, minimal cna help, and too much documentation to do. I have seen nurses taking shortcuts with assessments and things like SCD's just because they don't have time to do everything.

In the case of your family member...I would be upset too. The things you mentioned are basic nursing skills that MUST be done.

It is nice to hear that you have been polite to the staff, us nurses take alot of crap from mean demanding family members. You however, have valid complaints. I would ask to speak with the charge nurse and voice your concerns.

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I have worked as an Rn im the Ed and knwo that family members can be pains in the asses and I also know that most nurses try and avoid that room like the plague, so that is why I am trying to be polite and inviting. I do not enjoy confrontations and try to avoid them, I believe he is gonna be D/C's tomorrow (if he doesnt end up with PNA, DVT, MRSA, etc.) and I am gonna be sure to go up as early as possible to make sure he is alright. I am going back and forth on telling the charge nurse ro just letting it go. If he is let go tomorrow and I make sure that everything is done for him, I wont worry about him, but what about the rest of the pts? I dont think they will change their policies just because of me, but maybe I can find a way to inform the hospital without naming names (including my own), so that I dont have to deal with the headache. Thank you , I was wondering if I was going insane and over-reacting because it was my family member and that is the way I was taught. Please say a prayer that he is alright and gets those lungs open tonight! :)

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did you tell them you're a nurse, i find that being a nurse, doctor, lawyer etc and telling them that, basically gets you a differ (better) level of service/care.

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I always appreciate family members, yes, they can be a pain in the _ _ _. But...I've also found if I can find them jobs, helping their family member, they feel useful, and tend to criticize less.

At my facility, pre-op generally goes over much of the post-op instructions. Deep breathing/cough, ambulation. Floor staff reinforces the teaching, encouraging ambulation etc. Pre-op ALWAYS gives pt I.S. for any of our surgical pts.

Not sure why staff never assessed heart/lung/bowel sounds. Maybe it was done before you arrived? Maybe pt. didn't remember?

I once had a pt. tell me, "no one listened to my heart/lung's and no on put lidoderm patches on me the last 2 mornings like they are suppose to..." I assured her "yes, I did listen, and you told me you did not want the patches on the last 2 days and would ask for them..." her eyes opened wide, and she says something like "oh, yeah, thats right, you have been my nurse the last couple days, I forgot.:uhoh3:.."

I would be slow to blame/criticize, alot of times the pt is not a good historian, expecially if on narcs, and also, sometimes the pt. does not want the family to know everything about them. Did you leave the room during your 10-12hr stays? Perhaps staff was waiting for you to leave and then went in??? hopeful??

I would voice my concerns to the charge nurse, maybe she has some explanations??

Your family member is fortunate to have you as his advocate:) in the absence of his nurse:mad: advocate:o

Hope he is doing ok:heartbeat

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Specializes in PACU, CARDIAC ICU, TRAUMA, SICU, LTC.

All your concerns are valid!! Poor post-op nursing care, IMO! Four sources of post-op infection: wind (respiratory),

wound, water (GU), walk. What is being taught in nursing school today? There is NO excuse for the lack of BASIC post-op nursing care..I would speak to the NM; give the example of your loved one not having an incentive spirometer! I feel for the patients who do not have advocates in the profession! :crying2:

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Seems a bit dramatic - but, you're right. Someone needs to be assessing him closer, esp. his I/Os and h/l status as a post-op patient. When a family member was sick, the same thing happened to us. I brought in my stethoscope and assessed him myself (fortunately systems checked out ok) and asked my family member to record his I/Os on paper and hand it to the RN or aide. A temp of 99.0 - meh, not something I'd lose my head over just yet. But him not peeing after you pushing so much po fluids? That'd warrant a bit more attention I think.

It just seems like everytime there's a family member in the room, staff tends to leave the patient alone (what a shame). Speaking for myself, I feel like I'm being scrutinized up and down for what I'm doing but I buck it up and always think "This person here could be a nurse or doctor!" and just do what I have to do.

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Specializes in Cardiology, Psychiatry.

I applaud you for keeping your cool. I would have a very hard time not being one of those family members that can sometimes make me cringe. Do they know you are a nurse? Sometimes I think that when a medical person asks questions of a nurse, they feel as though you are questioning if they even know what they are doing. However, you do have some very valid concerns. Heck, I work on a cardiac step-down unit and get worried when someone doesn't pee. I can't imagine post op what the expectations for a patient would be. I really would bring everything to the charge nurse and have her address you concerns- maybe you can do it in a non-threatening manner- like I don't know about you're policies here regarding... whatever... I really wish you the best. Remember to speak up for yourself and your family!

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I was there when 4 new nurses came in and introduced themselves and was there for 2 oftheir full shifts. one looked at his wound, (only assessment done). I think the one answer is the closest, when I ask a question or make a suggestion , they think Im critisizing. I try to say it in a nice way, like "do you think he needs an IS?" "Im just worried that atelectesis may be creeping up, could we take him for a walk?" after I was told that a pulse of 114 was normal. i think one nurse tells the next nurse in report that a pain in the ass nurse is in there and I start with a predjudiced opinion before they even walk in and they try to avoid. I always made sure I explained everything to family members that were health care providers and if they had a suggestion , I would say sure we could try that or give a reason why I dont think its helpful. They found out I ws a nurse when I went in yesterday morning and asked if I could have the stuff to clean him up at 0930 (hes shy anyway and didnt want somone else doing it) then when he went xray I asked if I could have nedding (at around 1100 -noon) because it might be easier to change it while he was gone (it was really dirty) and I know how busy they are. The tech was nice and loved me! (she isnt intimidated by another nurse asking questions). I cant sleep and Im worried, I think Im gonna head back up ther now even though it 0615 now. Thanks for the kind words, I know that I will bring this back with me to my practice and always remember how it feels so I can make sure I dont treat another family memebr/ health care worker like this.

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