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who cannot care for ventilated TB pts?

MICU   (6,479 Views 13 Comments)
by elizadream elizadream (Member)

1,949 Profile Views; 54 Posts

An elderly man came in for a thoracotomy/decortication with pleural drainage (5 ribs removed ) and remained on a vent for 4 days before tests confirmed an active TB. This news came during the middle of the day shift (noon).

The nurse who had been caring for him the last 2 days refused to take care of him any longer because she was pregnant . We had another nurse on the same shift who was pregnant as well, so not wanting to be "uncaring about my coworkers" I took over his care. The patient was circling the drain and Infectious disease was on my back to transport him to a negative pressure room around the corner (must be done within 2hrs diagnosis). During the transfer, the original nurse never came to help (art lines, bagging, etc) but the other pregnant nurse donned the 'duck-bill' and helped.

I am wondering what other hopital policies are about this because NOBODY wants to subject themselves or their families to TB. Being a nonpregnant nurse I don't want to be taking all the cases that a pregnant nurse refuses to take either...is there some middle ground?

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smileyRn96 specializes in ER/ICU, CCRN, SRNA (class of 2010).

161 Posts; 1,901 Profile Views

Two things I must disclose before replying, #1 I am a male nurse, never been prego nor do I know what it is like, but I guess nor do you #2 I am the father of 2 gorgeous children, that I would die for. My wife is also a nurse and was prego with both and in the patient care arena.

If you contract an infectuos disease you just take your meds , rehab and move on. This is not the case for a pregnant person. Many antibiotics/drugs are not safe in pregnancy and therefore a choice needs to be made between damaging the fetus or not treating an illness. There is also the the fact that these woman spend 6-7 months up at night worrying did they infect their baby and what will be the outcome?

Why would you put someone though that???? If it could be avoided? I do not mind taking sicker patients to accomidate pregnant nurses on my floor.

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oMerMero specializes in ICU.

296 Posts; 3,819 Profile Views

I don't mind taking care of patients that pregnant nurses do not feel comfortable with. I don't know of any policies about pregnant nurses not being allowed to care for certain patient's, but I see it as a form of respect for the pregnant coworker. I know what it is like to worry about myself getting a nasty illness from work, I can not even imagine how much a pregnant nurse would worry about her safety and the safety of her baby. Like smileyrn96 said, it is easier and safer to treat a non-pregnant person. I am not saying the non-pregnant nurse should not take all precautions to avoid getting sick though. Were there other nurses available to help you move the patient to the other room, or were all your coworkers pregnant? I would be more upset with the nonpregnant nurses not helping you out than the pregnant nurses not helping you out. It is too bad the TB was diagnoses so late.

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54 Posts; 1,949 Profile Views

I don't mind taking care of patients that pregnant nurses do not feel comfortable with. I don't know of any policies about pregnant nurses not being allowed to care for certain patient's, but I see it as a form of respect for the pregnant coworker. I know what it is like to worry about myself getting a nasty illness from work, I can not even imagine how much a pregnant nurse would worry about her safety and the safety of her baby. Like smileyrn96 said, it is easier and safer to treat a non-pregnant person. I am not saying the non-pregnant nurse should not take all precautions to avoid getting sick though. Were there other nurses available to help you move the patient to the other room, or were all your coworkers pregnant? I would be more upset with the nonpregnant nurses not helping you out than the pregnant nurses not helping you out. It is too bad the TB was diagnoses so late.

Thanks for your reply...I guess all I wanted was a "thank You" from the original nurse but instead the charge nurse (the other preg. nurse who helped me ) thanked me.

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fsutallyrn specializes in critical care, med-surge.

14 Posts; 1,408 Profile Views

Wow. Our policy is that anyone even being tested for Tb be in a negative pressure room, immediately. Also, I agree with the others. When I was pregnant there were certain instances when I was worried about catching things from the patients. And we would change assignments. There are many medications that are unsafe to take during pregnancy and I would want to avoid putting myself and especially my unborn child at risk of health problems. I have done the same for my co workers when they were pregnant. No policies though.

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485 Posts; 5,506 Profile Views

Think about it... If you are pregnant you can't even take regular medicine if you have a cold, you live off of chicken soup and tea... I know that TB is a diffenrent microorganism. As others have said and from what I have experienced with having a very difficult pregnancy, there are ten thousand drugs that you can take if you aren't pregnant but not so many if you are. Also being pregnant is about 2 people not about one.

I also understand that a some form of acknowledgment from the original nurse could have been nice. because non- prego people do have small children at home.

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lifeLONGstudent specializes in MICU.

264 Posts; 4,491 Profile Views

some thoughts:

1 the pt was on a vent - closed system with filters and inline suction, not like he was coughing and spewing M. tb into the air for you all to breathe. Sounds like a relatively safe TB pt to have to care for.

2 - if I was preggo, I would have done the same thing. Not worth the risk of causing harm to my child -- the child that I will care for the rest of his life if something happens in the womb related to the exposure or meds. Sorry, but I would quit working there if coworkers wouldn't change assignments in these special circumstances.

3 - thus being said, I don't have a problem taking or changing assignments to work around someone who is preg. This even applies to the huge 300 kilo pts that it takes 4 nurses to turn. That is too much stress for a preg body to endure.

4 - She isn't going to be preg forever - after she has the baby, she is back into the rotation for crappy patients. Wear the mask and you are ok. I don't budge when ppl try to say, "well, I have young kids at home", sorry, so do I....

LifeLONGstudent

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smileyRn96 specializes in ER/ICU, CCRN, SRNA (class of 2010).

161 Posts; 1,901 Profile Views

some thoughts:

1 the pt was on a vent - closed system with filters and inline suction, not like he was coughing and spewing M. tb into the air for you all to breathe. Sounds like a relatively safe TB pt to have to care for.

I am not sure agree with your logic on this. Think of the ET tube or trach as a portal directly into an infected area. Most sputum and secretion are coughed up and swallowed (sorry for the graphic description) by a person. Now granted when you sneeze or cough a bit gets out, that is why we cover our mouths. With an intubated pt your risk of exposure is probably greater. That bacteria get all over the tubes, the bed rails, the ambu bag. I might be wrong and please correct me if I am, but this seems like high risk for occupation exposure and exposure to other patients. Vigilant precautions a must.

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Nurse Lulu specializes in critical care.

131 Posts; 6,170 Profile Views

I am having a similar issue. Not just with TB though. We typically have seven nurses on but...she won't take TB, AIDS, Herpes, Hepatitis, IVDA, and the list goes on. Who do you plan on taking care of on the unit????? That is 95% of the ICU population. Everyone is trying to be nice but come on. Sorry to vent on you guys just frustrated.

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8 Posts; 905 Profile Views

Did you consider asking the doctors from Infection Control what the rules/recommendations were regarding a pregnant woman caring for a vented pt with TB? I'm a pregnant nurse, working in the ED, who has been around pt's with TB, sometimes in isolation and sometimes not....that said, I've also been told that the vent is a closed system and the threat of catching TB is not much to worry about.

In these cases what is "believed" may not be actual fact and the best thing would be to ask those who can provide information to either reduce or increase (!) a staff person's concern.

That said, you can never escape that one incident where "something" happens, so allowing a pregnant nurse to care for another pt while taking over that person with TB is very much appreciated.

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Nurse Lulu specializes in critical care.

131 Posts; 6,170 Profile Views

Yeah we have a "fact sheet" but she doesn't believe it. Recently she gowned, gloved, masked, bonnetted, goggled just to remove and clean up a pt who stooled. It really is kind of funny. She is getting better though.

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dorie43rn specializes in Critical Care.

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I have a situation I was nervous about. My husband had a liver transplant in April, and I work in the ICU. I was scared to death of bringing something home. I ask his surgeons what to do, and they said as long as I use universal precautions, he will be fine. Now, I suit up for any isolation just to be cautious.

When we had pregnant nurses, we took the isolations just to be nice. But we also had pregnant nurses who took the iso's and wore the precautions with no ill effects to the baby. I mean really, can you really ever completely protect yourself from germs whether it be a isolation case, or a paitent who you don't find out has MRSA till a week later? Thats why we have the wonderful system called the "immune system." Just wear your gloves, and wash, wash wash.

Dorie

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