decub question

emily_mom · Nov 28, 2002

Is this pt totally incontinent? Where did she come from (home, another facility)? From what you say if she indedd well hydrated with good nutrition status, it would take longer than 8 hrs. Does she eat a high protein diet?

Kristy

sjoe · Nov 28, 2002

It could happen in a couple of minutes if the skin were in poor shape (for any of a number of reasons) and the person slid in bed, for example. Or on the saddle of a motorcycle during a sudden acceleration, for another.

kids · Nov 28, 2002

Depending on the area it may not be from pressure.

sunnygirl272 · Nov 28, 2002

location????

lol...had not looked at your screenname and saw the motorcycle comment, thought you had a sore on your butt from the motorcycle and were asking for advice.... :cool:

baseline · Nov 29, 2002

Location?

:-) I thought the same thing for a second sunnygirl! It may not be caused by pressure. More information needed. Unless it IS the result of sliding across the saddle of the bike? Then I can figure out the location ....... LOL

msdixiechopper · Nov 29, 2002

Originally posted by emily_mom
Is this pt totally incontinent? Where did she come from (home, another facility)? From what you say if she indedd well hydrated with good nutrition status, it would take longer than 8 hrs. Does she eat a high protein diet?

Kristy

Yes the pt is incontinent and she came from the hospital with her skin intact and I do belief she is eating a protein diet.

Problem is she refused to get out of neuro chair the night I worked and the next morning after several attempts to get her back into the bed she finally went around 5AM. The CNA was cleaning her up and called me to her room. I gave the CNA orders and wrote a report to my super. (pt right to refuse - right?)

Well low and behold when the morning CNA came in and saw her bottom she proceeded to anounce to the whole area about how bad this pts bottom was and it was b/c she had stayed in the chair all night. (tidbit- I wrote this CNA up several weeks ago and she is almost out the door). Anyway the family came in and she proceeded to tell THEM how awlful it was and that it was MY fault. I tend to think (if I remember corectly) that this was the CNA that worked till 11PM the day before and maybe was already aware of what her bottom looked like.

I am b/t a rock and hard place. I DO NOT feel as though this is all my problem and I am not getting any support from my higher ups. (Another tidbit - the nurses where I work usually leave me to find out problem areas or they just don't look. I believe SOMETIMES they just want a paycheck and don't care).

:angryfire

Maybe I should just get out of nursing - I care too much.

Or maybe I should start acting like the others see no evil, hear no evil, speak no evil.

Oh------ nice one about the MC seat. I never thought of that-----

O-U-C-H.

Nurse Ratched, RN · Nov 29, 2002

Dixiechopper - can't help you on the time frame of stuff, but I will advise you to write up that nurse aide...again. She clearly overstepped her bounds. Her place is NOT to communicate with families what she believes are HER diagnoses of the patients' conditions. If she doesn't understand that concept, or just doesn't care, she needs to be bounced.

sjoe · Nov 29, 2002

Write her up and also make sure you are keeping your own copy of the notes you make on this matter, including the facts about just exactly what you informed your supervisors about it and when.

You are correct that you will be left out to dry if you are unable to substantiate "your side" of things. I would also start shopping around for an attorney who is experienced in labor law. An initial consultation should cost you less than $50, just to see where you stand and to get a better idea of your rights (and ability to successfully sue, if need be).

Welcome to the BB and remember:

msdixiechopper · Nov 29, 2002

Thanks for your help........... there is lot more to this story that supports me and my position.

Does anyone know of website that has pictures.

PS - I was not asking for an exact time frame b/c I know that cannot be given. I am just looking for as much info as I can get.

:nurse:

Youda · Nov 29, 2002

Definitely write-up the CNA. Also care plan alot! Part of the care plan MUST include her refusal of care and interventions. Do every intervention known to nursing. Vitamins, OT consult for positioning and decub prevention and healing, require q 2 hours checks and repositioning by the CNAs and make them sign off that they did it as part of a "nursing order" in their ADL book. Notify doctor. Do skin assessment daily, etc.

The reason I'm saying this (not only because it's good nursing), but because if the family (and soon State) thinks that there was bad care, you need the documentation and interventions to prove otherwise and to CYA.

Although it may be a little late, be sure you have documented pts. refusal to get out of her chair and any/all interventions you tried to get her OUT of the chair. Do a late entry if you need to. Late is better than not at all.

Yes, admin is going to blame you. You were on duty. The amount of blame will be directly proportional to how much stink comes of this. You have the CNA to thank for that, so again, write her up. Along with insubordination and overstepping, bad attitude, also write her up for not informing her charge nurse that pt. refused to get out of her chair on HER shift. S_IT runs downhill.

And, Welcome to the Board! :)

kids · Nov 29, 2002

Another intervention for a patient refusals (of any thing) that is often over looked is document that the risks of refusal have been explained, and that the patient acknowledges the risks and continues to decline (I got dinged by a State MDS nurse for it once).

I was also told it is better to document things like "declines" and "chooses" rather than "refuses" (no rationale was given).