I have a private duty 65yr old quad, Pegtube, trache, catheter, and lives with daughter at home in his own house. Since day 1, daughter has been altering and not following with plan of care by PCP.
The problem is she expects us nurses to do the same. His feeding orders are continuous feeds at a certain rate. She decides to discontinue the formular altogether, and make up her own "food" of home made mashed potatoes,green beans, oatmeal and whatever she feels like adding in a blender and puree' it to be fed via Peg tube. She feels like her father cannot live on this "milk substance" alone and needs real food. Next thing tube is clogged, we're running to the ER to insert a new one. Pt has been loosing weight, his BMI below of what it should be based on his height and weight. He has had s/s of aspiration Pneumonia as said by MD, but refuses to send him to ER for abnormal sudden change of MS (less responsiveness), fever, thick/smelly mucus through trache and mouth. A Levaquin dose was ordered for 14days and she hid it away from nurses so as to not give the pt because as per her words "am sick and itired of him getting antibiotics." She insists it's just a cold. She has also decided to play around with his anticonvulsants, will sometimes give or hold Vimpat on her own discretion, thank God he hasn't had a major grand mal seizure. My agency office is well aware of this, and I document everything that happens in my shift, incl threats of "getting rid of y'all if you can't do what I want you to do", and "my father can't live on milk alone, he gets hungry for real food." This is a patient with a PMH of a CVA that left him aphasic and unable to swallow. She honestly believes her dad is not a quadraplegic, he was misdiagnosed. Her way of ROM for his extremities is to "stretch his left arm till it's straight" despite him being contracted and grimaces and moans when doing it to this extreme.
O and she discontinued his foley and changed it to a texas/condom cath w/o Dr orders.
I know family or POA cando the way they see fit at home, and we ought to respect that, but inorder for us to follow that, we need an MD order, and she feels like we need to stay away from the Drs this is her house/her father.
I'm getting exhausted of explaining the same thing over and over again of how important it is to follow 485, importance of treating Pneum and how vital it is to have him checked out should his VS become abnormal, and not missing a dose of his seizure meds and blood pressure meds. The last 2 shifts Pt's BP was elevated to 180s/100 due to the fact that his med was abruptly stopped by daughter about a month ago. I feel like it's unsafe for this man to be at home despite having skilled nursing because daughter wants to follow her own plan of care which can be dangerous to the Pt.
