Ethics in treating a 7 year old

UK2USA · May 14, 2004

There is an ethical dilemna if you are querying whether you were giving the pethdine for the child's sake or for the mothers. It might have been an idea to let her calm on her own (as it appeared she was doing) and keep the pethidine as pain relief once the MD had assessed how best to remove the suprapubic catheter. It is an interesting problem... at what point does parental involvement become an overstep?

SnowymtnRN · May 14, 2004

ok, here's the situation..
I'm a student, and i was nursing a 7 year old girl, with a bit of supervision from an RN when i needed it.
The girl had had surgery on her bladder and had had 2 drains removed already, leaving an SPC, which was due to come out the day i cared for her. She was worried that it might hurt, and when she asked me if it would, i didn't want to lie, and told her 'it might, but it shouldn't be for long', and she was happy with this. I did not want to do the removing, as i'm only a student and i'd never done it before, so my supervising nurse did it. all went well until the nurse tried to pull it, and the kid started screaming that it really hurt. We tried a few different methods, but could not get the thing to budge, which we put partially down to her clenching her stomach muscles around it and partially to it being dry and therefore difficult to slide out without sticking. Eventually we gave up and let her settle down, and then asked the CNM to have a try. She tried with no result either, and evenrually the little girl was so upset she was kicking at the nurses and her mother. When she'd had severe pain before, her doctor had ordered her pethidiene, so we asked her if she'd like that to stop it hurting, but she said the needles hurt too and got even more upset. eventually she was so worked up that they gave up trying to take the SPC out, and her mother asked that we call the doctor and get an order for pethidiene to make her settle down (it usually made her sleep for about 5 hours). The nurses left the room, called her doctor, got the order for pethidiene, prepared it, and returned to the room. This probably took about 10 minutes, and on returning to the room, the child appeared to have settled down significantly.
What would you do in this situation?
In my situation, the nurse upset her all over again by giving the pethidiene, even though she was screaming that she didn't want it, and had to be held down by another nurse and her mother to have it given. This upset her further, and in my opinion, had we not returned to the room with the needle, she would have settled down quickly anyway.
I ask because i have to write an assignment on ethics in nursing, and am using this situation as my topic. Any opinions, insights, useful information, references, ANYTHING, would help me out a lot!
Ta!

WELL this is tricky, but you honestly can't think like a nurse in this situation. you have to think like a 7 year old. The mom asked for the meds, and the nurse went and got it. She came back, the child was settled, BUT she was fine based on

a. she wasn't being messed with (SPC, no nurses touching her etc...)

b. she'd had a few minutes to calm down.

She didn't want the meds, but she didn't want the catheter either. To say she didn't want the meds is most likely not accurate. She didn't want to be touched, bothered, etc...because it was scary, painful, and in a 7 year olds mind if she says she doesn't want something then the pain goes away. KWIM? So EITHER way no matter what happened in this situaion she was going to be upset for getting meds AND having the SPC removed, so the best thing for her to make it EASIEST for her was the meds, which in turn would have made the SPC removal easier. If nothing else then to calm her down and help her manage the difficult situation better. Yes children have rights, but the SPC has to come out, so by getting the meds it would have made that as least painful as possible. When she asked if it would hurt, i would have told her "it will probably not feel good for a bit, but once its out its OVER and the pain will go away." I also would have pre medicated her for this situation because of the stress it was likely (and did) cause.

Good luck on the paper!!!

Mimi2RN, ASN, RN · May 14, 2004

Did you get the catheter out?

I have had a foley catheter balloon stay inflated in me, so anyone that complains when you are trying to d/c a foley would set off all kinds of alarms for me. The balloon did not deflate properly, even when the catheter was cut short. It took a urologist with a big needle to get it out.....and left me with a UTI after several hours with a hemostat clamping off the tubing!

**canoehead, BSN, RN** · May 15, 2004

If I can't get a catheter out with gentle pulling I call the MD and let them do it, so that was what I first noticed going wrong in the scenario. Second was, why did you need to give a shot- po meds would have done the trick to calm her. A little po Versed or maybe even something a little less potent, like Ativan, and you would have been all set.

goats'r'us, ASN, RN · May 19, 2004

Thanks for all your opinions -

snowymtnRN, the problem i had was that we had given up on removing the catheter by the time we gave the peth. Her doctor had already been organised to come the following day to take it out, and the peth was purely to calm her down - we just gave it, and then left her alone, pretty much.

canoehead - She was given a shot because that's what the doctor prescribed, and that's what's worked on her in the past. I've never even heard of the po meds you mentioned! (i'm a student)

We all felt very ripped off in the morning when her doctor showed up and basically the catheter came out just by him LOOKING at it!