I think that nursing today is often forgetting the basics. I had a patient this weekend who I transfered from a stepdown bed to med/surg. I followed the patient and floated to Med/Surg. By the end of the shift I became aware that the patient really needed a BM, and in report I suggested that the patient needs some MOM, ect.
This didn't get addressed and the patient went into A-fib with RVR in the night and ended up an ICU patient on a cardiziem drip. I took care of him the next day, he was distended and no appetite, and was more SOB (his underlying dx was pneumonia)
I told the hospitalist I was going to get his bowels moving when I reported some things to him in the AM, which I did with MOM and a suppository, much to the patient's relief. He had been having runs of wide-complex beats, most likely V-tach, and once he got into bed after his BM (med, hard) he settled down, his nausea went away (doctor had started troponin protocol based on nausea sx), and his heart gradually slowed down, allowing me to wean him off the drip. He converted to NSR at around 1500. The hospitalist put the patient on metamucil, and suggested that cardiziem (patient was on PO cardiziem at home) is a poor choice for a patient with tendency to be constipated.
My point in telling this story is that, I notice patients are being allowed to go too long without BMs. It seems that the basics of nursing care are being lost in a sea of regulatory overdrive demands and high tech wizardry.
Another peeve I have is the people who come out of the hospitals with decubitus ulcers because they didn't get turned or attention wasn't paid to bony prominences when they were lying in bed.
omg!
another peeve of mine.
yes, daytonite, yes, yes, yes!
a few yrs ago, my mil came home from the hosp w/a stage III decub.
it was massive, too.
i.
was.
FURIOUS.
i told hubby this was a case of not repositioning the pt.
i had told a nurse when i was visiting mom, that she had a stage I.
she thanked me and said she'd take care of it.
when she came home with the grossly infected, stage III, i went ape.
i called the hospital and spoke to the nurse who had been mom's primary, 'sharing' my concerns.
evidentally, she wasn't comfortable w/what i said, and the next person on the phone, was some nsg bigwig (either don or cno).
mom ended up in the icu r/t septicemia, and ultimately needed myoplasty sx.
and to top it off???
ed's family was furious w/me, for making a scene...
that my sister-in-law, had friends in high places, at this 'leading' hospital, and i had embarrassed the family.
:stone
still, and to this day, when mom is hospitalized, she automatically gets top notch treatment and a special mattress.
and to think this whole mess could have been prevented by basic nsg care.
Perhaps nurses could place more focus on the basics of nursing care if only they had reduced patient loads, less repetitive paperwork, minimal interruptions, less "customer service" duties, less phone calls, more understanding hospital administrators, and so forth.
When you're trying to cater to too many patients, the basics tend to be bypassed in favor of simply keeping the patients breathing and pulsating for the next shift. Patients should be walked to the toilet if they're physically able to, but some nurses take the easy way out and insert catheters without any medical justification to do so. Showers, back rubs, oral care, and all of the basics simply become lost in the sea of madness that we call the healthcare facility.
Give me less patients, and each one will have more of my time. Then, I can go back to the basics.
It is sad to say that before I quit my work loads were getting so heavy that I was praying the patients didn't poop.
I had a patient at clinical a few weeks back that had been in the hospital for a week and a half post surgery and I noticed he seemed a bit distended and asked when he last pooed and it was before he had the surgery! No wonder! He was on a ton of narcotics and was not drinking a lot of fluids or walking.
Specializes in ICU. Med/Surg: Ortho, Neuro, & Cardiac.
I work nights on a med-surg floor. As I go and do vitals (everyone at 0400) I am supposed to also do qshift I/O. If the pt doesn't have a foley/no hat in bathroom/no urinal and they aren't too confused to answer, the three questions are:
How much have you had to drink since 11 O'clock last night?
Have you used the restroom since 11?
Have you had a bowel movement since 11?
Unfortunately, most aides skip the third question altogether. Some aides (and nurses) don't even ask about I/O...they'll either just chart something and move on or chart nothing at all.
It's bad enough on ANY floor, but med/surg?? Most of our patients are elderly, and the possibility of an ileus or SBO is very likely.
I only worked as a floor nurse for a year but I developed a bit of a reputation amoung by co-workers as being bowel obsessed. I was always dosing my patients up and would be determined to have them all pooping! In fact, when I left my leaving gift was a basket of enemas, supps and other things bowel related..heehee, not that I used it on myself I might add!
Check out the other thread on You tube and net surfing being taken away from nurses at the hospital. Perhaps they are too busy surfing the web to worry about talking to their patients about BMs.
Lord... Last night I swear I was the Sergeant of Poop Patrol... Everyone and I mean Everyone was pooping... and some more than once. One suppository was ordered for one patient, and he pooped before the nurse could give it to him. It was not a pleasant evening.. but the results all got charted and I'm sure all of the patients felt better.
:lol2:
leslie :-D
11,191 Posts
omg!
another peeve of mine.
yes, daytonite, yes, yes, yes!
a few yrs ago, my mil came home from the hosp w/a stage III decub.
it was massive, too.
i.
was.
FURIOUS.
i told hubby this was a case of not repositioning the pt.
i had told a nurse when i was visiting mom, that she had a stage I.
she thanked me and said she'd take care of it.
when she came home with the grossly infected, stage III, i went ape.
i called the hospital and spoke to the nurse who had been mom's primary, 'sharing' my concerns.
evidentally, she wasn't comfortable w/what i said, and the next person on the phone, was some nsg bigwig (either don or cno).
mom ended up in the icu r/t septicemia, and ultimately needed myoplasty sx.
and to top it off???
ed's family was furious w/me, for making a scene...
that my sister-in-law, had friends in high places, at this 'leading' hospital, and i had embarrassed the family.
:stone
still, and to this day, when mom is hospitalized, she automatically gets top notch treatment and a special mattress.
and to think this whole mess could have been prevented by basic nsg care.
dang, i'm very emotional today, yes?
time to up my cymbalta. :)
leslie