Keeping my patient's dignity intact? Please help me!! (long but urgent)

[KateyBug]

I am nurse and caretaker to a partially mute male, 14 years old. He has failure throughout his body, including problems with digestive and nervous and vital systems, and I must tend to him.

He has good skills and intelligent and mentally independent. He can do and enjoys doing puzzles or hand activities, but can only do so much due to low coordination. He understands language and he can make noises that resemble words, however does not speak much. He prefers to make sounds or be silent.

I massage his belly to bring about eructation (burps) and flatulence and to improve digestion. I also massage him daily to help with digestion and circulation and to soothe him.

I handle hygiene and intimacy. I give him physicals or check ups once a week. I bathe and groom him regularly and take good care of his skin. I diaper him since he dislikes bed pans or catheters. Not to mention he does have sexual insecurity, even with puberty, so it is even worse on that part. I occasionally administer enemas or laxatives also.

We've agreed that it is acceptable for me to spoonfeed him, since he has poor coordination. Often he can feed himself but requires assistanxe. Although I do respect him and I assure meals are satisfying.

I do talk to him kindly and considerably. I communicate with him and make sure I know what he needs or what he wants me to know, even though he has difficulty replying or talking. He cannot communicate easily but he is very intelligent and he has a very active mind. Even though his body cannot function correctly, his mind and feelings are still working fully. So I am concerned. He does enjoy the care. He likes massages and such. He knows he can trust me and that I can help and comfort him. He knows I will respect him and do what he needs.

However, things can be too overwhelming, like my "full control" or his overdependence. I feel as if I invade or put too much pressure on his will.

Please help me. How can I keep his dignity intact? How can I help him yet allow him to not feel like he nothing?

[JustBeachyNurse, LPN]

He obsessively runs his hands or fingers along his lenses.

Not accidental smudges. Rather like he is deliberately messing with them.

How can I let him know I'm concerned and maybe communicate further enough to maybe find what or why this is a habit for him?

It's not an issue. It doesn't matter why he's doing it. If he has limited ability to move maybe this is the only thing he can do. Just clean his glasses and not obsess over it yourself.

[KateyBug]

Alright. Thank you.

Another few things, if it would would alright with you?

I've been having conflicts with feeding. He is very friendly and cooperates as much as he can.

But his body still has hardship.

First thing, his tongue and mouth have reflexes. Sometimes his tongue denies the food and often some bites shoot from his mouth. Once in a while he gags and brings his food up with vomut. A couple times he's gagged on saliva (he drools sometimes when he is hungry or ready to eat, when his system is malfunctioning) and it's hard.

Any advice?

Second, he has food dilemmas. He is usually not picky, and will eat or drink anything. However occasionally, he will refuse certain foods. For a week, he would not accept anything vegetable or dairy. I could not balance his nutrients with only fruit. He went back to his normal eating again, yet it was not good. Note, everything is currently good though

I spread it out. I'll use today's meals for example- a breakfast can be oatmeal and applesauce or yogurt with juice, a lunch could be chicken and rice in sauce and sweet peas with milk or juice, and a supper could be an entrë such as a loaf of soft meat with gravy and baked potatoes and corn and sweetened baked apples with milk and a piece of shortcake (he prefers supper to be lar, he likes a full tummy for bed).

I balance it out.

Although sometimes he will go through picky phases.

Advice? I'd like to compromise and and meet needs and comfort simultaneously. I'd like to be as kind as possible too. When he has an issue I want to be able to help him.

Finally, i massage him for circulation and digestion and gas. From meals, I will massage him specifically for gas. I relieve him of flatulance and eructation by thought of comfort. But sometimes I will work for a long time before he starts letting gas out. Is there a way that is convenient? Any specific areas to rub and focus on to relieve him even faster?

Possibly any more advice with gas, especially burping, that don't require medicine? (He has a he time with medication and only wants it when it's a must.

[BuckyBadgerRN, ASN, RN]

He obsessively runs his hands or fingers along his lenses.

Not accidental smudges. Rather like he is deliberately messing with them.

How can I let him know I'm concerned and maybe communicate further enough to maybe find what or why this is a habit for him?

You can't. Let it go. Clearly it's a tic or manifestation of all his disorders that you keep talking about. You seriously need to back off of some of these things and quit trying to "get into his head" and/or control his every move. In the grand scheme of things, smudged glasses aren't even on the radar for this child!

[BuckyBadgerRN, ASN, RN]

Alright. Thank you.

Another few things, if it would would alright with you?

I've been having conflicts with feeding. He is very friendly and cooperates as much as he can.

But his body still has hardship.

First thing, his tongue and mouth have reflexes. Sometimes his tongue denies the food and often some bites shoot from his mouth. Once in a while he gags and brings his food up with vomut. A couple times he's gagged on saliva (he drools sometimes when he is hungry or ready to eat, when his system is malfunctioning) and it's hard.

Any advice?

Second, he has food dilemmas. He is usually not picky, and will eat or drink anything. However occasionally, he will refuse certain foods. For a week, he would not accept anything vegetable or dairy. I could not balance his nutrients with only fruit. He went back to his normal eating again, yet it was not good. Note, everything is currently good though

I spread it out. I'll use today's meals for example- a breakfast can be oatmeal and applesauce or yogurt with juice, a lunch could be chicken and rice in sauce and sweet peas with milk or juice, and a supper could be an entrë such as a loaf of soft meat with gravy and baked potatoes and corn and sweetened baked apples with milk and a piece of shortcake (he prefers supper to be lar, he likes a full tummy for bed).

I balance it out.

Although sometimes he will go through picky phases.

Advice? I'd like to compromise and and meet needs and comfort simultaneously. I'd like to be as kind as possible too. When he has an issue I want to be able to help him.

Finally, i massage him for circulation and digestion and gas. From meals, I will massage him specifically for gas. I relieve him of flatulance and eructation by thought of comfort. But sometimes I will work for a long time before he starts letting gas out. Is there a way that is convenient? Any specific areas to rub and focus on to relieve him even faster?

Possibly any more advice with gas, especially burping, that don't require medicine? (He has a he time with medication and only wants it when it's a must.

Is someone supervising you? Where are this young man's parents? The more you post, the more it's clear to me that perhaps this is not the line of work for you.

Have you posed these questions to the nurse that oversees you? PLEASE tell me that someone with an actual nursing background/education/degree is also taking an interest in this case! What do you bosses or the parents have to say about these things you keep repeating here?

[JustBeachyNurse, LPN]

Those are not likely reflexes they sound like spastic cerebral palsy or a similar dystonic condition. These are involuntary movements. Not reflexes. Not behaviors. This is a minor child. Where are the parents? You are not a behaviorist, nurse, speech pathologist, occupational therapist or dietician. Being picky for a week will not likely cause adverse effects. You need to consult with his parents and your supervisor for assistance and training. Are abdominal massages in his plan of care? Who taught you to do them? Your supervising nurse? An occupational or physical therapist? If performed incorrectly you can cause damage and injury, reflux or aspiration. The tongue movements are likely spastic or dystonic and not purposeful. If increasing it can be a sign of worsening dysphagia. A medical consult is needed.

[JustBeachyNurse, LPN]

You cannot learn digestive massage online from a message board. You are crossing the line into treatment/medical advice. You need to consult his parents and/or your supervisor.

[psu_213, BSN, RN]

This thread has me baffled is all I can say as I look through my smudged glasses.

I agree…I hate to be skeptical about it, but, well, I am bit confused about the "confidential" nation west of Hawaii. I has only a few people, no real city, it totally isolate….yet has good internet access.

I realize that not every country has the health care "hierarchy" of the US--i.e., doctor writes orders, nurses implement some orders, delegate other, techs/aides carry out the delegated orders. However, it seems totally strange to me that there is no resources available for the OP to help guide her in the care of the client.

In short, I'm not ready to call this fake, but I certainly have my doubts about some things.

[KateyBug]

I'm heading off for a bit, letting you know.

I will return tonight at around 11.

Did not notify anyone before though now I am.

Graceful day everyone

[CloudySue]

At 11? I'm still trying to figure out what time zone you are in, LOL!! Please, I am still unable to determine where in the world you are. Can you please state the name of your country again? What you wrote before was very confusing. I plug those names into Google Maps and absolutely nothing comes up.

[SDALPN]

Ok, wow, just wow. The troll is full, looks like s/he was fed well.

The story sounds to me, like this....I'm a nurse, but I'm not. I was trained, but I wasn't. I live in a made up place, but I want attention so I'll tell everyone its secret to get their attention and curiosity. And I like making everything do vague that I lead people on, but never really get an answer to the question because I keep twisting and changing the story.

Yep, that's what it sounds like once the sugar coating has been removed.

I hope the OP realizes its illegal to use the title nurse if the OP isn't really a nurse. And I hope they realize IP addresses can be tracked. Uh, yeah, good luck with that!

I'm all for helping nurses and sharing info or learning from them. But this has gone way too far.

[BuckyBadgerRN, ASN, RN]

It must be ok in the Bermuda Triangle to call yourself a nurse, even if you don't know basic personal care!

[QuiltDog]

This is the strangest thread I have ever seen ?