Need some tips on dealing with slugs

[monkeyadale]

I work on a general surgical floor. Many of my patients are cooperative and take my advice seriously but a good number of them are not. I watch them suffer needless complications from immobility, overuse of narcotic meds, and refusal to cough and deep breathe. What should be a 2 day stay ends up turning into a month and now they have a uti or atelectasis which turns into pneumonia or they get MRSA, and a lovely little opiate addiction as a parting gift.

I have had patients ask me to scratch their feet for them, wipe their butts for them, help them put their pants on. I would not mind if they were not able to do these things for themselves but they are! It is very very frustrating and I really would love to hear how other nurses handle patients who refuse to get up and move around at all. I will always pre-medicate but they refuse anyway. One trick a PCT taught me was to tell them they have to get up in a chair so the tech can change their sheets, then the tech strips all the linens off the bed and doesn't come back for a couple of hours. Sneaky and underhanded perhaps but at least it gets them out of their beds for a little bit.

Any other tips you have found effective in your practice would be greatly appreciated!

[MedSurgeMess]

I would talk to them and let them know what is expected of them, be compassionate and explain that you understand pain issues, but movement is a must or they may get pneumonia, DVT/PEs, or UTIs, etc. Also, make the MD aware of what is going on, then let the patient know that the MD expects them up out of bed, walking x amount this am, x amount this afternoon, etc. Don't give them a choice, if they are able to do it. As far as wiping butts, I let them know that physically there is no reason for them not to be able to do it, and if they choose not to, then perhaps hiring a private duty or going to LTC would be in their best interest, as they will not have someone to do that for them at home. I've never had that fail, they usually are wiping before my spiel is done! No offense to my counterparts in LTC or private duty, I'm not trying to give y'all a bad name

[K+MgSO4, BSN]

hi

I have used the bedsheets trick myself many times it is great :smokin:also if possible offer them a shower or bath instead of a basin or sponge wash. It can work wonders!! there is no better feeling than coming out of the shower or bath when you havent had one for a week(give them the shower stool so they dont fall down!!!). Take offf their TEDS and wash them. Give them half an hour break while they dry on the condition they walk to the window for some fresh air. Tell them to look up when they are walking the floor is even but they might bump into somebody if they dont look where they are going :chuckle.

If that all fails start the DVT, pneuomima, constipation lecture...........maybe i can scare them because even though i am younger than them I am 6'1" tall and have an irish accent!!! It works wonders for me!!

But the most essential thing is PRE op education. i am all too aware of the emergencies that have to go straight to theatres but educate educate educate.............tell them the truth they will have pain - but you will give them pain relief, that they will be fasting - but they will have mouth care and lip balm, they wont want to get out of bed - but a little discomfort getting up that first time will benifit a shorter stay less complications and an improved recovery time.

If you are needing a sleeping pill while in hospital when you dont take one at home it could be because you havent tired yourself out -- go for a walk. I will walk beside / behind you push your iv pole or carry your catheter etc

If all else fails ask them how are they going to go back to work and earn a living or do they intend on living on benifits?? Or ask them how do you think you family are going to cope making your bed, washing you, taking your dinner in on a tray and taking it away again because you havent done any of that while you have been here? Sometimes best said with partner or adult children in room gives them a wake up call to why you are being so hard on their father / mother / husband / wife!!!

Getting down from my soap box!! But education and telling people the truth about what will happen to them are my pet peeves. Worked with a surgeon who however did not educate pre op in his clinics:banghead:

[monkeyadale]

Thank you both for your replies! Karenmarie, you bring up an excellent point, I don't think many of my patients, are getting much, if any education pre-op. Many times they will say to me...your the only one who says this stuff to me. Medsurgemess (cute name btw), I like your response about the LTC or private duty nurse and will be sure to use that one. Maybe that will spark some initiative.