Now I feel bad... What would you have done??

[TigerGalLE, BSN, RN]

Ok so it was the usual crazy day on my renal/respiratory floor today. I got a new pt up from the ER as an admission with possible small bowel obstruction. He was an ESRD pt and the renal dr admitted him and consulted GI. GI saw him around 1730 and then wrote a whole page of orders. Pt was NPO except ice chips. He ordered a CT with oral contrast and he also ordered an NG tube to be placed to LIS... So I ordered the NG tube from materials (they wanted a 14F and we only had 16F on the floor). Then CT brought up the oral contrast and the pt began drinking it. He was quite nauseous already so I gave him some Zofran and he continued drinking it.

I asked my charge nurse if she thought I should go ahead and place the NG tube or wait until after the CT. She said to wait. For one we couldn't place it on LIS b/c it would suck the contrast out... Also he was nauseous and I didn't want to place the NG and it cause him to gag and throw up the contrast. So I called CT and told them to get him down as soon as they possibly could.

When the next shift came out of report (we tape report) I asked the oncoming nurse (an LPN) if she had any questions. And she said yea, "what were you thinking?" I asked her to clarify and she said "Why the he** didn't you put down that NG tube?" And walked away muttering "now we have to do it, thanks a lot."

So that made me feel really bad. I try not to leave things for the oncoming shift even though they leave things for us all the time. But now i feel bad. Would you have already put down the NG?? Should i have done it first. Was this terrible judgment on my part?

[Lorie P.]

you did the exact same thing i would have done, no ngt!!

the poor soul was already sick, nasueated and unconfortable.

the charge nurse was right, if you had put the ngt down and up came the constrast, back to square one. also what good would it have done to give the constrast just to have it sucked out?

i would have politely told the on coming nurse, why the ngt wasn't put in and that my charge nurse was fully aware, any problems take it up with your charge nurse and mine.

again, i feel you did the right thing. just hang in there and know you were doing what a "prudent" nurse would have done.

[neneRN, BSN, RN]

No, it wasn't terrible judgement...I can think of much worse. However, I probably would have put down the NGT and given the contrast through the tube if the patient was so nauseous. (obviously leaving suction off until after scan) Nothing to beat yourself up over.

[ericalynn, BSN, RN]

I understand the feeling bad part. I think you did the right thing though. The NG tube would have only sucked the contrast out and that would have made the people in DI upset, and if he was nauseous sticking a tube through his nose down his throat would have only made that worse. I haven't seen alot of NG tubes inserted but every time I have there has been gaging involved. You also asked the charge nurse, who agreed with your rationale for not inserting the tube. The oncoming nurse was maybe just having a bad day and she maybe didn't fully understand your rationale. I say don't worry about it, but thats just me :roll

[twinmommy+2, ADN, BSN, MSN]

Oh, she'll get over it. I would have dropped the tube and given the contrast through that like the pp stated.

[EmmaG, RN]

Don't let it bother you. The tube could have been used to administer the contrast, but beyond that, it's no big deal for the next nurse to place the NGT.

I can pretty much guarantee you that if you HAD placed the NG, that nurse would have found something else to ***** about.

[Idon'tcodgerdodge]

I've got a question...if they admitted this guy with a possible obstruction, why on earth would they order the CT with oral contrast?? That doesn't make much sense, "we think he might be obstructed, and he's NPO, but lets go ahead and make him drink some contrast"...? Can someone explain that??

[EmmaG, RN]

I've got a question...if they admitted this guy with a possible obstruction why on earth would they order the CT with oral contrast?? That doesn't make much sense, "we think he might be obstructed, and he's NPO, but lets go ahead and make him drink some contrast"...? Can someone explain that??[/quote']

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1422542

[meownsmile, BSN, RN]

There is no reason for you to feel bad. When admissions like this come in there is always going to be something left for the next shift. Thats why nursing is a 24 hour a day job.

Being more experienced i probly would have put down the NG tube and got the suction going ASAP. It would have lightened his nausea to get what was already in there out and would have made the contrast easier to put down. Yes,, i would have put the contrast down the ng for him with a toomey instead of making the poor guy drink it. That stuff is nasty enough and with you being able to control how much was put down at a time he may have been able to avoid doing any more vomiting. Plus,, you could have connected him immediately on his return from xray and gotten what was left out of there and decompress the bowel. Now when the tube is put down,, whoever is doing it is going to get a red contrast bath when the tube gags him. This is just my rational,, but again i say dont feel bad about your decisions, its all a matter of how you view the whole situation. As you get more experienced you will be able to better rationalize and prioritize order of what you are doing.

And to Idontcodger,,, nothing better for clearing a possible fecal obstruction than a big old liter of CT contrast. OK,, maybe a bit extreme but if its ordered for a CT to dx a problem, it sure will rule one out if nothing else. If the bowel obstruction is of unknown origin,, they at least know the bowel is clear of any impactions while they look for a ileus or other problem. If the contrast doesnt go through,, it will be pulled out by the suction on the NG following the scan.

[TazziRN, RN]

Since he had already take the contrast, not dropping the tube was the right thing to do, and that LVN needs a slap upside the haid.

However, given that he was in with an SBO, he should have had the tube dropped in the ER, or as soon as he arrived on the floor, and the contrast should have been instilled via NG.

[Jo Dirt]

That ^%&*y nurse needs to get off her high horse and get over herself. Tell her in the amount of time she spent griping and whining she could have had it done.

I can't stand people like that.

[KR]

I would have dropped the NGT, hooked it up to suction for a little while, and then put the contrast down the NGT (and NOT hook the suction up until after the pt got back from CT). Although I will say that ideally it should have been dropped in the ER. If for some reason the patient was given the contrast, I would not drop the NGT until after the CT was done. I would not feel bad though, like others have said it is nursing judgement, different nurses think differently, and also their is a learning curve with it as well.