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?
i could see dropping the tube first, but remember, they didnt have the sz ordered, had to wait for it to arrive....meanwhile pt drank contrast, so now we dnt want to gag the poor guy, and wear the contrast, only to have to instill more......
Well it turned out that the guy refused the NG tube. He wouldn't let 3rd shift put it down.. CT showed that he had perforated!!! And he went straight to the OR and then to ICU.... I went home with a bad feeling.. I knew that man was sick. When I came in this morning the first thing i did was check to see if he was still there. And he wasn't.. so anyways i hope everything turns out okay for the guy!
Specializes in Ortho/Neuro...now, Oncology Research.
Poor guy..they should've obtained the CT down in ED to rule out..and if he had already perforated, you'd think the MD wouldn't have heard bowel sounds, he'd be stiff as a board, and in excruciating pain. But I guess that's in a perfect world.
Bowel perfs are scary scary things. They can kill you in a heartbeat. It has been a while since I dealt with any but man, that's something you don't forget. As for the nurse's attitude, don't let it worry you.
You didn't harm the patient, and dropping an NG is not like performing a 2-hour dressing change. The pp who said that in the time the other nurse spent complaining about it she could've had it done is right.
Yeah, it's scary. I perf'ed, and the ED doc diagnosed me as having LLL pneumonia. Never mind that I was bent over, couldn't raise my left foot off the floor, had all the signs of an acute abdomen, and I had actually felt it when it perforated. At least I got admitted, and when the doc covering for mine came in to do the admit physical, (while I was getting a neb LOL) he tapped me on my left flank. I came up out of the bed, and he said "I think you have left pyelo." I told him that was all well and good, except I don't have a left kidney. That got his attention.
Straight to CT with me ... a good 18 hours after I'd popped.
he tapped me on my left flank. I came up out of the bed, and he said "I think you have left pyelo." I told him that was all well and good, except I don't have a left kidney. That got his attention.
I have to deal with this frequently on my floor. I'm new, I don't know everything, I don't always do things exactly how the next shift wants and sometimes I forget stuff. Every morning I brace myself when the next shift shows up because I know I'm gonna get a lot of eye rolling and big sighs during report. Frustrating.
I just let it all roll off my back (hard to do!), go home and sleep it off. You did your best and that's all you can do.
morte, LPN, LVN
7,015 Posts
i could see dropping the tube first, but remember, they didnt have the sz ordered, had to wait for it to arrive....meanwhile pt drank contrast, so now we dnt want to gag the poor guy, and wear the contrast, only to have to instill more......