Nursing Concerns/Advice

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Specializes in Geriatrics, Pediatrics, Home Health.

I am working HH and desperately need some advice. I care for a 19 y/o male pt. He has a G-Tube and a Trache. He is not on a vent and is mobile. I care for 2 other pts with g-tubes. Neither of them has the problems the 1st pt has. He is constantly getting pneumonia.

Here is the problem:

I was caring for one pt and was thinking about the 19 y/o. Comparing the similarities, ie G-Tube, resp fail, etc.

It hit me like a ton of bricks. I almost puked when I realized why he was getting pneumonia constantly. Since Dec. he has had pneumonia no less than 6x. He spent a week at Riley Hospital. He came off the atb last week and this week Monday he had a fever. Tuesday he was dx with pneumonia again!!!

When I took over the case in Dec. the nurse before me had him lay down to give his bolus feedings. I was concerned about that given that he has a G-tube. I had him sit up to feed him. He has 1000 ml of feeding running at noc while he is sleeping. I have put him to bed and hooked the feeding up to the pump and his g-tube and let it run.

Here is the problem: HE IS NOT ELEVATED!! He sleeps on his side and has an almost flat pilow under his head. I immediately called his Mom and explained that he needed to be elevated at least 30 degrees while he was eating. She took my concerns to his dr. and the dr pretty much laughed and said good luck trying to keep him elevated!!! :angryfire

I took my concerns to my boss and asked if I needed to write an incident report. She looked at me like I was crazy and said the family had been doing this for years. Therefore, I wasn't responsible for the pneumonia. :angryfire

I don't feel like I am being a good advocate. Do I need to talk to the dr? I honestly believe that if we could get him elevated he wouldn't get pneumonia as often.

Please give me advice. Am I rght to be concerned? Am I wrong for not writing up a report?

Thanks!!

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uh....nsg 101...hob up w/fdgs.

yes, it definitely sounds like he's aspirating.

he needs a hospital bed.

and yes, i would fill out the report.

it may just be the first of many documents you will need, in order to support your findings.

good Lord.

leslie

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uh....nsg 101...hob up w/fdgs.

yes, it definitely sounds like he's aspirating.

he needs a hospital bed.

and yes, i would fill out the report.

it may just be the first of many documents you will need, in order to support your findings.

good Lord.

leslie

If no one wants to spring for a hospital bed, at least one of those "over the counter" big foam wedges designed to elevate the upper body in a regular bed ... Yeesh!

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If the pt refuses to be up, not much you can do except document the dickens out of it. Document the conversations with the doc, the mom, and the pt if he's at all with it.

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Specializes in Geriatrics, Pediatrics, Home Health.
If the pt refuses to be up, not much you can do except document the dickens out of it. Document the conversations with the doc, the mom, and the pt if he's at all with it.

He can't talk and may have the reasoning ability of a 3 y/o.

I found this site and copied the picture and info for her, but I can't make her order it. I wish I had the $$$ to buy it.

http://www.acidrefluxpillow.com/PTPDesign/toddler.html

He stands about 3'9" and his legs are crossed most of the time. He weights about 70 lbs. He can't walk but can scoot on his butt.

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Specializes in Pediatrics.

Head must, and MUST be elevated while the feeding is running. I have infants that refuse to stay up on a boppy or anything that keeps their heads elevated and I put them up in their wheel chairs. Like someone else mentioned, he needs a hospital bed and needs to hit that thirty degrees.

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Specializes in Jack of all trades, and still learning.

The fact is, you are right. I can't believe your supervisors attitude! Yep, document, and continue to advocate...

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Specializes in ED, ICU, PSYCH, PP, CEN.

Suggest a thirty day trial of doing it your way and see if pneumonia episodes decrease. If they do you have a strong case to push for elevation on a continuous basis.

You can only do so much, but documenting is important

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Suggest a thirty day trial of doing it your way and see if pneumonia episodes decrease. If they do you have a strong case to push for elevation on a continuous basis.

You can only do so much, but documenting is important

:yeahthat::yelclap:

Also, you need to teach, teach, and teach again. You need to document your efforts religiously, maybe every single day, to protect yourself. You must talk again with the supervisor and personally with the doctor and record everything. And get an Incident Report to Risk Management, DON, Admin. Even if nothing changes, you will have a clear conscience and, I would think, be free of legal complications, should anyone ever talk to a lawyer. I think it would be good for YOU to get a lawyer's advice as to what all you should or should not do if your boss is being a dunce and not recognizing the need to make this happen.

Is there an alternative to running a litre in at night? Can this be given in smaller amounts over longer periods when the patient is OOB and upright? Is he ever upright?

Is there a Social Worker who could help get better equipment for this poor child and his overwhelmed family?

What do you think it would take to prop him up? Is he in pain when propped up?

You are a great nurse. I think you will find a way to get this done. Or at least protect yourself.

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