preceptor and i disagree on a case.

[Jassynurse]

I am now doing clinical at our local children's hospital and i am assigned to a patient who has a repaired omphalocele(completely healed) this 3 year old has been admitted for observation. I was doing assessment with my preceptor and she said that because of the omphalocele, the patient has no bowel sounds. I auscultated his abdomen and i heard bowel tones, of course you have to listen a little bit longer otherwise you might come to the conclusion that there aren't any bowel sounds. She insisted that he has "no bowel times because his insides are all mixed up." I told her i heard bowel tones and of course it is most prominent in the midsection because that's were the sac is after the repair. The pt has a G-J tube and received tube feedings into his J for 23 hours a day and is being introduced to g-tube feeding by bolus twice daily. I was thinking ok, the pt is receiving feeding into his bowel so obviously he has peristalsis and movement there otherwise he'd have an obstruction or milk would be backing up and he'd regurgitate. and he is having normal output. How could you say that he absolutely has no bowel tones?? what do you guys think??? its really bothering me.

[cayenne06, MSN, CNM]

I am not a pediatric nurse but I can't imagine there wouldn't be bowel sounds if the patient had a functioning GI tract. But I could be wrong. I've definitely worked with preceptors who said...um..questionable things. I remember being told that peritoneal dialysis was performed by first inserting a "bag" into the patient's abdomen. Because otherwise the dialyzing fluid would leak into their legs. Sigh.

[chare]

First, it's your assessment. If you chart your own assessment and your preceptor either cosigns your note or writes their own, chart what you found. If your preceptor disagrees with your assessment, they can change t as they see fit.

If you and your preceptor discuss your findings, and then he or she charts the assessment, there's not much you can do.

Regarding not having bowel sounds because the patient had an omphalacele; let's just say I'm not sure how he or she came to this conclusion.

[caliotter3]

You heard BS, you heard BS. She did not hear BS, she did not hear BS. Each person is responsible for their own assessment and what they document about that assessment.

[NicuGal, MSN, RN]

Of course this child has bowel sounds. She has all her insides, they may be a bit boogled around but she has intestines.

I would chart hart what I heard. I am sure other people have charted positive BS. No bowel sounds is a huge problem.

i've heard preceptors in my own unit say some off the wall things.

[nurseprnRN, BSN, RN]

It goes in the top and comes out the bottom? There are bowel sounds.

[NicuGal, MSN, RN]

And there really is no

sac after the repair, The gut was up in the cord, the gut is pushed back in and it kind of drifts back down in the abdominal cavity. This child must have had a sizable defect to need a feeding tube put in.

[Ruby Vee, BSN]

If you're going to disagree with the preceptor make very, very sure it's a hill you want to die on.

[cayenne06, MSN, CNM]

You can disagree with a preceptor without making it a hill to die on. I've done it on more than a few occasions. If we still disagree after a discussion about the rationale/pathophys/whatever, I usually say something like "My understanding was xyz, based on this, that, and this other thing. I will review the information and make sure I have a clear understanding before my next clinical shift." Maybe I'll ask if my preceptor has any suggestions for references.

And then I do, indeed, review the information and come back to my preceptor with my findings. Sometimes they are right and I learn something new, and sometimes they are wrong and I get to practice my professional communication skills :) I've never had a problem with this.

But it is true- sometimes it's not worth it and I just let it go.

[morte, LPN, LVN]

It goes in the top and comes out the bottom? There are bowel sounds.

Love this answer, as usual Grn, straight to the point.