treecy

As it turned out, she was extubated and didn't need any tube. My point with the nurse was that she was AAO and cooperative. No restraints. The answer that she "never heard of that" concerned me. I understand your rationale that a patient may bite it, much as they do ET tubes. I also asked the nurse about using a Dobbhoff which, as you know is much smaller, but she kind of blew me off. I was just curious what happened at other facilities. I have done agency in places where they only use dobbhoffs for feeding and NGs for decompression. Generally, when we use OGs they are D/C'd when extubated and if there are nutrition issues we insert a dobbhoff.

Does your hospital have a protocol re: NGT vs OGT? In my hospital we routinely insert OGTs in orally intubated patients even if they are sedated. My mother was recently hospitalized and intubated. She lives far from me and when I arrived she was awake, calm, using yankour(sp?),etc. Her nurse told me they were going to insert an NGT for nutrition. I asked her to insert it orally since Mom was awake and didn't need trauma to nasal cavity. Nurse refused stating she had never heard of that. Finally called Sup. and Doc to get permission. Any thoughts?

I previously worked on an angioplasty unit that initially had the angioplasty fellows pull sheaths and then the RN's were trained. Our patients were admitted to us pre op and given plavix 300mg and ASA pre plasty and were on reopro, aggrestat or integrellin post plasty. We used C Clamps or manual pressure with the smaller sheaths. Femstops were available but noone used them. The Clin Spec and Nurse Mgr did trend the first 6 mos of RN pulls vs MD pulls and the RNs had fewer hematomas, pseudos and decreased discomfort of patients. Although I believe that many pseudos are caused by insertion not by removal. Maybe yoour mgr. could do some trending but it seems your unit just hit a bad row, these things happen. I wish I could find another job like the one I had.Ratio was 3-4:1, usually 3. Staff worked well together. Mgr. pitched in and was very accomodating with time off requests and because she was so accomodating we never had to use agency or pull from other floors. The unit generally closed on Saturday evening since most patients went home so we worked every other Saturday instead of everyother weekend. We all juggled our schedules to cover which rarely necessitated overtime and it worked.UNTIL......Administration decided we were only a Tele unit and increased our ratio to 5-6:1. So we would get 4 plastys and 2 caths or ICD/PM implants. Mind you we did all the admission paperwork and many times the pre procedure phlebotomy. Then we had the luxury of floating to ICU or CCU on Sundays when our unit was closed. Oh, and because we worked our Sundays we worked one less weekday so we then would get Agency or nurses pulled from other units for staffing. It became so difficult and scary I had to quit. Boy did I get off on a tangent. Sorry.

Oooow, I feel for your hubby. I had mine surgically removed (after several flair ups and I&Ds). After packing and applying 4x4s I used to abd pads and then used a sanitary napkin belt under my underwear and didn't need tape. Mind you this was 25 years ago. I don't know if they still make sanitary napkin belts but I'm sure the thong type underwear should work. Percocet controlled my pain, actually I think it was Percodan. Luckily I have had no further problems. Hope it is the same for your hubby.

Karo, what happened to you is so typical of nursing. Everyone's shortcoming is nursing's responsibility. You documented the elevated k+, called the MD, documented that and although you didn't say, I presume that you endorsed that to the next shift. What else could you do? An order for xray is entered. Radiology doesn't do the xray in a timely manner and that too is your fault. Management places these burdens on our shoulders. The supv. that said you should have contacted her about the xray is full of it. She probably wouldn't have been any help, but for the family conplaining. And who says the complaint was about you. It was about xray, and she decided it was your fault. The manager doesn't want you on the floor? Tell her you agree 100%, your nursing expertise can be utilized elsewhere.

At this point I can't imagine working staff. I love being able to make my own schedule. No weekend, shift rotation or holiday requirements. No charge duties or precepting. No hospital politics or mandatory meetings. AND much, much better pay. the holidays are coming and I don't have to worry about what holiday I'll have to work. Being a single parent I was intially concerned about being cancelled, but that hasn't been a problem. I've been able to buy a house and save more for retirement. There are some down sides. Sometimes you get the heaviest assignment, but if a place is really bad you don't have to go back. So... I try to never say never, but I just can't imagine taking a staff position again.

I worked on a 20 bed interventional unit (PTCA, Cath, ICD?PM, TEE, Cardioversion). We did the admission assessment, pre labs, sent for procedure, rec'd. post procedure with reopro, integrillen, aggrestat, dopamine, ntg.,dobutamine, lido, cardizem, milrinone, any drip except nipride and levophed. 99% of plastys and caths returned with sheaths, which we pulled and used c-clamp. There were hard wire monitors at each bedside. There was one aide who for the most part was useless. When meal trays came, she went to break. When I started on that unit the ratio was 3:1. Charge nurse had no patients but was available to accompany you for sheath pulls she also had to constantly juggle beds. The work was busy but we worked well together and helped each other and got everything done. Did I mention that we did all our own phlebotomy. Well administration felt that we could domore and increased our ratio to 4:1 and then to 5:1. That was a totally impossible work load. Pulling sheaths require your undivided attention until you get the clamp off. Well needless to say, I don't work there anymore, just too scary.