7nurse

Thanks to everyone for the reply's I've stopped beating on myself for now and am questioning the Wisdom of The MD. Please see my post on gastroenterology forum.(would paste it here but my web tv doesn't do that function)

Scenario: 88 year old female who's g-tube was out approx. 14 hours goes to ER. to have tube reinserted. Has had tube for 5+ years after throat cancer operation and radiation. In ER it was found that new tube would not go in due to stoma closure. Taken to op. room to put tube in. Found that scope would not pass through narrowed esophagus (due to radiation scarring) Patient goes into breathing distress,and flash pulmonary edma (almost requiring vent in icu. Tube put in under local anasthesia, and small incision at site, (without scope) 3 days later patient about to be dc,d after 8 days Will need rehab. to recover her post hospital functions. ( idependant, living alone) WHY: was scope method tried on a throat cancer patient with a radiation history (pt's voice is weak ,an indication of problems in the throat area,) also reading her chart and noting radiation to that area could have been a flag to expect trouble with passing a scope, AS:all her problems stem from her reaction to the trauma of the scope procedure.Why did this happen? Could this problem been avoided by the MD's alertness to this set of circumstances set in motion? IN : the future would the non-scope method of insertion be indicated for this type of patient? Does lack of experience on the MD's part account for the decison made and it's negative concequenses for the patient? Is this what medical "practice" means.

Last Sunday afternoon my mother who is 88 and lives alone,alert oriented,feeds self by g-tube,npo,post throat cancer,radiation, She called me and said her tube came out. (has had tube for about 5 years) I found she had taken all meds for the day. Had one bolus of 12oz. left to feed for the day. I--We decided to call the dr. in Am and have it put back in. To make what could have been a short story long..... she is still in hospital.had flash pulmonary edema from the g-enterolgist trying to get the scope down her esophages which was to narrow due to the cancer radiation took a couple of days to get edema stable(almost went on a vent) about day 3 the tube is inserted surgaclly with a small incision (no scope.. local anathesia) Ad iv's,x-rays,foleys,blood tests.,,,and the effect of everything on her health and you got me ...one disgusted nurse? who would resign today and work anywhere else if the money wasn;t a factor The moral of this sad story is... the stoma closes within 6 hours.....I should have,I could have, I would have.. dc sometime tommorow....8 days of hell and rehab at home for who knows, to get her back to that Sunday afternoon when my asumption that we had until "tommorow" to get the tube back in....

A Question: How soon before a g-tube must be reinserted? Or if it comes out on vacation (balloon breaks) what do you do? My personal story to follow..............

Thanks for both replys: I guess some of my problem is feeling guilty for not being able to do more on a personal basis for the residents, without running to te next task when I see a quality of life issue that I should atend to in the room I'm in. (for example, making sure they have everything attended to, They need pulled up in bed to be more comfortable,(which can be very important to the resident) DO I run up and down to find help,being stopped along the way with more requests and tasks.or do I stragetically let it "slip my mind" to attend to other agendas. To me it seems like a juggling act to please everyone and all the while having the pressure of write ups for infractions commited... which are many that management has to use whenever they want to Lori your ot for paperwork sounds good, But I have the same aversion to ot as I do to missing scheduled breaks and lunch. and btw, you hate needles ...I hate germs Carry on......

Surmised by lack of replies: 1.You don't take "shortcuts" 2. You are a by the "book" nurse, who has no time for breaks, lunch,or replying to this query

CURIOUS... to know how many nurses take "shortcuts" Not going strictly "by the book" in order to put in your shift,without shortcutting your own sanity. Keeping locks locked, charts charted, tx's completed, supplements passed, Myself, I cant do all by the Book.. Is this where Nursing Judgement covers, lack of time to get to the lower priorities? "First do no Harm" How do you rationalize a less than "perfect" completion of your many tasks? thanks for your time