Doll Head

Please help! I work for a rehab and we had this pt with us about a month ago who had a colostomy. He went for a reversal and they had some complications so they created an ileostomy. He was fine when he was d/c'd from the hospital and about the first or second day he came to us he dehisced in both places. One where the colostomy reversal attempt took place, and the other RIGHT next to his new ileostomy. So, I get into work last night to take care of him for the first time this visit, and I hear in report this awful wound, with this plan to treat his dehiscence that is anything but a solution. We're packing it with Aquacel AG, covering with gauze, and covering that with duoderm, we have to do these things first because his appliance literally goes into the wound bed vicinity. Mind you his ileostomy is leaking into his wound! Pretty much all of the time. So, we're changing the dressing, appliance, etc 4+ times a day and night therefore his skin is breaking down, his wound has BM in it most of the time and when the dehisce happened the facility sent him to the wound clinic in the hospital and they sent him back that day with this "plan" in place. I'm stressed out not only because this doesn't seem like a solution, but also because we have never gotten any formal training regarding brand new ostomy's not to mention how to manage a wound that seems like a set up for disaster. Any suggestions? I'm concerned this guy is going to go septic soon. What is the solution?

I'm a very new nurse and I have a pt who has a g tube, is non-verbal has a trach and is diabetic. Now his feeding last night was running. I checked for placement of the tube by instilling 20-30 ml of air and put my scope over his lower left epigastric area I heard the swooshing I'm never able to aspirate anything so I wasn't surprised to not have anything come back. But when I was giving him his 325 ml of water his tube popped out to the #8 FR mark. I was concerned and listened for placement again and heard it. I had a co-worker come down to confirm and so I started his feed again. At 3AM I went in to give him his water and this time during the admin his g tube came out to the #6 mark which is farther than I have ever seen it come out. I couldn't push it back in, every time I tried to pop it back in it would slide back out. I couldn't hear placement, and every time I tried to pull all of the air out of his stomach I was never meeting resistance like I had gotten it all. Also when I was flushing it with the water it was draining faster than whats usual for him. Are these all signs that it wasn't in the stomach? What do you think happened? I called the doc to hold the feed because I wasn't comfortable running it without a + placement, but I feel like I could have done things differently. Anyone have any experience with stuff like this. God Bless.

Thank you for your comment. I spoke with my supervisor today and I got a final written warning the next time I make a med mistake I'll lose my job. He wants me to come in before my shift and do what you had said which is to look at the MAR's and write all the med passes down on my report sheet. I also need to finish a task if I'm at the med cart before I engage in something else. I've started looking for another job, but I need something good to happen so I feel like I can do it. Having this ' one more med mistake and I'm out' over my head makes me feel like everyday I could lose my job.

I have been nursing for 3.5 months now and in that time I have had over 7 medication omissions, and 1 med error where I gave the a med to the wrong person. I have been counseled a couple times and I'm worried that I may be terminated soon if I can't get my act straight. I work in a LTC on the rehab unit. We can have up to 25 patients on the floor at times, but I've never had more then 19 since I've been with them. I work overnight with one aid and I am the only RN in the building, the other staff are LPN's and sometimes they can't answer my questions. When I was hired I was given three weeks of pseudo-orientation where I was working most of the time and not being trained, and my position is on weekends. Sometimes I can get an extra day in but most of the time I'm only there TWO days a week. Now my first big omission was PO vanco dosing for 10PM and I didn't give it two days in a row, and the next time I came in I didn't give it again. Thats three times in four days that I missed this order. after I was counseled I started sitting down with the MARs and doing a thorough check, or so I thought... This last big omission was for 6Am dose of valium and again three times I didn't give this med. After my review last night I finally registered it and put an incident report on my supervisors desk. I was so scared when I saw that I had missed a med this many times in a row again. I had a panic attack. We put a red dot next to the meds that the night nurse needs to pass, but somehow I passes by it 50 times without "seeing" it. The wrong pt with a med was when I was on another unit orienting. It was my second orientation day and I had the whole floor passing meds. I thought I knew a resident and gave her a bite of applesauce with metoporol in it, the pt was demented and non-verbal. The orienting nurse saw and stopped me thank god! This was my bad. I have gotten out of the habit of asking people their names and looking at their wrist bands since working here. Now I know that I needed to straighten out my act, but this last omission killed me. I'm not sure what to do? Or what to say to my supervisor? Is there no excuse for me? Between passing meds and answering call lights, helping people to bed, toileting people, answering the phone, getting meds from pharmacy, and completing treatments I feel so out of my body that when I do review the MAR I don't see things. I don't like that we have a manual system at all, and I take responsibility for what happens, but I can't help resenting the facility for the lack of support as a new nurse and lack of employee safe guards when it comes to passing meds. I also feel like everyone else is doing it right so whats wrong with me? Isn't the med pass supposed to be the "easy" part of nursing? At least I wasn't thinking that it would be one of my greatest challenges. I don't feel like a nurse. I feel like a fraud when I even tell people I'm a nurse. I want to be excited about my work, I want to be a hospice nurse and I thought I should have a bit of experience with pt care first before I did, I thought rehab nursing would be easy. Now I don't have any confidence with my work, I feel worse then I did when I was in clinicals in nursing school. Is it possible for me to get a job at a hospital with a REAL orientation if I have fudged it up so bad at this place? Can I even use this place as a reference if I've made so many mistakes? Who will hire me with this track record? I'm also worried that this anxiety and failure is going to follow me to the next place. I just moved here and I don't really have anyone to talk to please provide any advice. God Bless.