stimulating a vented patient

RN1982 · Jan 9, 2009

I tell the families that even though the patient is sedated, they can still hear. I tell them to hold their family member's hand and talk to them. Not yell, talk. I recently had an elderly patient who was intubated after an assault and I had the family tell her that she was safe and that the person who hurt her could no longer do so.

On the other hand, I get annoyed when family members stimulate patients who shouldn't be stimulated even after educating them about not stimulating. I've resorted to the "Look, if you keep stimulating your relative like that, the pressure in their brain will increase and they could die." It works 97% of the time. I've also had family members flash the flashlight we have in each room in the patient's eyes. I end up confiscating it.

Anyhow, sorry to hijack.

JeanettePNP, MSN, RN, NP · Jan 9, 2009

No, that's not a hijack. That's useful information. What, people actually flash a flashlight into a vented patient's eyes? What goes through people's minds? If something wouldn't be comfortable for them, why on earth do they think a vented patient would be comfortable with it? When I said stimulation, I meant calm, gentle things they can do to keep the patient from vegetating, not rough noisy things to shake them up.

RN1982 · Jan 9, 2009

LOL. It makes you wonder. They didn't even know what the purpose of me flashing the light in the patient's eyes meant. I guess they figured if I could do it they could do it. I took the flashlight out of the room and that ended that problem.

On a side note, my little old lady that was assaulted was extubated last week and is recovering. Usually I tell families to go home, get rest but her family, I couldn't tell them to go home, I didn't have the heart to and they were all very upset. They stayed every night in the waiting room and called my from there to see if it was ok to come and see her. God bless families like that.

JeanettePNP, MSN, RN, NP · Jan 9, 2009

I'm thinking of my uncle. He doesn't get enough visitors, even though there is a large extended family, and a large part of the reason is that people just don't know what to do when they go. I am working on compiling a list of suggestions and wanted to hear what ideas the smart nurses here can offer.

MisterSimba, BSN · Jan 9, 2009

What about reading to him? Does he like poetry? Is he a fan of any particular author? Maybe the visitor could read him a chapter of a favorite book each time they go see him.

Also, what about applying lotion to his hands, brushing his hair, etc? Many very sick patients find this to be soothing.

JeanettePNP, MSN, RN, NP · Jan 9, 2009

Reading aloud is on the list.

Lotion and hair brushing. Good suggestions.

Keep 'em coming!

oncnursemsn · Jan 9, 2009

Hi- ChayaN,

Good question. Working on adult Bone marrow transplant unit- our patients do get transferred to MICU. I admit "stimulate" is hard for me. They are so tired and suffering and in resp distress.

I encourage verbally comforting- "we love you and will miss you and you can rest now."

"We care so much for you and want you to end your suffering."

I'm sorry. Most of our patients do die but we want them to have peace.

Aside from that- back rubs. Hmm? Where'd that come from ? I encourage back rubs, arm rubs, leg rugs and hugging from the husband who will lose his wife.

Love the 21st century but have not forgotten physical touch. I will not forget the wife who stayed in bed with Henry. All day long she stayed with him and comforted him. They were married over 40 years. He died after a few weeks in in-patient hospice. We supported her, gave her privacy. Who knows what they did in his final weeks/days? NOT my business.

Only reason I can do this is that we as cancer nurses can make a difference.

You only get 1 shot to get it right.

JeanettePNP, MSN, RN, NP · Jan 9, 2009

Thanks Oncnurse. Maybe "stimulating" is the wrong word to use. I just see him lying there day after day, nothing to look at, nothing to do, barely able to move but still conscious. I just want to stimulate his senses, give him a sense of still being human, of having a connection to this world.

We still have hopes of him coming back to himself... He doesn't have one big thing that will kill him, it's just the combination of things and the complications on top of complications... :'(.

callmekipling · Jan 9, 2009

Books. Books on tape. Jazz music, if he's a classy bloke find stuff from his era. Tell him about your life. Babble endlessly. Tell him about his family, if they won't come. The same sorts of conversations you'd (hopefully) have, now you keep up both sides of.

You will feel like a lunatic. Worse, you'll feel like nothing's there to hear you and you're merely deluding yourself. Almost everyone who does what you're doing gets the feeling. If it helps, shut the curtain.

Personally, I will sing to vented/dying pts, but i've already got a rep for having a screw loose.

JeanettePNP, MSN, RN, NP · Jan 9, 2009

LOL at having a screw loose! Yeah, it does feel awkward to keep a one-sided conversation going, especially since I'm not a very talkative person in the best of times. But I think it's worth it.

Dealing with vented/aware patients is much different than vented/unaware patients. On the one hand it's more tragic becauase they can feel everything that their body is being put through. On the other hand there's still someone home and you get response, either through eye tracking or grunts or even that faint grimace of a smile.

Over-the-hill-Nurse · Jan 9, 2009

Personally, I talk to my vent patients when they are awake, I talk about the news, the weather, about fashion, about music, books, whatever may interest them. If you know what he was like when he was active and what he liked to do, talk about those things, about family, if he had pets, talk about the pets, talk about what he did for a living.

I also use physical touch, holding the hand, brushing the hair, anything that would just give them the feeling that someone cares about them.

Just being there and visiting when you can is a lot. I applaude you for doing that for your Uncle. So many times you see patients initially have a lot of visitors but when the condition becomes a more permanent part of their lives, people stop visiting.

Bring familiar things into his room that he knows, like a favorite blanket, a favorite picture, anything that will remind him of home.

And just simply let him know that you love him, and enjoy spending time with him. Sometimes words and actions are not needing. Just sitting and holding his hand and watching tv with him is enough. He knows that you are there. He just can't tell you that physically.

Even patients who are sedated, I still talk to them. I tell them who I am, what I am going to do, and give them as much reassurance as I can to make them more comfortable. I squeeze their hand, put lotion on their legs, arms, brush their hair, etc. I let them know that visitors came to see them. I don't try to stimulate them alot but sometimes just a simple qesture does wonders.