What did I suction out of my patient?

[mandana]

Hi all - I'm new here - I'm wrapping up my second semester of an accelerated ADN program.

I've had some really interesting clinical experiences, but nothing beats this one, and I'm so curious about what this was. I had a patient with ESRD who was severely hypernatremic (167!!). He was terminal and we were waiting for transfer to a full-care hospice facility. The first day I had him, he was altered and combative but his lungs sounded good, his heart sounded good and his vitals were WNL and his sodium level was actually falling a bit. The second morning when I walked in, his lungs sounded awful, so I decided that I'd keep a real close eye on him. A bit later in the day, he started sounding like he was drowning. I have never heard the "death rattle" before, but I thought that had to be it, but I decided to suction him just on a hunch. I ended up suctioning out this large, black, hard chunk of something. Any guesses as to what it was?!?! I was very scared, and paged the RN I was assigned to into the room. She walks in, takes a look at it and says, "Man, how did you get that out?" I loved how unfazed she was by it, I was shaking like a leaf!

Thanks for the opinions, guesses.

Amanda

[lsyorke, RN]

Mucus plug. Old mucus plug.

[NebbyLPN]

You know, this happened to us a couple of years ago too. Someone told us it was probably a bezoar that had come up from the stomach. I like the idea of it being old dried mucus better, but how could it have hung around in the respiratory track for so lung. I one we got was about the size of a golf ball and it was dark brown in color.

[mandana]

Yeah, it was about the size of a golf ball, but a little oblong. I keep calling it the avocado seed. The worst part was that the suction was not strong enough to keep it on the end of the Yankauer, so it fell off into the bed, which is why I had to pick it up and how I know it was hard.

Thanks both of you!

[babynurselsa, RN]

IT is very common the way less than responsive people breath for the secretions to sit in the back of the throat and get very tenacious. They typically don't swallow much so stuff that normally would be swallowed just sits there and dries out.

Another good reason to keep HOB slightly elevated and provide frequent oral care.

[Cute_CNA, CNA]

:barf01: Ugh. Thank God there are people willing to do the gross stuff.

[geekgolightly, BSN, RN]

oh man! this happened to me as well but it was dark brown with streaks of red and green and I thought that the patient had hacked up part of his lung! He became SOA suddenly so another nurse and I were taking turns suctioning and taking vitals and all of a sudden HACK HACK PLUAHHH up comes the nastiest 3" oblong piece of ...whatever(!) I had ever seen.

:uhoh21: :barf01:

I actually cut into it I was so freaked out. All I saw was more of the same. An older nurse said "Oh yeah, mucus plug" like it was nothing. I guess eventually it will be nothing, but that day it was horrifying.

[TweetiePieRN]

The other day another nurse's patient was "choking", but still able to make small coughing noises. Large amounts of orange stringy mucus-like stuff starting slowing falling out of her mouth. It looked so disgusting...coming to find out...it was an ORANGE! We suctioned it out of her mouth/throat!

At first though, we had no idea what this mysterious substance was!

[meownsmile, BSN, RN]

Thats exactly what i was thinking tweety,, it very easily could have been food that the patient either never swallowed and had sat there at the epiglottis for an extended period, or maybe something he actually had aspirated soemtime in the past and it had just now dislodged.

Either way,whatever it was, im sure the patient felt better to have that out of his way.