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Just realized today that I can't stand ostomy appliances. It's not the poop, it's just cutting and sizing the appliance and that messy paste. Tedious and irritating but somebody's gotta do it.
How about you?
Accessing ports. I haaaate it and will pawn that task off ASAP if possible. I've no idea why, I guess because I am so used to peripheral IV access that it's foreign to me. I will actually try to do a peripheral stick on a pt with a port before I try to access the port. I would take a fecal disinpaction before I would a port, and that is saying A LOT.
When I worked nights I always hated travelling for HCTs. It would put me SO far behind to get packed up, getting the CT itself, and then making the pt presentable. All those lines and wires get SO tangled, esp. if the pt has an EVD, an art line, and CVP setup. Because then you have not only lines but the pressure bags/EVD canister etc. (Scheduled HCTs are done around 0500.)
YES!! I hate having to travel with my patient. Even if it's a quick and easy CT head (takes less than 20 min to get there and back). Don't even get me started on MRI and IR. Having to leave the unit to get anything besides food/coffee makes me want to die.
I swear the following is true.After one particularly difficult disimpaction the patient shuddered and proclaimed, "I feel so giddy!" I was thinking they do not pay me enough for that kind of service..
This reminded me of my Hospice patient who played around with her pain meds, ignored her bowel program and flat out lied to me regarding the amount of BM she was having. She also refused to let me do rectal exams.
Got a call from the office on a Monday morning to see her for severe constipation. Really. I get there, she's in agony. She's so impacted her orifice is dilated and stool is protruding.
I give her some Roxanol, get gloves and Surgilube, and start digging for gold. After I dug out this huge, hellish amount of rock hard stool, she said, "Two things: One, I will never lie to you again. Two, I refuse to believe that gay men actually like having stuff put there!"
This reminded me of my Hospice patient who played around with her pain meds, ignored her bowel program and flat out lied to me regarding the amount of BM she was having. She also refused to let me do rectal exams.Got a call from the office on a Monday morning to see her for severe constipation. Really. I get there, she's in agony. She's so impacted her orifice is dilated and stool is protruding.
I give her some Roxanol, get gloves and Surgilube, and start digging for gold. After I dug out this huge, hellish amount of rock hard stool, she said, "Two things: One, I will never lie to you again. Two, I refuse to believe that gay men actually like having stuff put there!"
Forgive my naivety, I didn't realize hospice pts had regular rectal exams. Is it because of the large amount of pain meds they're on?
Forgive my naivety, I didn't realize hospice pts had regular rectal exams. Is it because of the large amount of pain meds they're on?
Bowel protocol is huge due to the pain medication. And yes, if someone hasn't had a BM in a certain amount of days and your protocol isn't working (stool softeners, laxatives, suppositories, Mg. Citrate, MOM, etc.) then an enema is advised which entails a rectal exam first.
I do have patients who refuse enemas and rectal exams. One out of shyness and I gave him suppositories to place himself as he is able to do so and it worked. Other people can't do it themselves. It is a challenge to keep a person's bowels healthy and moving.
Edited to add - I just remembered a recent patient who'd become used to having a BM only by enema. She'd done it for years. She refused to allow the nurses to give her an enema and could handle doing it herself until the last few days of life.
ToyaB
79 Posts
Uh, yes! I had a woman who had just delivered using the bed pan and when I went to get the thing out, I came so close to being splashed with bloody urine that I yelped! I always have trouble with that. God forbid, one day it's going to happen. I'm going to start wearing mask and goggles when I take them off. LOL!