What part of pt care gets overlooked most often

Nurses General Nursing

Published

Ive noticed oral care.

Last night I went in to check on a patient I heard moaning (not my patient, but was concerned). She was half in bed/half out, O2 off her face (sat 72), slumped in bed, leg stuck between mattress and siderail and hanging off bed. I straightened her up and was putting her O2 back on her face when I noticed her mouth looked awful. After her sats went back up, I did oral care over and over and over to remove the gunk in her mouth. I pulled out this huge CHUNK of stuff that was like hard plastic approximately 5 cm in size! She had thick slime all over her gums and her lips were cracked. That gets overlooked at our hospital with about 95% patients.

Specializes in Med/Surg, Home Health.

I can honestly say that 2 nights ago I gave one of my patients a back rub. She was in with a bowel obstruction and had a colectomy and had chronic back probs. Lying in the bed so long had made her back hurt, pain meds didnt touch the pain. I applied heat packs, which didnt help. I finally eased her up in the bed and gave her a back rub with baby lotion. The look on her face was priceless. And it did help.

IV's are definitely one at our hospital too that gets overlooked, they do not get changed when they need to be. The previous nurse will say "I didnt because it looks good and has good blood return". Well, if they are a HARD stick, maybe. But not when they have veins that look like garden hoses. We are sooooo short-staffed and overworked, we honestly dont have time to do the things that need to get done. Last night, we had ONE assistant on the entire floor. How on earth was she supposed to be able to provide care to everyone. Its horrible. The ones who decide to short staff will be the ones in that bed one day and then they will see what these patients are going through. Its sad.

Specializes in Medical.

After a patient develpoed a septic IV site it's hospital-wide policy that all cannulae are changed every 72 hours, so that's not a problem here. But I have to agree with everyone else - mouth care closely followed by bowel regime. The latter is not helped by residents who write elderly patients up for a number of strong analgesics and no aperients, which I see over and over. Argh!

Specializes in Internal Medicine Unit.

Definitely oral care. Changing any tubing including feeding tubing runs a close 2nd. Usually gets done by certain nurses consistently, and not done by others consistently. Our assessment screen flags IV sites that are over 72 hours old (computerized charting). If you had to wait until after shift to finish charting, then this doesn't help, of course.:lol2:

What are the things about oral care put it so high on the list?

I know that when I was doing ICU nursing years ago, having an adequate supply of GOOD oral care supplies was a problem sometimes.

What else?

What are the things about oral care put it so high on the list?

I know that when I was doing ICU nursing years ago, having an adequate supply of GOOD oral care supplies was a problem sometimes.

What else?

Our patient care committee embarrassed management into providing sufficient numbers of the right supplies when we used the AACN Practice Alert to change our oral care policy. We had a class held just before and after each shift taught by a Clinical Nurse Specialist (CNS) from a sister hospital.

I'm going to try to attach the alert.

Specializes in brain injury,.

I see that range of motion is hugely missed on a lot of patients. oral care for sure is at the top. Actually cleaning the ears with qtips and for patients who are unable cleaning the noses. I work with brain injured people and so many have crusty noses inside. It would drive me crazy to not be able to blow my nose. Turning patients every two hours/

Specializes in ER/ ICU.

Oral care and turning patients on time. Some times on a crazy day,we pass off dressings that we couldn't get to. I forget to change IV tubing and relabeling it.

Specializes in Nursing assistant.

Oral care is the one that I have seen overlooked so often in hospitals.

There seems to be a lack of understanding that hospice or tube fed patient's mouths could be uncomfortably dry. I had a patient last week who literally opened her mouth when she say me coming. She had had no consistent oral care before I had her,and was craving the moisture. I have had three similar patients in the past few weeks, and the other aides just honestly dont seem to be aware of this need, and frankly dont have the time.

Hospitals dont seem to be as intune with comfort measure or hygenic needs. It probably is not priority, but I think that it cannot be ignored.

Nutrition is also high on the list. Very often food is put by the patient and no-one comes to help them cut or chop the food or even feed! The next idiot comes along & takes the tray away, thinking that the patient doesn't want it. Or at mealtimes, they will get a visit from the doctor/physio whoever. By the time they are done, their food has been removed. We have implemneted a few measures to overcome these issues.

1. Protected mealtimes. Everyone, visitors, doctors, the lot, are kicked out at mealtimes. No-one is allowed to enter re-enter the ward until it is over.

2. Nursing staff cannot take their own mealbreaks at these times. This allows "all hands on deck"

3. Patients who have difficulty with food are given red trays.... everyone else is yellow... so that they are easily identified

4 A probably the most important one. LEADERSHIP. Someone is designated to take control of the whole process for all patients. They have a duty to ensure visitors have left and that everyone is fed & watered by delegating as necessasry

These measures work really well for us

Excellent policy, wouldnt mind this on my unit..

oral care, bowel regimen, dirty nails, stage 1-11 ulcers from tubing behind ears or in nares....

my worst is catheter care.

90% of the time, i will note dried feces on the (female) catheter and further exploration reveals dried feces on the lady partsl area, inbetween labia.

when i've asked techs about this, they shrug their shoulders: one said "we don't go near there"....

so i do all cath care to ensure e coli isn't ascending up into their urethra.

just another statistic for a uti.

sigh.....

leslie

Specializes in Trauma, Teaching.

Hospitals dont seem to be as intune with comfort measure or hygenic needs. It probably is not priority, but I think that it cannot be ignored.

It was mostly basic hygeine that Nightengale used to cut death rates so dramatically in the Crimean War. She stressed controlling the environment as essential to nursing care. Technology is making us forget the very basics of the difference that good nursing practice can make. That, and paperwork that prevents us from getting in there to do it.

Specializes in Tele, ICU, ER.
is tops of ears where the O2 line sits.

I can't tell you how many times I've found skin breakdown in this area because no one ever looks. And it's so simple to prevent.

On this note my other pet peeve for these folks is when they're on continuous O2 sat monitoring. Please please relocate the probe every shift - I've seen some pretty grody fingers under those probes. Looks like they've been soaking it in a bathtub for 2 weeks. The excoriation can be nasty and then the adhesive on them pulls painfully on the skin when you DO take them off to change sites!

+ Add a Comment