I'm sorry this is very long but please bear with me...
I was sent out recently to do an admission for HH on a young man who was paraplegic from a car accident. He had orders for catheter care/change and wound care three times weekly.
I went out and changed his catheter and noticed a small amount of blood on the catheter when I pulled it out. The caregiver (his SO) said the catheter hadn't been changed in well over a month and this happened when he went too long between catheter changes, since I didn't notice any further bleeding I just made note of it and went on about my business. She also mentioned he had a fever the previous night but when I checked him he was afebrile.
When I mentioned the dressing changes the cg said they only do wet to dry gauze and that it is a major deal to change the dressings, which she had been doing every three days. She said he would have to put his O2 on for about 45 minutes...at her request to wait until the wound care nurse would come out to help the next day I did not pursue the matter.
When the wound care nurse came out the next day she was horrified to see the decubitus ulcer on this man's lower back and buttocks. He is a big guy and the wound was the size of two large hands, you could easily fit a whole roll of kerlix in the wound with plenty of room left. But what was very disturbing was when she noticed the deep tissue involvement and saw what looked like a rubber tube with a bulb on the end; the bedsore had eaten its way through the intestines and bladder, what she was actually seeing was the catheter and bulb inside his bladder. She told the couple she was going to be frank with them and that he was going to go septic and die soon if he didn't get to the hospital. So they called the ambulance. This was several days ago. We got news from the hospital today that he is in ICU with plans to be sent home under hospice care.
This is so sad, because I remember how the three of us really clicked--we were laughing and cutting up like old friends when I did the admission and I was looking forward to coming out for visits. Now to find out the guy is dying is hard. I even think I'm in some denial...I'm thinking maybe... and if they can just...even though intellectually I know this man is seeing his final days emotionally I don't want to accept it.
How would you approach this situation? What do you do and say as a hospice nurse when you go out for the first visit? The guy was so bright and still full of life and I know he and his SO are taking this hard.
