Sunday, February 23, 2014

Getting back on the horse

I went back to work. First day wasn't too bad. A LOT of new orders.

I have a patient with Ogilvie syndrome - it's like uber megacolon - the colon is SUPER dilated but there's no mechanical obstruction. My pt got a NG and rectal tube - he's full of air on both ends. When the surgeon was putting the rectal tube in the pt started belching majorly and passing excessive amounts of gas. And the NG was hooked up to suction - then the Dr came in today and decided to run PegLyte (bowel prep medication) but didn't write an order to stop the suction. So of course I had to call him for that. Which of course I got the order. But this guy also has an IV running and a foley so we have to watch the IN&OUT... which when I added it up during shift change he was sitting at a fluid EXCESS of +400mL. I notified the Dr of this and he wasn't concerned about this AT ALL - except that in my opinion it was only going to get worse because this guy's clearance was <30cc/hr and we're running his IV at 100 which means his fluid excess would just get higher and higher. Dr said that until his scrotum became the sizes of watermelon not to notify him of the fluid excess. He asked me what I wanted him to do - I said some Lasix would be nice. Shot me down on that one - said that his kidney function was already going kaput so that wouldn't really help. I asked HIM what we were doing for this guy then - why have the IV if you aren't going to do anything about the excess. I was told that he wants him to be a DNR but that family won't approve - that they are living in a fantasy world of denial and think that he can improve...

Let me paint this picture for you about this guy -

* Bilateral stroke (rare and very detrimental)
* Obese
* Diabetic
* 2 previous MI
* Blind (due to the diabetes)
* and this bowel issue
Now, if I ever had a family  member with this sort of picture - hello DNR! But they just don't get it - no matter how many Dr's talk to them - even our best palliative doctor. I hope this guy codes on someone else's shift and not mine!

1 comment:

  1. Very sad. :( This is why I don't think I could ever be a nurse. I am not squeamish but emotionally I would be a disaster.