Question for hospital Nurses

Discussion in 'Community Board' started by JoiseyMom, Jan 5, 2013.

  1. The Mystery Machine

    The Mystery Machine Sunrise at my house. :+)

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    I am not a nurse but since you say this is for a broken hip, then a foley would be something that is necessary.

    I am not sure why you are fighting it. Adult diapers would not be a good choice at all.

    My dh just had a triple bypass and while he was not thrilled getting the foley, it had to be done.
     
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  3. MomRN

    MomRN DIS Veteran

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    This is right up my alley since I work on a specialized unit that includes ortho and urology.

    We have had broken hips refuse a foley before. Those are usually alert and oriented men who can use a urinal. No one that has a broken hip wants to be put on a bed pan or be changed due to incontinence.

    She was likely screaming in pain due to the hip and the positioning required to get the the foley inserted. Adequate pain control was not established the first and second time. I assume when pain was controlled it was easier on both staff and the patient to have the foley inserted. Quite possibly there was an opportunity, and while maybe they should have called your husband, the nurses deciced to take the opportunity to get the procedure done that really did need done in her case. Maybe they misinterpreted your husbands "no foley" to "no foley right now."

    BTW- our assisted nursing care manager isn't our best at anchoring a foley. That honor belongs to a LPN that has been a bedside nurse for 15 years. On that note, since we are a urology floor, we get calls all the time from other floors to insert a foley because we have specialized training and can use different meds (lidocaine) and tools (in the insertion of larger catheters).

    Not all nurses are great. There are some bad seeds that are way pass burned out but can't afford to retire. I know, I work with some of them. I don't know if your grandma-in-law had one of those nurses, or someone who was having a bad day, or it was a big miscommunication, but I'm sorry that you have to deal with this. The statistics do not fair well for someone her age with a broken hip. Remember a DNR is not comfort measures, and that there may need to be that consideration at some point in time.
     
  4. Sadie22

    Sadie22 DIS Veteran

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    Unless the legal documents state that FIlL can designate someone other himself to make decisions about care, that's probably not something he can do legally. That's why normally there would be more than one powerholder designated, so the first one could go on vacation or if the first one were ill or had passed away, the next would take over. The designated powerholder cannot just say I don't want to do this, I appoint someone else, unless the documents give him that power and he puts it in writing in proper form. If the hospital staff has no documents with the name of FIL's son, OP's DH, on them, legally they are not required to follow his suggestions. He may have already burned some bridges if he used a demanding demeanor and tried to act against the best interests of the patient and keep staff members from doing their jobs to care for this patient. They know what they need to do and OP's DH does not.

    It's hard to watch some procedures, but as disfan07 and others have stated so well, some things are for the comfort care of the patient. The staff is there to act in the best interests of the patient. Everyone needs to be on the same team.
     
  5. meeshi

    meeshi <font color=green>Partial to finger toes<br><font

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    OP I just want to send you a hug.:hug:

    I can relate, my 92 yo MIL fell and broke her hip the day after Christmas and has been in the hospital since. She went through surgery with flying colors and is now getting rehab and should be back "home" by the end of the week.

    She does have dementia and it's been difficult seeing her upset over certain things. But we also know that there are things that may not be pleasant but had/have to be done.

    The hospital should have a copy of her DNR, I know they wouldn't do surgery on my MIL until they had a copy of hers.
     
  6. npmommie

    npmommie <font color=red>Channels George Michael in her car

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    agree with the quoted.
    she needs the foley for her comfort as well as being pre op for the surgery. they need to keep accurate i&o for her.
    I am also sorry your dh encountered someone not so nice. but it really is in the best interests of his grandmother to have the foley.
    and I also agree about the legality. they need to have the papers in place for your dh to legally be able to make decisions for his grandmother.
     
  7. Disney  Doll

    Disney Doll DIS Security Matron

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    A 100 year old female with a broken hip needs a Foley.

    Turning her every time she needs to void is going to cause extreme pain.

    Diapering her so that the urine sits against her skin causing it to break down into a bedsore is going to cause extreme pain, not to mention death, not to mention that the hospital is going to get blamed for not taking good care of her.

    Having to change that diaper every time she is wet is going to cause extreme pain.

    A 100 year old female with dementia may have been screaming during a Foley insertion for a number of reasons beyond pain....fear, embarrassment, not understanding what was going on.

    If she was screaming in pain, then I would agree with you that the nurses should have premedicated her with pain medicine or something to relax her...however, the concern with that in someone who is 100 years old is that they are 100 years old. Giving a lot of medication to someone who is 100 years old can be dicey at best. Medication affects the elderly far differently than younger people....It can be a "darned if you do and darned if you don't" situation.

    Your friend in the ER doesn't really have any pull or power elsewhere in the hospital. Frankly, if the ER chief came up to my floor to intrude in the care of one of his personal friends he'd be told to go back and run his department and let us run ours.

    You didn't ask opinions on the surgery but I'm going to throw one out there. You stated above that if she has the surgery she probably won't survive it and if she doesn't have the surgery she'll probably die in a few months. My question would be "then why put her through surgery?"

    She probably won't survive the surgery.

    If she survives the surgery, what do they expect in terms of her recovery? Was she walking prior to this event? Was she able to care for herself? Was living independently or semi-independently? if she survives the surgery, will she be back to some sort of functional status or will she just be in less pain? And pain relief may be a good reason to do the surgery, but I think you all need to get an idea of what realistic expectations to have post-operatively if she survives, what will her quality of life be, how will she be cared for and by whom? In other words, what positive thing will this surgery do for her?

    If this were my 100 year old grandmother with dementia (and I am aware that it is not), I would think long and hard about putting her through a surgery that might kill her as opposed to doing what is neccesary to keep her comfortable and take care of her.

    In any event, I wish you well. These are not easy discussions to have or decisions to make. Just be certain you are looking at your grandmother's whole picture, quality of life etc. Sometimes the last loving thing we can do for someone is to let them go.....
     
  8. kidzmom3

    kidzmom3 <font color=green>DIS Veteran</font><br><font colo

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    It may be too late to enact one of these, but there are some new directives that have been really helping families with questions as to what specific treatments their family members want.

    Look into a POLST, physician orders for life sustaining treatment.

    These are more than a DNR as you can make specific choices for care and since they are truly a physician order...they cannot be ignored.

    examples of POLST treatment decisions:
    Check one:

    CPR Order: Attempt Cardio-Pulmonary Resuscitation
    CPR involves artificial breathing and forceful pressure on the chest to try to restart the heart. It usually involves electric shock (defibrillation) and a
    plastic tube down the throat into the windpipe to assist breathing (intubation). It means that all medical treatments will be done to prolong life when
    the heart stops or breathing stops, including being placed on a breathing machine and being transferred to the hospital.

    DNR Order: Do Not Attempt Resuscitation (Allow Natural Death)
    This means do not begin CPR, as defined above, to make the heart or breathing start again if either stops.

    Instructions for Intubation and Mechanical Ventilation Check one:

    Do not intubate (DNI) Do not place a tube down the patient’s throat or connect to a breathing machine that pumps air into and out of lungs. Treatments are available for symptoms of shortness of breath, such as oxygen and morphine. (This box should not be checked if full CPR is checked in Section A.)

    A trial period Check one or both:
    Intubation and mechanical ventilation
    Noninvasive ventilation (e.g. BIPAP), if the health care professional agrees that it is appropriate
    Intubation and long-term mechanical ventilation, if needed Place a tube down the patient’s throat and connect to a breathing machine as long as
    it is medically needed.

    Future Hospitalization/Transfer Check one:
    Do not send to the hospital unless pain or severe symptoms cannot be otherwise controlled.

    Send to the hospital, if necessary, based on MOLST orders.

    Artificially Administered Fluids and Nutrition When a patient can no longer eat or drink, liquid food or fluids can be given by a tube inserted in the
    stomach or fluids can be given by a small plastic tube (catheter) inserted directly into the vein. If a patient chooses not to have either a feeding tube or IV fluids, food and fluids are offered as tolerated using careful hand feeding.

    Check one each for feeding tube and IV fluids:
    No feeding tube No IV fluids
    A trial period of feeding tube A trial period of IV fluids
    Long-term feeding tube, if needed

    Antibiotics Check one:
    Do not use antibiotics. Use other comfort measures to relieve symptoms.
    Determine use or limitation of antibiotics when infection occurs.
    Use antibiotics to treat infections, if medically indicated.
    Other Instructions about starting or stopping treatments discuss
     
  9. JoiseyMom

    JoiseyMom <font color=orange>Have you had your SPANX today??

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    We would love to let her go and be in peace, but we live in NJ, and it isn't legal. Now we can put down our pets, but not our loved ones, but I digress.

    Not knowing what this morning would bring my DH brought his father from the airport to the hospital at 10:30 last night. I called our eldest to come, and he and his wife got there at 10:00 pm. We were all leaving the room but my DH, who stayed behind to tell her it would be ok if she wanted to go.

    Surgery was this morning and she made it through with flying colors. She is a tough old bird. My mil (DH's mom) has said for years she is going to out live us all :thumbsup2. They are supposed to release her in a few days to rehab, where she will be for two weeks, and then she will be sent home again.

    I also informed FIL this morning while she was in surgery that I will not let him go back to Florida until he has given DH and BIL written medical POA for her for when he is not local!!
     
  10. twinboysmom

    twinboysmom DIS Veteran

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    OP, I am trying to sympathize with you but I am not sure what your point is starting this thread was. You seem defensive over the answers you were given. Because you have never had a broken hip I am pretty sure you do not realize how painful it is. She needs a catheter to keep the urine off of her skin. While she is still wearing a diaper it is for bowel incontinence. For urine, she would need to be changed many times a day and night which equals tremendous pain to her. With wet diapers she is at an increased risk of skin breakdown on her bottom (painful bed sores).

    As a long time nurse I will try to give you some advice that I imagine you won't like much. Please remember that all of these rude nurses are most likely doing their best to take care of your family member. It's a tough job. You and your DH also have a tough job as well making decisions for someone who is 100 years old. But, the way you come across on this thread is difficult and argumentstive. Remember that those nurses do not work for the ER director. If you aren't happy, call the administrators. And also remember, a little bit of honey goes a long way. You don't want your family member to be the one patient that nobody wants to take care of. I sincerely hope she does well for the surgery. Sometimes they surprise you.
     
  11. dakcp2001

    dakcp2001 <font color=darkorchid>Am I wrong to want a cashie

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    A wet diaper is what causes skin breakdown not a dry one. With a foley she would be placed on a pad, not in a diaper. You said that the person who had the poa was in another state. Did the poa say no foley to the hospital? To a random nurse or to a doctor? To someone who made it a clear order? Doesn't sound like it. The md and hospital need to care for the patient and do what is best for the patient. What the patient wants is not always what the patient needs. An elderly lady with dementia ànd a broken hip needs a foley, period. It is incredibly painful to roll a person with a broken hip and if she was in bucks traction it is extremely difficult. Her circulation is impaired from the fracture and skin breakdown is a major concern as is patient comfort. As a nurse and patient advocate, I would have educated the family on why she needs it and how we will do it. If a patient is scared or confused, or difficult to cath there are ways to combat this. We can give the patient medication to calm them and have a urologist do the insertion. We can also call the OR nurses, they are very skilled in insertion of foleys. If someone ñeeds it we do everything we can to help them.
     
  12. dakcp2001

    dakcp2001 <font color=darkorchid>Am I wrong to want a cashie

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    :thumbsup2
     
  13. badblackpug

    badblackpug <font color=blue>If you knew her you would be shoc

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    Actually, yes it is legal to "let her go." It is called "comfort care" while in the hospital. Which means her pain will be treated, she will be kept comfortable, but no medical conditions will be treated. She will receive pain medicine.

    I am also sure that with dementia she would also be a candidate for hospice.
     
  14. Disney  Doll

    Disney Doll DIS Security Matron

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    OP, I'm going to stop responding to you because it is not my intention to upset and you don't seem to like what I am saying. You asked for a hospital nurse's perspective and that is what I am giving you, but if it distresses you that is not my intention. Based on the tone of your replies to me, it distresses you, so I will do you the favor of stopping.

    I sincerely hope your husband's grandmother continues to recover. She will be in my prayers.
     
  15. Ceila

    Ceila DIS Veteran

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    I guess I'm confused. If your FIL had POA and had not signed anything designating your DH or your BIL as such in his absence, I don't see how the nurses could have legally listened to your DH when he said "no foley." If he didn't have legal POA at the time, and since your FIL was not giving any directives, then they had to do what they knew was best for her, which as many have explained was to do the foley. I know you are upset that someone you care about was in pain, but I think your anger toward the nursing staff is misdirected.
     
  16. burnurcomputer

    burnurcomputer DIS Veteran

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    A foley cath is a much better option for caring for her private area. You void urine with a much higher frequency and volume, then you pass a bm. Turning her as often as you would need to (for a well hydrated person with normal voiding) would cause her extreme pain and may cause her to be combative, due to age, pain level, congnition, and comfort with her surroundings.

    A foley cath can be hard to place in an elderly person, for many of the above listed reasons fo other nurses. Position and the actual tissues condition may make it difficult to place a foley. Lack of estrogen and other female and male hormones can make it uncomfortable for a pt. as they age. Also, urinary meatus postion is approximate. Everyone has slighlty different postioning and size. Not everyone is an ace in the hole with every procedure, which is why it is not abnormal to have someone who is good at it to take a turn and try. Think of it as needing an i.v team. Yes, the nursing staff can all place i.v's, but some are just better at it then others.

    A nurse is a pt. advocate, if the need be. The placement of a foley cath in a 100 year old incontent woman who has not had surgery for hip repair is not a course that would be considered abnormal procedure for the intregrity of her skin and her comfort.

    As noted by others, your DH does not hold power of attorney. While nursing staff would take his opinion under due consideration at the time of the procedure, it is not considered wrong to reattempt the procedure in a more private setting, at another time, as ordered by a physician.

    I have worked in Geriatrics my entire nursing career, on the long term and sub-acute realm.
     
  17. bittybabygrower

    bittybabygrower Mouseketeer

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    I'm glad she is doing well. But referring to nurses as nasty women...maybe you should walk a day in their shoes. I agree her pain was not being managed as well as it should have been, but she needed the foley.... Dying from a bedsore from lying in pee etc is a horrible way to go. And changing the diaper frequently to prevent that would be excruciating for her. Our job is to be an advocate for our patient.

    And as for the ER doc coming up... He would have no legal right to look in her chart or do orders on someone that is not his patient. This is a huge HIPPA violation and could get him fired.
     
  18. burnurcomputer

    burnurcomputer DIS Veteran

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    I forgot this very important bit on my original post: I am glad to hear that her surgery went well and that she is on the road to recovery. I prayed for her recovery last night and will continue to do so :)
     
  19. HamTown

    HamTown Friend of the Banned

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    One other reason for a Foley in a 100 year old woman would be to prevent urine retention and probable UTI. UTI's quickly go septic in elderly patients and the broken hip would become a moot point. Pressure sores (from constantly damp skin and immobility) can also easily become infected.

    I hope she continues to recover.
     

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