NU 310 Exemplar
I arrived to work well rested and ready to start the day. I had just returned after a two week long vacation. Because of the time off, I arrived to 7 East to find that the assortment of patients was not familiar at all. As I began getting reports on my patients, one in particular I started to feel a little anxious and stressed. At first glance I could tell I would be busy for the next twelve hours. Lynda was a 45 year old woman that was admitted almost a week ago after having an emergent tracheostomy placed. Lynda was newly diagnosed with laryngeal cancer with already having several other diagnoses including: seizure disorders, mild mental retardation, behavioral issues, and was legally blind. Lynda also lived in an apartment for assisted living, and her only support that was occasional present was her brother, Steven.
That first day I have Lynda, she was started on a full liquid diet. It quickly became clear that she was aspirating food. She was very angry with me after I took away her first real meal she was having in 5 days. After the physicians came to see Lynda and she had a swallow evaluation preformed it was decided that the best option for Lynda would be to have a percutaneous endoscopic gastrostomy (PEG) tube placed, for feedings. Lynda was added to the schedule and had her PEG tube placed that day. She was not happy with me and blamed me. I explained to Lynda why she needed to have the PEG tube, she told me that she understood why, but just wanted to go home. I told her that we just had to look at this as another path she had to take in order to get home. I told her that if she was able to care for her tracheostomy that a PEG tube would be nothing. It was at about this point I learned that even though, she had already been on our floor for almost a week with what would be a permanent tracheostomy no one had yet taught her to suction herself. As they were calling for her to go downstairs for the PEG... [continues]
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