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 tube placement, I assured Lynda that she was strong and that she would be able to do this. I told her that I would be there when she came back, and I would be there all week to teach her. With that Lynda felt confident and off she went.
As Lynda was having her PEG tube I was thinking about all the questions I had about Lynda. I started reading her history and physicals, and the clinic reports. The first clinic appointment she had was when she came in almost one week ago. At this visit she was told that she was not breathing adequately enough and it was because she had a large tumor that was starting to block off her airway. She was told that she need to have a tracheostomy and soon before it would close off her airway, and then she had two options radiation so see if it would shrink the tumor or surgery to remove the tumor. She agreed to have the tracheostomy and planed to have surgery as it was explained to be her best option. It really didn’t say if Lynda understood the full extent of the surgery she would have, she just saw it as something she had to do and then she could go home. While waiting for Lynda to come back I met her friend Sister Mary. Sister Mary told me all about Lynda, about how she has known her since she was a teenager and all the hardships that Lynda has gone though. Of the many things I learned about Lynda from Sister Mary was that Lynda was a trooper and she would be able to care for her tracheostomy and PEG tube. As my shift came to an end, and Lynda was still in recovery. I decided to write Lynda a note that state for her to get some rest because we had a busy day ahead of us tomorrow.
Day two, my mission was to teach Lynda the basics of self suctioning. As I walked into her room this morning she was all smiles and told me she was ready to learn. We started with the basics showing and explaining her tracheostomy tube and the suction catheters to her. I then gave her a dummy doll we teach patients how to suction on, and she was able to...