I love when people ask you what you do you can proudly say "im a STAFF NURSE", and then they go "oh i couldnt do that , all that sick and poo". Well people this might be contraversial but i dont see that much of the nasty stuff. Well normal nurses dont but if a patient is going to have explosive C-Diff diarrhoea it will be on my shift. But i love the challenge of extracating them from the loo without getting any on you lovely white uniform or without them slipping over because the place you want them is on the floor as the increses the percentage chance of u getting "eww" on your togs.
As for the sick/vomiting thing i pride myself on my administration of S/c anti emetics. everytime i pass them "are you feeling a wee bit queasy, ropey, sicky,dodgy" and the next question is "do you want some anti-sickness". This works well for patients that we kind of know have the chance of feeling sick but also for the patients that have medical reasons for being sick.
Im really interested in SABO (oh i love using abbreviations that nobody knows so i look smart). come on ...Sub Acute Bowel Obstruction.
If there is an obstruction, it cant go down so it comes up, its a funny kind of vomit, very green and water with little digested floaty bits, like onion soup but green. It is great as we put down and Nasogastric tube and sook out the contents of the patients stomach with a 50ml syringe, it is very rewarding when you see the lovely green stuff in your syringe and the patient doesnt feel sick anymore.
Oh i forgot to say there is quite a bit of it, some patients refuse a NG tube, its not the nicest thing to have done, so those patients just vomit because its really difficuly to know when they are going to vomit we try and pre empty it but i doesnt always work Everytime the feel sick we do it again and this rests the bowel enough to hopefully kick it into working again and resolve the obstruction.
Punters who have an obstruction have terrible bad breath, it is almost faecal so we also attack it from the other end with high phosphate enaemas, that is 14-16" foley cathater attached to the end of the enaema and inserted as far as it can go into the bowel. It has to be high, hot and helluva lot. and we usually tilt the bed as much as we can to keep it in and it seems to have the desired effect. this can be as often as 4 times a day. Constipation is a terrible thing and very painful and if it is really high it takes a lot of work to get it moving . Its hard to give systemic lavitives because we just would sook them out when aspirated their stomach contents. So we have to take a very active line of treatment.
We have to be careful giving these punters Anti emetic as you dont want to give them anything that will make their bowels more motile like Metoclopramide as this can cause pain and thats not good but the thing is it is the best anti emetic for job apart from Octriotride which is £100 a vial, it is the dogs but we dont use it very often as it is usually need in large volumes. So really we have to give people metoclopramide and a pain killer , we usually use buscopan in a 24 hour subcutaneous infusion which works really well for the abdominal cramping and bloating. You can buy it off the shelf in supermarkets and it is a wonder drug, for period pain or abdominal pain as experienced by call due to diarrhoea. The only thing is buscopan is also used to dry up secreations in palliative care patients so remember to drink a lot of water but i bet it wont quency your thirst, so no pain but very thirsty. you cant have everything.
After all this we hope the obstruction is resolved, this can be seen by a plain abdominal xray, it can take days or weeks and usually the punters slip in and out of obstruction and are never totally free from it. but it all really depends on the cause.
This is by no way exahustive just my feelings and i thought i would share them.
