Wednesday, January 21, 2009
Name That Tube
There's a large aspect of nursing that deals with tubes. You're either putting in a tube, taking out a tube, putting something into a tube (or, well, yes) taking something out of a tube or you're checking tubes.
So, my preceptor tells me, "We're going in to see the patient and I want you to check her tubes." Got it. Check the tubes. I check out her iv site and all the tubes stemming from it(lactated ringer's, Pitocin. ampicillin) I assess the Foley catheter and, hm, what else. Right. Her IUPC (intrauterine pressure catheter to measure uterine contractions in millimeters of mercury). I brush my hands together in that "I'm done and I'm washing my hands of it" gesture and then my preceptor says, "Don't forget the epidural." *Another* tube (connected to a locked plastic box. Oh what fun it would be for some, I suppose to have that bag o' bupivacaine and fentanyl). And this for a relatively normal delivery. (Yeah. We'll talk about that whole can of monkeys later) Are you keeping count?
One of the fun activities I get to do is to d/c ("discontinue" for you non-nurse-y types) the epidural catheter. You take off all the tape which runs all the way from shoulder to waist and from left to right side. That tape is almost embedded in the poor woman's skin and, after labor, pretty much I want to baby the new mom, but instead I'm removing the hair from her back: ouch. And then taking the epidural catheter itself out is unsettling. I can d/c a nasogastric tube, I can d/c an iv, but something about pulling that thin (thinner than a pencil lead) tube out of someone's back (pull down, not up or out)... It doesn't give easily, there's resistance and it's coming from the spine. Tip: yes, that's it: tip. Check for the tip (it's black) because it could get left behind (I've heard tales of this occurring, "Why just last week..." began one).
So, I'm motoring right along in studying for the NCLEX. I'm on page 228 (almost done: just 1000 + more pages to go!) and I'm about finished with the chapter called Tubes! (It's really called something like Caring For The Patient With Tubes, but I like my title better. It's more festive and jazzy). My favorite tubes are the GI tubes. And by "favorite", I mean that I like the names: Lavocuator (the infamous pump-your-stomach tube), the Salem Sump, and the lovely Sengstaken-Blakemore tube (I think the Sengstaken-Blakemores used to live next door to me) for all your esophageal hemorrhage needs (well, many of those needs, anywho). And you gotta love the respiratory tubes. Cuffed or fenstrated, single or double lumen: you want 'em, I need to know 'em to pass my boards! Do not get me started on chest tubes. Should it bubble? Is it ebbing and neaping like the tides? A possibly deadly leak in the system or normal functioning of the equipment? I remember in our skills lab, the instructor was so confused she said, "Read the manufacturer's instructions."
Another unsettling thing. In Anatomy and Physiology (geez, years ago now) I learned that we're all tubes. The center part of our tube runs from our mouth to our anus. I don't know why being a tube bothers me, but it does so I'm going to move on now.
NCLEX tip number one: If the question asks you which symptom requires a call to the MD and "stridor" is one of the answers you should pick it.
That's one of our inaugural cupcakes. My mom made the cupcakes, I did the frosting and the kids sorted out and sprinkled the red and blue M & M's.