Hospital-savvy people, please spill

Parent Cafe
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<p>All good points about the meds, and of course every patient is different. I remember being with patients who were in pain and seeing them start to squirm, moan, wake up, or complain when their pain meds were starting to wear off. Sometimes people behave very uncharacteristically when they are confused and in pain so be aware a behavior may be pain related. Being in pain is miserable, of course.</p>

<p>The other thing I want to say is that I hope you have someone who can “spell you” while you are there. Being the advocate, sitting around the hospital all day with a sick person, is mentally and physically exhausting. Sometimes you just need to get OUT OF THERE for awhile. I hate to say this, but you may need to sleep at the hospital, especially at the beginning, or after he gets out of ICU. Talk to the nurses about this.</p>

<p>Lots of different hospital professionals and para-professionals will come through and may say contradictory things about what is going to happen next. You have to just roll with this, and try to get things clarified as you go along. Waiting for your main doctor(s), who will waltz in and out and you never know when, is a challenge. Have your questions and comments written down (in your notebook) so you don’t forget them when the doctor arrives.</p>

<p>In general, if they tell you the patient needs to be getting up (sitting up, walking, breathing deeply, whatever), know that the patient will feel better AFTER they do these things. They may be uncomfortable WHILE they do them, but doing them will make them get better faster. So try to support and encourage the activities they tell your husband to do, no matter how scary it seems.</p>

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<p>Some people experience very little pain with open heart surgery…I’ve been told there are not a lot of nerve endings in the area. In my dad’s case the nurses practically had to force him to take them because he kept saying he wasn’t in pain…they wanted to make sure that his breathing exercises weren’t being hampered in any way. It was amazing but he really never needed pain meds after the first day; I on the other hand, would have been asking for them BEFORE the surgery-the thought of what they were about to do to him caused me pain :)</p>

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<p>Thank you for clarifying that point about open heart surgery. I am entirely unfamiliar with that type of surgery and I don’t want to give the OP the impression that I was referring to that surgery in particular.</p>

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<p>eadad, that’s a good point. Because pain is such an individual and subjective issue, doctors often write the orders for pain medicine “prn” rather than scheduling them at certain intervals. It’s good in that patients are not pressured into taking medicine they neither want nor need, but can be frustrating for patients who do need them at fairly regular intervals. To the family, it can seem ridiculous to have to ask for pain medicine each time rather than the nurses just bringing it to them at the allowed intervals. So be aware as a family member that your loved one’s nurses aren’t being negligent or cruel when they don’t bring pain pills “every four hours 'cause the doctor said he could have them every four hours.” PRN orders do not appear on the scheduled medical sheet the nurses use when they look up the meds the patient “must have” at certain times. PRN meds are usually on another sheet which is consulted when the patient brings up an issue of concern, such as pain, constipation, anxiety, etc. Doctors will have written these “just in case” meds on a prn basis only. Another reason for this is the expectation that as time goes by, the patient won’t need as much pain medicine today as yesterday, and it is a good thing to wean them appropriately vs. just keeping them on a fixed schedule that could result in giving unnecessary medications or foster dependence. Pain management is not an exact science and can be a source of frustration for all involved.</p>

<p>I hope that explanation makes sense. I don’t always communicate clearly…</p>

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<p>I am reading each post with appreciation and taking notes.</p>

<p>I would sleep all night in the hospital and stay with him 24/7 but for the recliner chairs. I tried recliner chairs several nights with my MIL in her home during hospice care and learned I needed a horizontal cot; otherwise a night of sleep less-than-completely horizontal damages my neck and back which has been surgically fused several times (that’s the disability) and awaits surgery (now on hold). Recliners + p3t = disfunctional the next day. Cot + p3t = boundless energy.</p>

<p>My current plan is to go to my relatives at night a few blocks from the hospital, catch some sleep and cab over before 6 a.m. to catch the dr’s on rounds. But really I’d rather sleep there with H. There’ve been so many other matters to tend to by phone this week that his attempt to mention this was appropriately sidelined. I understand that as we’re not yet on the scene.
I’m going to try, once we are there, to twist some arms so a cot can be procured. I might ask for a social worker, ombudsman there…but after he’s into the surgery. He’s the main one on their minds, and appropriately so. But once he’s admitted, it seems like a hospital ought to be able to find a cot…somewhere.</p>

<p>I might pack a sleeping bag and tent :p</p>

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<p>I understand your back issues, Paying3, and you will not be able to help anyone if you can’t get any sleep.</p>

<p>However, check with the nurses. Our teaching hospital now has wide padded chairs that fold out flat to make a cot. They’re pretty comfortable.</p>

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<p>^that’d do it, Skyhook. Will ask. Thanks~!</p>

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<p>p3t, hugs to you and your hubby! May his surgery and hospital stay be as uneventful and short as they can get. Speedy recovery to him!</p>

<p>One thing to add to the wise advice already given: please wash your hands, wash your hands, wash your hands! And demand that anyone touching your DH do the same before touching him! Hospitals are crawling with infectious bugs, and it pays off to be vigilant.</p>

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<p>P3T, so sorry your family is going through this challenging time. The need for bypass surgery tends to enter your life rather suddenly, and certainly can be an overwhelming thing to contemplate, as well as rearrange your life and commitments to accommodate on short notice. </p>

<p>Reading the many good suggestions above was informative. For ages I’ve worked in cardiology/critical care, and I appreciate the patient eye view. </p>

<p>I hope you can get a cot or, best case is that you’d have the fold flat couch, similar to what my floor now has for family members staying the night. Take care of yourself, and if staying at a nearby house is the best way to do this, then that is just what needs to happen. Nursing assistants are often the best people to find a cot, as they sometimes know where equipment is stashed. </p>

<p>You are so good with people that I can’t imagine you needing to find a special way to curry favor with hospital staff. Be your kindly self. As far as I’m concerned, you should not have to help with physical care, aside from helping him with rather basic things like setting up the food tray, and perhaps getting to the bathroom, and walking in the hall after he’s safely back on his feet. I personally don’t let family help with repositioning or making beds-being there for their loved one is a plenty big job already. </p>

<p>One poster mentioned massaging the patient’s legs. Your H may have a leg incision, depending on where they take the bypasses from. My training discouraged leg massage for any hospitalized patients-as you don’t want clots to break loose, if present, to cause greater harm elsewhere. Most bypass patients have TED stockings, and compression stockings in the first few days to avoid clot formation. Ankle circles are helpful. Getting out of bed early and frequently is of greatest benefit. </p>

<p>Yes, write things down. Short term memory tends to be shot, both yours and his, and everything is new and sometimes intimidating. But one way to alienate staff is to obsessively write down every action and who performed it. Being cautious, informed and aware in a hospital is good. Sometimes I am saddened that the media has made some of the public so afraid of hospitals that the experience is more fraught with angst than it needs to be. </p>

<p>Nursing I’d hope will be asking him about need for pain medication frequently. CABG’s (as we call them) have widely varying levels of pain. Many need impressively little medication after the first 24 to 48 hours. Some people have a lot with the chest tube and then are fine when it comes out. Others are bothered by leg incisional pain, but not chest incision pain. REgardless, taking enough medication to allow coughing and deep breathing is essential. Never hesitate to call a second time if the first call doesn’t bring the help you need. Or maybe it is just taciturn midwesterners who need this reminder? </p>

<p>Appetites can take some time to recover and protein is important for healing. Which can make for some times of family urging patients to eat when they really don’t feel like it. The dietary department can work with you if it seems the hospital food is not to his liking. </p>

<p>Anyhow, keep us informed. Will be thinking of you.</p>

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<p>p3t, sending wishes for a refuah sheleimah for your H (hope I spelled that reasonably correctly). For others on the thread, this means “complete healing” in Hebrew.</p>

<p>Will add to the chorus for a notebook. Write down questions you have for the docs/staff in advance so you remember to ask when you get those few precious minutes with them. </p>

<p>If at all possible, try to attend all the pre-op appointments so you are hearing the same things your DH is. It’s amazing how two people can get different info from one conversation. An extra pair of ears can be quite useful.</p>

<p>Re: cot/bed – Do let the staff know of your limitations in terms of helping your H turn over, etc. When S2 was readmitted to the ped dept. for high bilirubin after he’d already been discharged from the nursery, they said they normally have moms sleep in a chair. Did not take much pushing to get a bed (and meals!) for me, since I was doing all his care except the bloodwork.</p>

<p>Another suggestion: if your H has any medical allergies or sensitivities, tell every doc/nurse who comes through that door. (Make sure your H tells YOU about same before he goes in for surgery, just so that you are fully informed.) I can’t tell you how many times docs have looked right past the big orange Codeine Allergy label on my medical folder and given an Rx for same.</p>

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<p>I just found this thread. You and your H are in my prayers, paying3. My dad had a triple by-pass ten years ago and is doing fine. Please take care of yourself also, as others here have suggested. Let us know how he’s doing when you get the opportunity. God Bless!</p>

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<p>P3T, if it gets too exhausting, can you hire a nurse’s aide to come in for you at times? (I have not been able to read every post here, it may have been suggested) My mother found help so thin at the hospital, she was concerned about the safety of her mother who had just had hip surgery. My grandmonther was a non-compliant patient, and had some post ICU psychosis - the routine ended up exhausting my parents. So, of course, the nursing staff didn’t like her much, because she was not likable at that time! She was rather belligerent. </p>

<p>My mother even ended up hiring aides when her mother was in the rehab facility as well. It was worth it for the sanity and safety of everyone. The aide was not 24x7 - they filled in when others could not be there.</p>

<p>I’ve also seen this post op psychosis thing in several people and it is quite awful. I don’t know what predisposes individuals to it. My aunt has it right now…she was so bad the hospital put an aide with her around the clock for 2 days.</p>

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<p>Bringing food to the staff is a great idea - happy staff make happy patients.</p>

<p>Timing, quality and safety of food gifts are important. </p>

<p>First, individually wrapped food items are appealing to staff, since every OR or ICU has a slob who never washes his hands. Individually wrapped, non-perishable items also allow busy staff to stash items for later consumption. (In our hospital, [Big</a> Island Candies](<a href=“http://www.bigislandcandies.com/bic/dept.asp?dept_id=3]Big”>http://www.bigislandcandies.com/bic/dept.asp?dept_id=3) is the gold standard for patient gifts.)</p>

<p>Second, try to provide treats prior to encounters - something like tipping the maitre d’hotel before a meal. Bringing treats to pre-op for the surgical team (pre-op nurse, surgeon, anesthesiologist, perfusionist, circulating nurse and scrub nurse/tech) will make many people happy at a key time. Sending treats to ICU on ICU day 1 is better than ICU day 3. Bringing treats early is money in the bank.</p>

<p>Third, spending a little extra for a premium brand goes a long way among hospital staff. If you bring Gevalia coffee or fancy chocolates, you’ll hear about it from staff members for days. (Admittedly, hospital staff are not picky about food).</p>

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<p>I agree with the wash your hands sooo important. I am a nurse and currently out on medical leave.(tough year) this may sound bad but some nurses forget to wipe with alcohol . Actually its just poor technique. but insist on this. I did not give the nurses food, until treatment was done. I actually gave fruit, (Harry and David) as I know that there is always too much junk around. I did give gourmet cupcakes to my techs. I gave it to them to let them know I appreciated what they did and actually told them what it was I appreciated. Its a way of learning for them and it gets passed on to other patients. medicine is a learned art. I also think (unfortunately) that the patient with attentive family nearby gets better attention. (this is not how I practice but it is true) I can be a pain but a nice pain but I make no apologies for advocating for myself and family. its too easy to get ignored in the current system.</p>

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<p>I think bringing treats for the staff is great, but using as a bribe to get better treatment is not really a good idea. I have people in my own family who think you can get someone in your pocket if you give them stuff. Believe me nurses are very aware of all of this. I’m a nurse and we try to treat everyone with respect. The pt’s and/or family members who are obnoxious and rude to staff get less interaction from the staff, not less care, but they will stay away to avoid your claws and glares. They will not go out of their way. Trut me on this.
Staff absolutely wil not touch treats that are open and unwrapped, they evaluate where the treats are coming from just as you are watching and evaluating them.</p>

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<p>P3T - am holding you in my thoughts today.</p>

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<p>I had the same reaction as you to the massage the calves comment. Walking, TED hose or other compression devices, and flex and extend exercises while in bed are the best ways to avoid blood clots imo. Depending on the surgery, doctors will often order small doses of “blood thinners” to prevent them. I personally wouldn’t recommend calf massage-the above are really better and safer alternatives imo.</p>

<p>I once walked into a patient’s room just as his wife was beginning to massage his calf. I asked her why she was doing that and she replied “his calf is hurting and he asked me to.” I asked her to hold off and called the doctor since his calf was warm, sore, and larger than the other one. A doppler ultrasound was done on the calf and sure enough, he had a deep vein thrombosis. Massaging that calf could have dislodged the clot and resulted in serious problems-including death.</p>

<p>OP-don’t take this story as something to be really concerned about. As long as he walks early and often and the aforementioned are in place (compression stockings or devices, ankle circles and other such in bed exercises, blood thinners, etc.), this complication will be unlikely.</p>

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<p>After reading all 6 pgs of this thread may I add my prayers and wishes for a quick recovery. Like the other nurses that commented, I have never heard of a cardiac telemetry unit staffing ratios like those mentioned. I’ve worked ED/ICU 32 years and would strongly suggest that if you have any concerns that are not addressed promptly by the staff, request a nursing supervisor. Not the “charge nurse”, the supervisor. Some hospitals use rapid response teams; ask whether your hospital has one. When there is a problem, time is of the essence. BTW, my Dad has had 2 CABG’s and still plays golf twice a week and he is 83. His first surgery was at age 52!</p>

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<p>OMG, p3t-- just found this thread!! YOu’ve gotten lots of good advice here. Just sending you best wishes for an uneventful surgery and speedy recovery. I second the idea of bringing goodies for the support staff. YO want to keep the floor nurses , secretarial staff, etc very happy. It will come back 10X over</p>

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<p>p3t, I am very sorry to have missed this thread. I was away on vacation when you started it. I had no idea! I just came across it. </p>

<p>By now, your husband has likely had the surgery. You are both in my thoughts and Im sending positive vibes for a speedy and uneventful recovery. </p>

<p>You already got wonderful advice here. I don’t even know if you’ll be checking here. When my teenage D was in the hospital, first in ICU, eventually surgery and then another unit, I stayed the entire 10 days and did not go home. But I was able to get a cot in her room. I hope you have found a way to get that too.</p>