Originally Posted: 6/29/2011
A few weeks ago, I admitted an older teen to the ICU. She had been transferred down from the oncology floor due to persistent hypertension, a scenario we see quite often. Patients are managed on the floor for as long as possible, but in the event that they need a cardiac drip, they need to come to the ICU. Needless to say, the decision to transfer was made quite late in the evening, and it was well after midnight by the time we got her down and settled in. I had heard in report that she was quite upset about having to come to the ICU. After all, no one LIKES coming to the ICU. As she told me, “Clearly it means I’m going in the WRONG direction!”
In addition to the hypertension, she had an NG tube in place due to excessive vomiting. An NG tube is a small plastic tube that is inserted through the nose and down into the stomach, allowing for decompression of the stomach- a way to pull out the fluid and bile that is unable to move through the intestines, and therefore sitting in the stomach of a person with an obstruction. She had had the NG placed earlier in the day, and was very protective of it. “I’m not too sure that nurse knew what she was doing when she put this thing in,” she told me, “and there is NO WAY anyone is putting in another one if this thing falls out!”
I reassured her that we had patients all the time with NG tubes and that I was very familiar with them. She was complaining of having a dry mouth from not being able to eat or drink anything so I suggested we clean her mouth out with our minty swabs and the doctor agreed that we could also occasionally wipe her mouth out with ice water. Several times throughout the course of the night, she asked me to wipe her mouth out with either the minty swabs or the ice water. Unlike younger patients, she understood why it was important for her not to swallow too much (if any) water- because it would most likely make her throw up. But when you have not been allowed to eat or drink for several days, “Ice water swabs in a dry mouth feels just like heaven,” according to my patient.
At one point during the night, my patient suddenly turned to me and said “Liz- I need you to be my advocate. You need to stop me if you think I am asking for too many swabs. I don’t want to get sick again”
I reassured her that she was asking for a reasonable amount of swabs, and that I noticed how careful she was being to not swallow any of the water (I helped out by suctioning the extra water out of her mouth).
But she was right. I have found that one of the largest roles that nurses play in the ICU is as a patient and family advocate. Someone to act as a voice when they don’t have one. Or their judgement becomes foggy after a long night with an uncomfortable tube in their nose and no food or drink. Sure, it would have been easy for me to never ask for the swabs at all. Or, I could have also easily given her a swab every time she asked for it, without monitoring how much she was actually swallowing and potentially making her sick again. But it is being able to find the fine line between those scenarios that allows you to be the advocate each patient needs.