Tuesday, February 13, 2007

PSW care

Brian, after his massage therapy, went in to see dad. He had refused to take his pills today and he was loud, yelling and in pain. Brian went to see the nurse. Dad had refused his Ativan and his other pills. They talked him into taking his Percoset (Oxycodone), which lessens his pain, and after some time it will kick in. What do we do if he refuses to take the pain pills? Sure enough he has refused them, as he has so often done with pills when I am there. It must happen once a day.

The CCS research has told me that one result of the brain tumour is intercranial pressure (ICP). These are the symptoms of this. I know that dad has shown these symptoms over the course of the past eleven months, since his tumour was rediagnosed.

1. headache – often occurring early in the morning and made worse by coughing, bending or straining
2. nausea
3. vomiting
4. dizziness
5. vision problems
6. difficulty speaking
7. confusion
8. restlessness
9. drowsiness and decreased consciousness
10. trouble with coordination
11. loss of muscle strength
12. loss of the ability to move a body part (paralysis)
13. seizure
14. coma

I went in to see dad before choir practice in Orillia. A PSW had just changed dad’s sheets. I had seen her from the parking lot as I looked up at dad’s window. His Valentine decorations were a bright spot in an otherwise bland institutional building. Snow has piled up and was quite a chill in the minus 15-degree brisk winter air. Once I made it up to his room I found him in his chair, with his head lolling over to one side. I mentally kicked myself since I had washed his Obus form cover and had forgotten it at home. I had forgotten to send Brian in with it, too. It would have helped him greatly. He won’t lean back and put his head on the headrest. Occasionally his head would shake with tremours. It pained me to look at him.

He was trying to form words but could not speak clearly. He spoke as if he had marbles in his mouth. I thought I heard, “Yie down.” meaning he wanted to lie down. He spoke this phrase several times, too ill to gesture any more. He just cannot relax. I heard him say aaggghh. I knew that there were two staff members on breaks after the meal they had just served at five. I could hear staff calling for help with ‘lifts’, putting residents into bed. I decided to sit and wait until staff came, as I knew they would eventually.

The PSW came into the room. The PSW mentioned that she had just changed his bed, as it was quite messy and smelly with bowel movements. I thanked her for doing so and showing such concern. We spoke of his ear problem. There were crusted bits in it. I told her he had big wax problems and she thought that he had an ear infection. I told her that I though he was in more pain than the medications could help.

When they began to change his adult diaper there was a big problem. Nursing staff had given him a laxative, since he had been constipated. He hadn’t eaten anything in ages, but I am just the daughter. The ladies began to lift him; he groaned as they did so. He could be having any number of symptoms, but I am sure he was in pain. He had been nauseous for months. I could see the bones in his back sticking out. He was as gaunt as a holocaust survivor. He had pressure sores from his bones digging through his thin buttock skin into where he sat on the cushioned wheelchair. They wiped and washed and changed him several times, as he was still evacuating his bowels. The kept their sense of humour and smiled. He grunted and moaned. I know the man is in pain. I do not know how to convince them to give him something different. I am so frustrated with the RNs.

1 comment:

Anonymous said...

I can understand why you would be frustrated, a nurse can only do so much without getting a doctors order and giving him medication that he refused would qualify as abuse. PSWs are very important but they are not regulated or registered, nurses are. PSWs do not have a license on the line. I work in a pharmacy where I try to problem solve with RNs, often they have brought a problem up to the doctor, and the doctor has done nothing, what are they to do? I know so many RNs who become frustrated, and then the patients are frustrated with them, no wonder there is so much turnover and burnout in LTC, but equally true there are those who have not even tried. I hope someone helps him soon, its not right that he should suffer. Find out what actions have been explored maybe, to see what they have done to try to help.