Rachael is once again not tolerating drugs, water or feed. She is in absolute agony and seems to be producing huge amounts of yellow bile which is leaking from the rig when left open. When we go to syringe air from the rig to try and minimise Rachael’s pain, it is pulling yellow bile out into the syringe. The thought of having a feed is causing Rachael distress. She simply cannot tolerate another bolus feed today. Even Oramorph is not helping with the pain. C left a message with dietician to call back urgently to try and help remedy the situation.
N rang re: message left and asked for specifics of Rachael’s current condition. After running through a list of questions, N said that it sounds like Rachael is suffering from either chronic constipation or gastric reflux. N said to get Rachael to see a doctor so they can review the situation. N said she would ring back on Monday to see how Rachael got on over the weekend.
Spoke to Dr O who asked how Rachael was. Explained Rachael was in constant agony today, with the pain peaking when anything is put through the rig. Explained Rachael was also losing a lot of yellow bile through rig when its open. Dr O said she could come and assess Rachael when surgery is finished, at around 6.30/7.00pm. Dr O did say that she thought Rachael needed to go to hospital to be assessed.
Brother got to Rachael’s for 5.30pm. Rachael was in a lot of pain in her stomach. Dr O (GP) came at 6.30pm and examined Rachael. Dr O said that Rachael was particularly sore on the stomach. Dr explained that she could treat Rachael with other drugs however as this hasn’t worked before she recommended going to hospital. Rachael said she hates the idea but she can’t go on like she has been. Dr gave Rachael the option of a local hospital or SR. Rachael chose SR. Rachael, S and E arrived at the hospital at 8pm. Rachael was seen by triage and her blood pressure, pulse and temperature were taken. We were then taken to a room in Majors. Rachael had blood taken from her although the first attempt made her vein swell and possibly bruise. Temperature, pulse and blood pressure were taken again. We were then moved on to the Emergency Assessment Unit room 20. We were asked to put Rachael in a bed and they were told no as she can’t go into the bed as it affects her respiratory system. Rachael needed to change her pad so we asked for the hoist which they brought but didn’t know how to use it. 3 nurses lifted Rachael into the bed which she was fine with for a few minutes. The nurses with E supervising changed Rachael’s clothes, pad and dressed a pressure sore on her bottom. She was then lifted into the chair. S and E enjoyed a cold McDonalds meal. At 5 am Rachael woke in pain and asked for pain relief. The nurse told S and R they were giving her 2.5 ml or 5 of another measurement. Rachael felt woosey and was unable to communicate. Rachael then slept. At 6am Rachael complained of gas in her stomach which was syringed. At 6.45 R arrived and took E home. At 8.00 am a new nurse introduced herself and carer arrived.
The new nurse informed us Rachael had been given 5 ml of Oramorph not 2.5 ml as they were told. S told the nurse that Rachael can’t communicate if she is given more than 2.5 ml. The nurse informed Rachael that she would need to go on a trolley for the x ray. She said that it would be 5 – 10 minutes. Rachael said that she would be fine with that. At 8.45am I gave Rachael her morning drugs. At 9.10am Rachael was transferred to a trolley and taken through to X Ray. It was very traumatic for Rachael especially when they tried to lie her back. Eventually they decided to X ray Rachael sitting up which worked. Once back in the room the nurses and I washed Rachael and then transferred her back to her chair. The hoist was used to lift Rachael to change her pad and straighten her blanket. Rachael was transferred to ward L2 at 10.30. She was placed on a main ward with 7 beds. Rachael had 4 loose bowel movements throughout the day and night. She was in pain through hoisting on all but the last hoist.
Rachael saw a doctor at 6pm (approx.) and after discussing her options with him she decided to go with his recommendation of staying the night and then going home in the morning so that she could spend her birthday at home. This option did involve Rachael returning to the ward Sunday evening so that she could be seen by a Gastro-Enterology specialist on the Monday morning.
As Rachael is currently suffering with an upset stomach the suggestion was made by J, the night nurse, that Rachael would maybe have to move to a side ward but this would require input from the Doctors.
Rachael has currently got a dressing on a bed sore on her bottom. This area is very tender and requires ongoing care. Rachael would like the District nurses to provide a daily drip for her as it vastly improved things for her.