DOI: 10.1097/01.SGA.0000334039.17173.7d

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PMID: 18708837

Issn Print: 1042-895X

Publication Date: 2008/07/01


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G-Tubes and Skin Care, Oh My!

Kathryn Vukson

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Excerpt

Icall my patient Dorothy because her favorite movie is The Wizard of Oz. I truly needed my brain, heart, and courage to earn Dorothy's trust and provide her the best care. It takes a little longer to get to know an ambulatory patient. Appointments are usually accomplished as efficiently as possible. With Dorothy, I had been given information before meeting her for our first appointment—or you could say I was given a “cautionary” warning; Dorothy's reputation precedes her wherever she goes.
I am a longtime nurse with a new position in the gastroenterology and nutrition department. I am always ready for a new challenge and experience. Dorothy became one of my first gastroenterology primary patients and also my first gastrostomy-tube (g-tube) change. Dorothy is 18 years old and has Smith–Lemli–Opitz syndrome. Smith–Lemli–Opitz syndrome is an autosomal recessive developmental disorder that affects many parts of the body. Characteristics of Smith–Lemli–Opitz syndrome vary widely from mild physical abnormalities to severe and life-threatening organ dysfunction. Many affected children have characteristic features of autism. Malformations of the heart, lungs, kidneys, gastrointestinal (GI) tract, and genitalia are also common. Feeding difficulties, motility problems, and slow growth are factors that bring these children to the gastroenterologist.
Dorothy is nonverbal and g-tube dependent for nutrition. That is the easy part of caring for Dorothy. Dorothy does not like coming to the hospital and is difficult to handle. She is self-abusive, hitting herself and biting her hands, and abusive to others if you get in her line of fire. She is also difficult to handle at home, which is why her mother brings her to the GI clinic for assistance with g-tube changes.
Meeting Dorothy presented nothing unusual at first. She was a slight young lady in her wheelchair with very alert eyes watching all that goes on around her. I spoke directly to Dorothy, introducing myself to her and her mother. Dorothy sat calmly in her wheelchair as I prepared for the g-tube change, discussing with her mother how best to approach this procedure with Dorothy. Then the tornado begins!
The objects in the room began to swirl. My two assistants and I were being tossed around by a 100-lb ball of determined energy. I had about 6 inches of space to change the Mic-G button g-tube, squeezed in between Dorothy's mother, my supervisor, and one of the doctors trying to hold Dorothy stable enough to do the g-tube change. I had well prepared for the procedure and changed the g-tube in record time, but in my inexperience with g-tube changes, I forgot to close the end ports. Gastric contents come spilling out, getting Dorothy's clothing all wet.
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