The aim of this essay is to describe and discuss the nursing care given to an eighty-four year old lady who is placed under percutaneous endoscope gastrostomy (PEG) tube for a long term enthral nutrition. Valentine also has moderate impairment and is dependent to maintain her personal cleansing and dressing. This study focuses on the care and monitoring of the tube and keeping the wound site free from infection. This study will also discuss the nursing interventions addressing her dependency on personal cleansing and dressing. A study by Lumen et al (2001) among the patients in nursing home who received Pegs revealed that the incidence of wound infection was the most commonly reported complication. Lynch and Fang (2004) also reported that site leakage and skin irritation occur frequently as a result of poor management of the PEG site. Reflecting from this study, the quality of care to be administered to Valentine is crucial considering her present status of which she has limited mobility. The conclusion of this study will focus on the effectiveness of nursing management administered in maintaining PEG tubes and incision site and the aspect of care given to Valentine.
In writing this essay, permission was requested and obtained from the patient provided that this study will be use for academic purposes only. A pseudonym Valentine was used to maintain confidentiality in compliance with the MNC Code of Conduct (2004).
The nursing model applied to plan Valentine’s care was the Roper Logan and Tierney based on activities of living. This model offers a framework for nurses to take into account the individuality of every patient in delivering nursing care (Roper et al, 2003). Further, this model is also inclined with the National Service Framework for Older People (2001) taking into consideration that older people should be treated as individuals and enables them to make choices about their own care. Based on the Roper-Logan-Tierney model, the twelve activities of daily living have interconnectedness and impact with one another. However, only two aspect of care will be discuss in this study.
Mrs Valentine was referred to a general hospital five years ago due to food refusal. She was also reported of experiencing regurgitation after eating. For weeks her condition was investigated and different textures of food and supplements were tried to see which Valentine could tolerate. Eventually she managed to take a combination of porridge mixed with supplements and fortified pudding. Still, she finds it very hard to take most solid foods. She was then discharged to a nursing home but her condition worsened which led to re-admission at the same hospital. She was then diagnosed of having oesophageal stricture and oesophagi is. Oesophageal stricture is a narrowing of the oesophagus. In order for her to achieve the best possible nourishment, a PEG was intended for a long term enthral nutrition. Since her discharge back to a nursing home, she has managed much better.
Valentine is a cheerful and happy lady. She was a choir member during her younger years and today, when she is in her room, she sometimes likes to sing at the top of her voice. Her singing at night occasionally does annoy other residents. She can express her needs and she likes to dress and look smart. She loves to join every tour the home provides and she is fond of wearing beautiful hats every time she goes out. She likes to converse and she is alert, retains and response to information, however she is forgetful and vague at times. Football is her favourite game to watch whenever there is a scheduled program in the television. She even received autographed pictures of the whole Arsenal team through the facilitation by the nursing home’s activity lady. A divorcee with no children, Valentine is looked after by her younger sister who is only her remaining relative. Valentine is still just weight bearing and can stand but is no longer able to use a frame safely. She uses a wheelchair to run about and has two carers to help with all transfers and all her aspects of personal care. She is regularly checked as she is doubly incontinent. She is able to reposition herself in the chair and uses an air mattress to prevent pressure sores.
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