A Day with Walter: One Home Care Nurse Shares What a Typical Shift Looks Like
Kelsey Graves, RN, BSN, PHN, is a home care nurse for Pediatric Home Service and recently documented one of her days with PHS patient Walter – read along to learn the ins and outs of caring for a medically complex child at home and in the community.
When going to work a shift with Walter as his home care nurse, I am always prepared for an adventure. His days vary from being home when he works hard at his therapies, or a day where he needs to rest due to an illness, to a day with multiple appointments, to a day out on the boat or a trip to the zoo. His family is very adventurous, and I am prepared to fully provide Walter with the best quality of life whether at home or out exploring the world. No matter what the agenda is for the day, all medications, treatments, and daily maintenance duties are executed along with safety checks and emergency preparedness at all times.
Walter and his family are such an inspiration and I am continually amazed at Walter’s daily progress.
I arrive at the home, put away belongings, wash hands, and greet the night nurse.
Today we have a bath and trach change scheduled in addition to daily treatments. We also have an appointment to see the dentist at 10:00.
- I receive report from the night nurse and perform safety checks on all equipment (ventilator, heater pot, bedside emergency supplies, bedside suction machine, travel ventilator, emergency bag, portable suction machine)
- Perform a full head to toe assessment on Walter, check medications for the day, set up supplies for all cares and treatments, and read the communication book.
- I administer PRN Atropine buccally to help reduce Walter’s tracheal, oral, and nasal secretions.
- Take Walter off the ventilator and place an HME so he can be more independent. When Walter wakes up, he is ready to get up and play so I place him on a blanket in his room to play with toys while I prep for the day. He feels like he’s made progress then =)
- Check GT balloon
- Change inline suction catheter
- Walter’s mom comes in to greet us and to assist with Walter’s cares
- Walter has suction needs that require his suction machine to be within reach of him at all times. Over the course of the day, his suction needs included trach x91, oral x14, and nasal x12.
- Bath in the tub and then back to changing table for morning cares:
- GT cares
- Trach cares, change, and trach tie change
- Scheduled eye lubricant
- Coconut oil massage
- Connect GT extension
- Get dressed, brush teeth, and comb hair
- Walter snuggles with Mom while I clean up and gather all the equipment to bring down to the family room with him for the day. I pack bags, meds, feedings, and the van with our equipment, including his wheelchair, before leaving for the appointment. When leaving for appointments, I always pack as if we are going to be gone with entire shift.
- Start feeding in the car via G-tube while travelling to the appointment.
- Walter fell asleep during car ride, so I took this time to do some charting.
- Medication administered via G-tube followed by a 10 mL water flush
- Feeding stopped while we’re at Gillette to eliminate emesis from occurring as this often happens when Walter is upset or frustrated.
- 10 mL water flush given via G-tube
- Walter placed in his wheelchair along with all his equipment loaded onto the chair
- Suctioning needs increased during this time due to Walter not wanting to be in his wheelchair.
- PRN Atropine administered buccally to help minimize secretions
- Many distraction techniques used to help ease discontent for Walter at Gillette – toys, songs, books, entertainment by Dad using Disney character voices, and taking him out of his wheelchair to be held.
- Change tracheal, oral, and nasal suction devices on portable suction to sterile/clean ones
- Feeding restarted while going home
- Head to toe assessment performed along with vitals
- Medication administered via G-tube, followed by a 10 mL water flush
- We arrive home and Walter goes up to his crib for time on his ventilator until 1:30pm while he plays with toys. This allows him a break as it assists him with breathing, helps to reduce secretions, and promotes pulmonary health.
- Scheduled eye lubricant is applied
- Feeding finished followed by a 10 mL water flush
- Unpacked equipment and put used supplies in necessary bins to be cleaned. I write a progress note to update Walter’s team on visit to the dentist
- Started second daytime feeding via G-tube
- Walter is off the ventilator and placed on HME, and brought downstairs to family room
- I put Walter’s AFOs on and get him in the stander. During stander time Walter likes to be in the kitchen to open and close drawers that are designated for him to be in. He enjoys looking in the refrigerator at all the colorful food and to feel the chilly air. This is refreshing for him. 60 minutes 2x a day is his daily goal.
- PRN Atropine given to help with secretions that tend to increase as the day goes on
- Restock supplies and prepare for family hours by having medications drawn up, water flushes drawn up, clean extension, white cloths/bibs ready to be used, and any other requests by Mom and Dad that fit the needs for that afternoon.
- Wipe down equipment, empty suction canister, and change suction devices to sterile/clean upon leaving
- Report Walter’s needs and cares to mom and go home. They have scheduled family time now, where they are nurse-free for a bit – it’s been a fun day with Walter, but I know families enjoy when they can have some time alone as well!
Are you a home care nurse or do you have this service in your home? We’d love to hear what a day in your life looks like! Feel free to contact us at email@example.com to share your routine.
Originally published: April 11, 2018