T-tube Discharge: Patient Education (Nursing)

by Prof. Lawes

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    00:00 Whoa, that's a lot of things to remember.

    00:04 No patient is going to keep all this in list form.

    00:08 So, what do we do as healthcare providers? I promise you, this is what the average discharge sheet looks like and it's useless to your patient. Here's what you wanna tell them.

    00:18 Mr. Smith, I'm glad you're getting to go home today.

    00:22 I know you see a long list of things here, but i'm gonna tell you what we're looking for.

    00:26 Two things, what I'm watching for are signs that your tube is blocked and not working or that you're developing an infection.

    00:34 That's it. Now, let's talk about the things that might indicate your tube's not working or you're developing an infection. See that? Now, think through each one of these things. We can present it to them.

    00:48 So, if you're worried about an infection, you wanna watch that incision, make sure that it doesn't show signs of getting red or they've got things leaking.

    00:55 You wanna make sure there's no unusual leakage coming out of that T-tube or bile.

    00:59 That would tell us your tube isn't working.

    01:02 Any changes. See how your dressing looks right now? See how your incision looks right now, Mr. Smith? If it gets more red, if it gets more warm, if you see more fluid draining for, or it looks a different color, let us know.

    01:17 Because we expect this incision that's gonna heal about 3-5 days.

    01:21 It should be pretty good to go. Are you following me? See the difference in rather than giving them this long laundry list of things? Now, we told you that we're watching for signs of infection, right? Fever is another good one to watch for in case you're developing an infection.

    01:36 Now, what about this tube? Mr. Smith, I know it's kinda weird going home with this little drinking straw coming out of your belly, but remember, that's helping that duct to heal cuz we don't want to ever have you to go back to surgery for work on that duct again.

    01:53 So, if something starts to be unusual, you start to notice a change, or you don't feel good, you start to feel nauseated, you have vomiting, those are the things we want you to call us about because here's a real specific list just in case you need to look up your symptom.

    02:08 That's good for your reference, but I want you to know the two things I would be looking for if you were my husband, I'd be looking for one, signs of infection, and two, showing me that that tube is blocked and not working well.

    02:23 All right? Any questions? I just encourage you to read through this list and ask me any questions that you have.

    02:29 See? It's that simple. Patients are just ready to go home.

    02:33 Their brains can't really function, but I will write on that sheet, watch for infection, watch for signs that tube isn't working, and I've got a much better shot at that patient understanding that and remembering those two things than that entire laundry list of items you see there on your screen.

    02:50 So, let's talk about discharge teaching. This is some of the coolest stuff we do as nurses.

    02:55 You might not see it as real flashy, but this is so important to do good and effective discharge teaching. So, you wanna teach that patient.

    03:05 Remember that, hey, it's okay that you don't have a gallbladder now, but that bile is now gonna flow directly into your small intestines so you might notice some changes in your stool initially as your body adjust to this.

    03:19 So, you want to encourage them to take practical steps toward a healthier lifestyle with smaller meals that have lower fat.

    03:28 Remember, they don't have that reserve anymore.

    03:30 They don't have that gallbladder that stores all that bile.

    03:33 So, smaller meals with lower fat is a good idea for everybody, but really good idea for somebody recovering from gallbladder surgery.

    03:42 Now, the patient may experience this weird diarrhea.

    03:45 Remember, I told you that bile is heading right on down so they might have this yellow diarrhea, particularly for the first couple weeks because it's kind of irritating.

    03:55 Those bile salts are kinda difficult on the body, so expect them to anticipate it.

    04:00 It's not really pleasant, but it's not actually harmful either.

    04:04 Help them know that this should resolved.

    04:06 If it doesn't, they can let the healthcare provider know and we can come up with another plan.

    04:10 Encourage the patient to talk about how they're gonna increase their activity.

    04:15 Don't just tell them, yeah, you need to be more active.

    04:17 No, it's really important that they get moving.

    04:20 That's good for their gut, that's good for their lungs, that's good for their healing.

    04:23 So, we need them to have developed a plan on what do they plan to do.

    04:27 What are you gonna do on day one? How are you gonna work on day two? So, they need to keep increasing that activity.

    04:34 It is critically important in everything getting moving again.

    04:38 And lastly, the pharm professor in me cannot move on from discharge teaching unless I give you a gentle reminder to reinforce medication education for this patient, particular in individualize medication plan.

    About the Lecture

    The lecture T-tube Discharge: Patient Education (Nursing) by Prof. Lawes is from the course Gallstones and Cholecystitis: Treatment (Nursing).

    Included Quiz Questions

    1. Pain in the right upper portion of the belly
    2. Fluid leaking around the tube
    3. Nausea or vomiting
    4. Increased itching
    5. A bad smell from the incision site
    1. Yellow diarrhea for the first few weeks is normal
    2. Eat smaller meals with lower fat
    3. Increase activity
    4. Stools may be hard and infrequent
    5. Eat a high-fat meal every day

    Author of lecture T-tube Discharge: Patient Education (Nursing)

     Prof. Lawes

    Prof. Lawes

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