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An experienced nurse attorney has surely helped a lot of RNs and LVNs when it comes to cases that may lead toward disciplinary action. Unfortunately, not all nurses were able to hire a nurse attorney as they underwent such cases. This incident that an LVN committed on April 30, 2014, was one of those examples.

While employed as a staff nurse in a medical center in Live Oak, the LVN failed to intervene and notify the physician when a patient quickly filled a canister with coffee ground colored emesis when a Nasogastric Tube (NGT) was inserted, requiring replacement of the canister with a second canister.

Coffee ground colored emesis could be indicative of internal bleeding, and there is no documentation in the medical record showing   that the LVN notified the physician when she noted the color of the emesis. 

Additionally, the LVN failed to assess vital signs for the patient when excessive amounts of coffee ground emesis drained into the canister.

The LVN’s conduct exposed the patient to risk of harm by depriving the physician of vital information that would be required to institute timely medical intervention to stabilize the patient’s gastrointestinal condition.

Because of this, the Texas Board of Nursing summoned the LVN to defend herself.  She states that the vital signs at 00:50 were temperature 96.5, pulse 79, respirations 21, Blood Pressure  151/70, 02 saturation 98 on 2 liters per nasal cannula.

The LVN continues  to state that around 00:57, Phenergan was administered to the patient, and upon assessment, the patient’s abdomen  was very  distended and  hypoactive, and  the patient  had  persistent and  recurrent emesis  that looked  like undigested food mixed  with dark tea, giving contents  a darker tint with a thick consistency, and the emesis  remain  unchanged for the rest of the shift.

There were two (2) attempts to insert the Nasogastric Tube (NGT) because the first attempt was confirmed by x-ray to be looped in the esophagus. X-ray of the second NG placement occurred at 04:09.

The LVN assessed  the  patient   at  04: 19  and  found  the  patient’s  abdomen   to  still  be distended   while  the  NG  remained  clamped,   awaiting x-ray  confirmation  of placement. Confirmation of placement of the second NGT was made at 05:03. Thereafter, the NG was connected to low intermittent wall suction.

The LVN further states that near the end of her shift, between  06:23  and  07:00,  a total  of 900  cc  of emesis  was  recorded  as NGT  output.  She states it is a nursing judgment when providing care to take and record vital signs as needed. She states that vital signs were stable at 00:50 and nothing had changed from patient’s status while she was frequently in the patient’s room providing care. The 900 cc canister of emesis filled over a period of one and a half hours.

The following incident and defense against the case caused the Texas Board of Nursing to place the LVN and her license into disciplinary proceedings. She would have sought assistance from a good nurse attorney to provide clarifications towards the case.

If you’ve ever done any errors or misdemeanor during your shift as an RN or LVN, and you wish to preserve your career and your license, an experienced nurse attorney is what you need. Nurse Attorney Yong J. An, an experienced nurse attorney for various licensing cases for 14 years, can assist you by contacting him at (832) 428-5679.