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- Jun 20 by tinyonernVery interesting case. My first reaction was bladder infection caused mild confusion, which led to mis-taking meds, which led to NMS or serotonin syndrome, which led to... I never worked with adults (hospitalized) other than in psych, and part of that was in gero psych. Towards the end of my working career I worked telephonic disease management with the elderly, and one of the things I tried to stress was having a safety plan in place. It didn't have to be elaborate, just a phone call daily from a neighbor, someone checking if they didn't pick up paper, pull up blinds, or something that they did daily that would be noticed if they didn't do it. This person might still have gotten sick, but maybe it wouldn't have been 3 days before it was noticed. In my experience, many seniors want to remain independent, not be a burden, and many aren't willing to have strangers in their homes, but are willing to develop simple safety plans with neighbors.
- Jun 20 by texascelesteJuan, this was a GREAT post. Please share more like this if you have the chance!
- Jun 20 by judihhI have not a clue---- I myself am 71 and am not particularly fond of this scenario. Is she still smoking? Why is she not doing her own light housework? What does she do socially? Does she still drive? Is her only social life her 20 pack deadly friends? After she does improve she should be plugged into a stop smoking group. And her activity should be questioned and improved if need. As it is she is an accident waiting to happen. At the very least she should have a "life alert", as the next time she may be found DEAD!
- Jun 20 by jstrawberryrabies?
- Jun 22 by lamazeteacherIt's good to know that there's now "turn teams" doing that very necessary aspect of patient care, in acute care settings, especially for COPD PATIENTS; and some discharge planning occurred when the patient was discharged. It seems that the plan was economically based ("the patient was willing to pay"). Was her family present to oversee coverage, however? Was the 24 hour care provided by an R.N. or uncertified aide? Did her family physician concur and order discharge meds, or was it assumed that her former regimen was adequate? What preventive plans to assure that rehospitalization or repeat performance would occur? One of the biggest costs for Medicare, is repeated hospitalization, largely based on assumptions that appropriate care and followup happen.
To answer the impertinent question regarding my direct ICU experience, I haven't staffed ICU in the past few decades, and I have done Home Health Nursing after my advanced age caused physical limitations, which inspired me to change my role at work. One of the most neglected needs of nurses, is a pension plan. We work at different facilities according to opportunities to advance, and the work we do is full of stress. However age creeps in with destructive capacity, even though we have delayed those changes, considerably.
When I was working in hospitals, I was an Infection Control Nurse and Nursing Educator, in the late '80s and early '90s. After that I worked to promote umbilical cord blood stem cell preservation. I believe that stem cell treatment will revolutionize medical and nursing care in the future. First, however it's necessary for innovative thinking and observation of disease process folks to get off their "high horses" and realize that "after the fact" care wastes time, lives, and money. It's quality of life that is essential as the objective for our profession. To that end, quality of nursing care is intrinsic!Last edit by lamazeteacher on Jun 22
- Jun 26 by Esme12I think that educating bedside nurses with case studies is important so that they can recognize the complications and symptoms of something so they can better care for their patients. While I have never worked at a facility the employed "turn Teams" and the bedside nurse was responsible for that care....it is understood that these basic needs are performed as the standard of care.......so what else does the patient need....right now.
We all know that at 3 am and the patient presents with some symptom or deterioration it is the nurse who call the MD and acts as their "eyes" and assess the patient for their needs and Ideas....how many times have I said wouldn't you like to order xyz? or wouldn't a xyz be helpful? so that when they ask WHY...you can have an intelligent answer for them with rationale.
Admittedly.....I have been a nurse for 35 years.....and I know very little about discharge planning for I have always left that up to the experts so that they could organize, brainstorm, and advocate for what the patients need at home.
Unfortunately, is is all about money.....medicare restricts what it will pay for and why they will/will not pay for any govern treatment/care/therapy and unfortunately many of the elderly and disable just don't have disposable income to pay cash and the their quality of outpatient/home care is affected.
- Jun 27 by MauraRNQuote from barrymedicI was thinking along the same line. SSRI overdoses are bears. On the other side of the coin, stopping her paxil or lorazepam can cause problems too. Paxil potentiates many other meds, including OTC/herbals. Could lead to the LOC, which led to the PNA, etc.Thinking about serotonin syndrome also. An over dose of her paxil may have caused it.