Oy! I have had the crud for over 3 weeks now. Working in the cold wet snow last week did nothing to help me!!
Yesterday, I woke up, saw the cold rain, and called out. Thank goodness it was mild and sunny today, so I worked. I think I was punished for calling in sick...
I had 2 news admits and three re-visits. 14 mile total mileage.
Called one of the revisits b/c I was to teach the sister to draw up the insulin. She waas not able to make the appt, and since he had enough syringes drawn up and FBS was 120, I told him we'd be there wed at the latest. (Did not tell the supervisor of the opening...sssshhhh, I only do this when I feel like doo doo!)
Next re-visit, a wound, no biggie, simple visit.
Next re-visit, in a roach motel (aka high-rise bldg) was a daily wound. She attempted to refuse visit yesterday, why I don't know and why nurse pushed for visit I don't know, but when I got there today (no phone of course, so I had to make the trip) she "wasn't home, but the person ansering the door would only crack it open, like she didn;t want me to see inside. I'm thinking Hey lady, you don't have to tell me twice...LATER!!!!
First new admit. OMG, obese lady with gigunda breasts, s/p cabg. No mentions of open wounds/wound care on referral. (see where I am going w this?) I get there she can barely stand, has diff ambulating, is crying in pain, and person in home was snapping at her, and got hostile w her b/c she asked him to clear a space for me to sit (major clutter and junk on the floor, this place hasn't seen a vacuum in a dozen years)
She says she is having CP, aka incision, plus arthritic pain in shoulders. She needs more celebrex, but no Rx given, only thing that helped her pre-op.
She has to beg to get a glass of water, which finally I just went inot the kitchen and got for her, avoiding the hostile one. was a little afraid to have too open of a conversation w her d/t this semi-scary dude over-hearing and possibly over-reacting.
She can't even put pain pill into her own mouth, I have to put it in, along w her other am meds, and hold the water to her lips.
At this point, it is clear that the 4 wounds I discovered will not be able to be taught to this CG, pt can't reac/see areas, and this lady is not appropro for HH. I tell her as much, and she cries, saying her son won't lift a finbger to help her. I explain that due to her pain (figured we could play the CP card, even tho I know it was incisional pain) and call 911, and I could speak to the docs and try to get her re-admitted so she could 1 get the assistance she needs, 2 get her meds, 3 get her drsg's changed, and 4 get her meals and adl's met.
She absolutely refused this. This baffles me. I mean I know it is depressing to go back to the hospital, but isn't risking sitting in your own poo kind of depressing too?? I do not pass judgement on the pt, but I do think to myself, well, you made this choice, so now you have to live w it.
Her breats were so HUGE, there was no way she could hold them up to even look at her would in a mirror d/t her arthritis. This teensy area btw the breasts that was not healing, gushed a cup of serosang fuid when I did lift them to do the drsg change. I was grossed out w this cold and all. But no odor, and clear fluid. It won't be long before she gets and infection in this environment and unable to control sugars, and she will be septic. She never told anyone what home situation waas like, if she had, they probably would not have d/c her to home.
So urgent MSW referral made, per our policy, they do NOT want US to call APS, they want all communication to go thru MSW. I am OK w this b/c all APS would have done on Sunday is offer her the same options I had, and she had already refused that.
Also PT and HHA. RD may be needed at a later date, but her RBS was 149, so not too bad.
I documented that she was probably not appropriate for HH< but that "ethically, SN felt that assistance offered by VNA was better than no assistance." I did of course call the sup, but d/t lurking mean guy, I was afraid to discuss this IN the home w sup, so I had no choice but to commit. I'll probably catch some heat for this one!
Next admit, a sweet LOL, clean neat house
s/p CHF. She has complete faith in her docs. Takes meds as directed on bottles, and has no idea what any of these meds are for, despite the fact that she has been taking them for 2 years or more. Teaching started. But you know how you can't always tell if someone is wifty on the first visit? I have a gut feeling we may have a little wiftiness going on here, that will come out eventually. She has a caring involved dtr, but she couldn't be there today. We'll see how this develops.
Just wated to share this one b/c of the ethical dilemma. What would you guys have done in my place?
PS Sun, thanks for the bump, you think I should stick this one too?
Reg, glad you are enjoying it!
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