What part of pt care gets overlooked most often

Nurses General Nursing

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Ive noticed oral care.

Last night I went in to check on a patient I heard moaning (not my patient, but was concerned). She was half in bed/half out, O2 off her face (sat 72), slumped in bed, leg stuck between mattress and siderail and hanging off bed. I straightened her up and was putting her O2 back on her face when I noticed her mouth looked awful. After her sats went back up, I did oral care over and over and over to remove the gunk in her mouth. I pulled out this huge CHUNK of stuff that was like hard plastic approximately 5 cm in size! She had thick slime all over her gums and her lips were cracked. That gets overlooked at our hospital with about 95% patients.

I can honestly say that 2 nights ago I gave one of my patients a back rub. She was in with a bowel obstruction and had a colectomy and had chronic back probs. Lying in the bed so long had made her back hurt, pain meds didnt touch the pain. I applied heat packs, which didnt help. I finally eased her up in the bed and gave her a back rub with baby lotion. The look on her face was priceless. And it did help.

IV's are definitely one at our hospital too that gets overlooked, they do not get changed when they need to be. The previous nurse will say "I didnt because it looks good and has good blood return". Well, if they are a HARD stick, maybe. But not when they have veins that look like garden hoses. We are sooooo short-staffed and overworked, we honestly dont have time to do the things that need to get done. Last night, we had ONE assistant on the entire floor. How on earth was she supposed to be able to provide care to everyone. Its horrible. The ones who decide to short staff will be the ones in that bed one day and then they will see what these patients are going through. Its sad.

Wow.. seems like in addition to the physical it was the TLC that helped :)

Specializes in Med-Surg, Tele, DOU.

oral care. finger nails.

Oh, how many times have I asked little old ladies to keep those nails clean or get rid of them.

I noticed a big difference when we went to 12 hour shifts. When we did the 8 hour evening shifts, especially, we were generally organized enough, assessments done, orders checked and meds passed, to do HS care, part of which was oral care. Sometimes, since days were so busy, it was the only oral care the poor patient got unless there was a disease process going on there.

Coming on duty at 7PM and needing to do full body assessments, new order checks, med passes and everything else we needed to do in the first 4 hours, we seldom had time to chivvy the ambulatory patients into the bathroom to do their own oral care, much less do it for non ambulatory patients. HS care was reduced to pain meds and sleepers, with an occasional back rub for a post op patient who'd overdone it during the day. We didn't settle down enough for oral care until midnight, and by then they were all trying to sleep.

Chalk the lack of consistent oral care up to decreased staffing, longer shifts with badly timed shift changes, and the need to set priorities in order for patient safety and not comfort.

I Work In Ltc, Everyone Is On Some Kind Of Bowel Prep. Tubing Is Changed Every Sunday On 11-7, We Only Have Picc Lines, Dressings Are Changed Once A Week If Opsite Is Used, Everyday If Insertion Site Covered By A 2x2. If These Are Not Done We Have The State Crawling Up Our Butts. We Use Oral Balance For Oral Care And It's Great. I Guess Trimming Fingernails And Toenails Is Our Downfall.

We Just Started A Program Where The W.cn. Assistant Will Do Nails. Usually, The Np Will Do The Diabetics.

Specializes in Cardiology, Oncology, Medsurge.

I agree with the oral care business; too many things to do and oral care is last on the list of priorities lol

Last time i worked my female obese patient had not had a BM in 7 days!

She was on Vicodin 5/300 q 4hours so this didn't help matters any...

I suggested a soap suds enema with warm water and she took me up on it, however after getting the order approved from the Doc it took 6 hours for myself and my CNA to coordinate our efforts to give this lady her enema.

So often we treat people with pain but forget to assess the causes!

:caduceus:

Specializes in OB, HH, ADMIN, IC, ED, QI.

Consideration of all bodily systems (not just the errant one(s) being treated), emotional well being, and need to know. How many times have we been told to "explain the process to the patient"? How many times have we neglected that, or assumed someone else did that?

I think an easy to use daily list needs to be placed at the patient's bedside where it is in plain view and not likely to be thrown out or spilled upon, like they have to maintain cleanliness in public restrooms at restaurants, etc. with a writing utensil attached to it, to initial basic needs.

Those facilities with handheld computer data must be conscientiously used. That means, don't chart something as accomplished, if it wasn't done!

Now that all charts are not on the foot of patients' beds, or outside their doors or taken away in the mistaken belief that information therein is the purview of professional staff only and not for patients' review, something

needs to be at the bedside as a reminder, but not where vistors can access it. It could be in a waterproof closed folder, to maintain privacy, and if visitors show an interest in reading it, labelling it "Private and Confidential would absolve the Nurse from breaking HIPPAA..

Patients used to be made to feel like naughty children whose hands were caught in the cookie jar if they looked at information originated by others about them. I feel strongly that rounds need to be made again by charge Nurses with the chart each shift. reviewing with the conscious patient the lab results and vitals, and procedures they had or will have soon, and to treat them as a member of the healthcare team, to ascertain that they did receive the care that was noted, even if that means looking in their mouths if it is thought they may not remember having oral care. or are not fully conscious. Remember to act interested in each person/patient, as if they were a favorite relative pr friend.

This will impress patients with your concern about them, and can be done quickly by explaining that you will come back if they have questions that can't be answered during rounds, and WRITE DOWN the patient's "need to know", so the charge Nurse (not the caregiver about whom the patient may have a complaint) WILL COME BACK LATER!

This really will save time (if misunderstandings occur) and increase confidence of patients in the care they receive. Make time to save time.

I'm in an ICU so we have more time for hygiene stuff. I would say we aren't able to give enough time to patient/family education. We're always just running in and out of rooms in a rush as we go over our "to do list."

ahh the illussive teaching - yeah id have to say that isbiggie for me - had a daughter come in to our dementia unit freaking out - had had dad in several NH where they handed her a pamphlet and said nothing - then coming to a unit with a LOT of dementias in onee place spooked her- thank god it was a half quiet ( if ya can ever have that hahah) night and i was able to spend over half hour showing her around and explaining things she might see and calming her - reassuring her and basically explaining what i could abot dementia. she was so upset that dad said things that were not like him- i felt good by the end of talking woith her that i di dgood but it is a very very rare chance to get to do so.

Specializes in Diabetes ED, (CDE), CCU, Pulmonary/HIV.

I agree with oral care on total care pts. However, this is getting better in ICU/CCU setting because of the push to reduce Ventilator Associated Pneumonia (VAP)

Specializes in Rehab, LTC, Peds, Hospice.

Oral care big time. I'm responsible if the CNA's don't do it. If I"m made aware I make sure they do. My NPO patients I usually do try to do even though the CNA's are supposed to. The other day of course I didn't get to it with a patient that of course is the families big concern (focusing on that lets them forget how sick he is, I think). It was just a hellish day. I gave him lots of attention that day, just not mouth care yet. (Breathing treatments etc) I was totally honest with them about it, luckily they know me and know I try very hard to make sure my patients get good care. It's so frustrating though! I have 26 patients and 2 cnas (LTC and rehab) theres just sometimes a limit to what can get accomplished in 12 hours with that many people. As far as quality care goes, incentives are not going to magically give me more time to do the things I"m already committed to provide to my patients, more staff is!

Specializes in OB, HH, ADMIN, IC, ED, QI.

Only in the UK and British Commonwealth are there times when visitors aren't allowed, still. In the US, we value their participation in patient care. They feed their friends and kin, and I'll bet if we handed them a toothbrush or mouth swabs and demonstrated it, they'd help with oral care (with patient permission, of course). There are times when procedures are done, that they are asked to wait outside - and won't leave if given an approximate time for re-entry.

I like the signal buffet restaurants have to indicate the time for the dirty dishes to be removed - a sign that says so.

Range of motion is also a big issue, as is the need to avoid "foot fall" by positioning correctly. How many times does a patient on qh turning, actually get turned?

Specializes in ORTHOPAEDICS-CERTIFIED SINCE 89.

I confess I didn't read all pages. I have an eye floater that's driving me batty.

But I'll vote for tooths and hoofs, ears and rears.

I can't tell you how many patients tell me their feet had never been soaked in the bath basin.

I also can't tell you how many tell me they have never been given a hot wash cloth before meals and another after they use the bed pan.

Specializes in Psychiatric.

I think the patient's feelings get overlooked more often than not. We go about our business and hurry to get things done, charted, passed out, etc., but I think sometimes we fail to notice how the patient FEELS.

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