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Is this neglect



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Jan 24, 2009 09:43 AM

Is this neglect


We have a sever dialysis patient at our long term care facility. He is new. He is on a fluid restriction of 1600 a day which he gets with his meals and fluids he gets with his medication. He will demand water I have educated the CNA's that I manage to not give him water. I also would not allow a cup in his room because if one is in there he will go to the sink and fill it up. I know I could not take a cup of water out of his hand if he should do that but is it neglect to not give him a cup of ice. all of our other patients get a cup of ice 3 times a day. I am not concerned about the ice melting and him drinking that but I am concerned about him using the cup and we really would have no record of how much water he has drank. but is it neglect? I worry that if something did happen then my license is on the line . they would say you knew he was on a fluid restriction yet you allowed a cup to be in the room knowing he would use it. What would you all do in this situation. the nurses where I work are divided on this.


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12 Comments
No. 1
Old Jan 24, 2009, 10:02 AM

Default Re: Is this neglect
It depends on his level of orientation. People do have the right to be non-compliant.

This is a question for the super, and whomever care plans for him.
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No. 2
from lisaf79
Old Jan 24, 2009, 01:15 PM

Default Re: Is this neglect
i would give him the ice cup but remove it from the room after about 15 minutes or so. make sure you document on it thats very important. I would also confirm with the supervisor of what your plan is. At least your making an attempt to keep him hydrated.
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No. 3
from kat7ap
Old Jan 24, 2009, 03:02 PM
Updated Jan 24, 2009 at 03:02 PM by kat7ap

Default Re: Is this neglect
Is he alert and oriented and able to make his own decisions? Does he have a POA? I would say the bigger issue is that he's being denied the right to make his own decisions if in fact he is deemed able to.
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No. 4
from patrick1rn
Old Jan 24, 2009, 03:07 PM

Default Re: Is this neglect
No it is not neglect
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No. 5
from truern
Old Jan 24, 2009, 03:15 PM

Default Re: Is this neglect
I, too, am in the camp of if he's A&O he has the right to be non-compliant. I know how very frustrating it is for staff, but he is an adult and can make choices...including bad ones.

That is IF HE IS A&O.
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No. 6
Old Jan 25, 2009, 01:47 PM

Default Re: Is this neglect
Originally Posted by lisaf79 View Post
i would give him the ice cup but remove it from the room after about 15 minutes or so. make sure you document on it thats very important. I would also confirm with the supervisor of what your plan is. At least your making an attempt to keep him hydrated.
This may be hard to maintain...especially in nursing homes. I think that I would speak to the powers that be to alert them, ask their input and make sure that I document his behavior , esp. if he is a/o x3.

Originally Posted by truern View Post
I, too, am in the camp of if he's A&O he has the right to be non-compliant. I know how very frustrating it is for staff, but he is an adult and can make choices...including bad ones.

That is IF HE IS A&O.
I agree with this...I'd document the teaching, the instructions to staff, who was alerted that is over me and patient's behavior.
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No. 7
from Jolie
Old Jan 25, 2009, 02:13 PM

Default Re: Is this neglect
I wonder if part of the problem may be that he feels helpless to quench his thirst between meals.

Would it be possible to schedule a meeting with the patient/family, nursing and dietary? Perhaps his mealtime fluids could be cut back just enough to allow him to keep a small bottle of water with him during the day, with the agreement (if he is capable of cooperating) that he won't refill it. Or perhaps a pouch-type container (like Capri Sun) that can't be refilled.
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No. 8
from funnypharm
Old Jan 26, 2009, 06:42 PM
Updated Jan 26, 2009 at 08:02 PM by funnypharm

Default Re: Is this neglect
If I was in that situation I would find out if there was any kind of way that I could get him an ice tray with pop sticks. Maybe toss in a mint leaf if available. This way he could have a 1oz. ice pops between meals.
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No. 9
from lpn2icu
Old Jan 28, 2009, 04:10 PM

Default Re: Is this neglect
Explain, teaching and document it!
Otherwise, ask him to sign the AMA (Against Medical Advice)!
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