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FranEMTnurse, LPN, EMT-I Pro 42,262 Views

Joined Jun 7, '02. Posts: 14,165 (24% Liked) Likes: 7,528

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  • Apr 7

    Several come to mind. Inpatient geropsych unit in a metropolitan hospital, female patient who seemed to have her days and nights inverted, resisted being put to bed at night. Would walk the halls checking doors and looking in rooms. Found out after talking to family members that she was a retired RN who worked night shift for many years. I noticed that when she checked doors, it wasn't as if she was trying to escape the unit, but rather that she was checking to make sure that the doors were secured. If we let her sit in the nurse station for a few minutes and arrange papers, she was much happier because she believed that she was helping.

    Inpatient geropsych unit, free-standing mental health hospital. Female patient who didn't seem to have much memory left, walked by the desk where we had a copy of the patient rules and regulations out on the counter. Stopped, picked up the paper, read aloud word for word what was on the paper, put it down, and immediately walked into another patient's room.

    Inpatient adult mental health unit. Male patient from our companion geropsych unit came over to sit in the activity room. Spotted the piano, sat down and played beautifully (this man couldn't remember his own name).

    Same unit as above. Male patient from geropsych unit, convinced that he was the President of the United States. Wasn't happy until I agreed to sit down with him and listen to his ideas about foreign policy.

  • Apr 4

    My dad's mom suffered from Alzheimer's and lived with one of my aunts until it became evident she needed much more than family support.

    Anyway, Grandma believed (in her demented state - this was not *her*) that my cousin Evie was not her actual grandchild and said some horrible things to her. So, Evie, as a young teen, lived with a grandmother who kept insulting her.

    Well...her other grandmother had suffered a CVA and afterwards seemed to have a unique dementia of her own. Evie was staying over at this grandmother's house and this grandmother locked her in the bathroom! So, my poor cousin had both grandmothers against her. She climbed out of the bathroom window and went back home.

  • Feb 26

    Interesting. I just did my re-certification for CPR/BLS and there were a number of people in this class who were unable to do regular chest compressions for one reason or another. Nobody was turned away because of that. Some were offered a stepping stool to make it easier on their back. Don't know how this would work in a real life situation. Either way, they all passed the entire class/course and will be getting their certification. This was a mixed group of professionals through a large hospital.

  • Feb 24

    Quote from SmilingBluEyes
    "Elder dust"

  • Feb 24

    Wow, seriously you guys with all the hate? I was asking a serious question and NO IT'S NOT A DENTAL ISSUE. I floss every night and have perfect teeth and gums and have never had a cavity.

    And YES, I wanted to slap the nurse, b/c we were taught that you are supposed to roll up the dirty bedding gently and so that the dirty side is on the inside, while having the dirty linens bin nearby, not just fling it all over the place and eventually onto the floor, causing debris to go everywhere.

    The residual "taste" has mostly gone away, and I have several nurse friends who have confirmed that they have had this happen as well.

    So, yeah, you can all get off your high horse. Jeez...

  • Feb 24

    Keep a stick of gum or a piece of peppermint in your mouth and keep it moving because, Suga, you ain't seen nothin' yet.

  • Feb 24

    I've seen patients bow and squeak to nurses, humble themselves actually because of their vulnerability in sickness hoping by this action, they will be treated with kindness and humanity.

  • Feb 24

    Re. family members in the role of "advocates":

    where I work, it is encountered pretty often. In 95+% of cases it is more than one person permanently camping in the room, sometimes charged with family chores like babysitting, granny watching (other granny, not a patient, for whom the staff may be asked to provide care as well), online shopping and, for one case, pet care. Everything this person usually does is writing everything he/she sees down in form of utter nonsense, like "Nurse A came at x PM. Had tired face, gave me attitude when I just asked her for some iced tea with lemon, changed some blue tube on some machine and said that Mother doin' fine" and/or attempt filming it all and streaming it online for the whole family to enjoy. They bring zero benefits for anyone, and much trouble for everyone INCLUDING the patient.

    On the other hand, a few times families employed private duty RN to come for a few hours a day to keep patient' company as well as to meet doctors, get plans, etc. In those cases, the nurses were of tremendous help both for personnel and family just because they knew what you were doing. Even SNF "caregivers" (whose medical knowledge is very limited but who really know patient and can do some limited body care) are more useful as "advocates" than nit-picking family members.

    Take home fact: only one case when family member can play a role of "advocate" and be good at it is when the said family member has at least some sort of medical knowledge/is teacheable, knows his limits, able to hold himself within limits of civil behavior at all times AND knows the patient well enough to be able to make some serious decision. In all other cases, the worst case scenario is going to happen early or later - that being the staff not seeking contact/softly avoiding/rotating care for the patient.

  • Feb 24

    I would add a few things. Some of them might sound blunt but...

    - learn who is who and who is doing what. If you feel a new and significant pain, for one example, pain, immediately ask for your NURSE. Passing information through secretary/CENA/etc. takes time.

    - thou mustn't tell lies... seriously. For example, if you take 4 pain pills a day but tell that you only take "some", or smoke 2 ppd but afraid to say it so that you won't be treated like an addict, everything that happen is you going into withdrawal. It won't feel good, and it won't help anyone, you including.
    Believe me, there is no many things you can surprise anyone in health care. Relax and TELL THE TRUTH.

    - if you need help, ask for it. If you don't (and you KNOW it), go ahead and do it as long as it is safe. I am not telling about programming IV pump; I am telling about wiping yourself after visiting restroom.

    - do not think you come in a healthcare facility to get anything except what you came there for in the first place. It is not a resort, an entertainment center, spa or restaurant, whatever is said otherwise. If you do, the staff will eventually start to softly avoid communicating with you, and it will be truly the worst thing ever that could happen with you in a hospital. It will bring more risks than pretty much anything else. So, make staff LIKING to work with you, and you greatly improve yoyr chances to get outta there alive and better than before.



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  • Feb 24

    Tragically, many people die from medical errors every year in hospitals.

    It’s hard to know how many. “Medical error”is never listed as a cause of death on death certificates. But according to Johns Hopkins Hospital patient safety experts in a report published in 2016 in the BMJ (formerly the British Medical Journal), medical errors are the third leading cause of death, causing more than 250,000 deaths per year. In order of prevalence, here are the leading causes of death in the US:

    • Heart disease
    • Cancer
    • Medical errors
    • Respiratory disease

    Note: Not all doctors agree with the study results, saying the study did not differentiate complications from medical mistakes. For example, a pulmonary embolism following surgery is a known complication, whereas amputating a wrong limb is an error.Still, the article brought the subject into the spotlight. Medical errors include failing to diagnose, such as sepsis, failure to rescue, surgical mistakes, medication errors, and more.
    Sometimes even Nurses Make Fatal Errors.

    Hospitals are dangerous places. But there are things you can do proactively to reduce your risk for harm.

    Family Member

    You need to have a family member or friend with you. Patients with family present at the bedside receive more attention than those without. This is my observation and seems to follow human nature. It holds staff more accountable even when it is not a conscious effort.

    Identify a spokesperson to speak with the doctors and communicate to the rest of the family. The spokesperson should avoid calling the nurse at the beginning of their shift- give them time and you’ll be better received as well as get better information.

    Personalize Yourself


    For a longer hospitalization, put pictures on the wall or bedside table. It makes you a parent or a sibling. A person with stories. An animal lover or a guy who fishes. Not just another patient in a faded gown.

    Get to know the caregivers by name and be appreciative. It goes a long way.

    Speak Up

    Ask health care workers, including doctors, if they have washed their hands. Healthcare workers go from patient to patient and not all are conscientious about handwashing.

    Using an alcohol based gel is considered the same as washing with soap and water in most cases (unless they have been exposed to Clostridium difficile (C Diff).

    Informed consent

    You have a right to informed consent for all invasive procedures. Informed consent is provided by the provider.

    Informed consent is the provider explaining the risks and benefits so you can make an informed choice. There are risks to everything, including taking an aspirin!

    Don’t assume doctors and nurses know best or are infallible. It’s your body. Surgeons may see something as a surgical problem, while medical doctors see a medical problem. Some doctors are aggressive in treatment while others are conservative. Listen carefully to the risks and benefits.
    A pulmonologist once recommended my husband have an invasive and painful procedure (pleurodesis) to keep his lung inflated. His cardiologist barged in and dismissed the notion with a wave of his hand. “Ridiculous! You’ll be fine without it.” He was right.

    Hand Hygiene

    Wash your hands. Keep a packet of hand wipes close by and do not eat or drink anything without first using them. Picture invisible spores of bacteria clinging to high touch areas such as your bed rails and overbed table.

    Many serious diseases are contracted by hand to mouth transmission (actually fecal- oral transmission) such as Clostridium difficile (C. diff) spores. Avoid touching your eyes, nose and mouth -you may unknowingly infect yourself.

    Get Up

    Mobilize. Get out of bed. When you are in bed, natural processes slow down. For example, in bed, blood pools in the vessels. Clots form in pooled blood.

    Blood clots can be life-threatening. You will most likely be provided intermittent pneumatic compression devices to improve leg circulation. But the best prevention is to get out of bed.. When in bed, flex your feet and make foot circles.

    Staying in bed puts you at higher risk for pressure ulcers, lung problems...you name it. Sitting up on the side of the bed is better than laying in bed. Sitting up in a chair is better than sitting up on the side of the bed. Walking is better than sitting and getting out of the hospital is the best way to avoid complications.

    Falls

    Wear slip-resistant socks when out of bed and always ask for help when needed. Poor lighting, an unfamiliar environment, and the effects of medications can all put you at increased risk of falls.

    Infections

    Get your urinary catheter out. Catheters are a portal of entry for bugs. Ask your nurse if your catheter is still needed, and what is the plan for it to be removed. The standard is for urinary catheters to be removed 1-2 days post-op to help prevent catheter associated urinary tract infections (CAUTI).

    Likewise, central lines, including PICC lines, are a source of infection and should be evaluated for necessity daily.

    Medications

    Keep an updated list of your medications with you so your doctor can reconcile your hospital medications with your home medications.

    When a nurse administers a medication that is new to you, you should be informed what the medication is, and the reason for taking it.If you are a nurse, be sure and read 6 Essential Tips for Avoiding Medication Errors

    I hope these tips help next time you or a loved one is in the hospital. What other tips do you have to add?

    Nurse Beth

    Leading Causes of Death. CDC. Accessed February 2017 FastStats - Leading Causes of Death

    Makary, M. A., & Daniel, M. (2016). Medical error—the third leading cause of death in the US. Bmj, 353, i2139.

  • Feb 21

    Well written and easy to follow. Thank you!

    I knew a woman that ended up with peripartum cardiomyopathy and in need of a heart transplant. She delivered at 24 weeks and remained on a ventricular assist device for about a month waiting for a heart transplant. Fortunately her gift arrived and she was able to go on with a fairly normal life. She and her daughter both went on to become avid spokes people for organ donation. What an even a more amazing gift to be able to watch her daughter grow up...an opportunity that looked slim at one point.

  • Feb 19

    Even though it is apparently "rare," I still had no idea it happened as often as it does. Thanks for the informative article.

  • Feb 5

    Pinkberry77, thank you for your kind words. I wish you peace and courage in your challenging situation.

  • Feb 2

    After a 20+ year career as a professional photographer, I started my pre-reqs for my ASN at the age of 40. I earned my RN license 4 days after my 43rd birthday. I'm now 47 and I just earned a BS degree in Health Informatics. I'm the first person in my family to ever earn a bachelors degree and I'm super proud of my accomplishments. Couldn't have imagined that I'd be where I am today when I was 20 something. Never think you are too old. Never believe you are incapable of achieving success. Never give up on your dreams. And never ever let anyone tell you you can't do it!

  • Jan 29

    I thought this was our break! Even out here we have to deal with impatiens.


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