Latest Comments by CoffeeRTC

Latest Comments by CoffeeRTC

CoffeeRTC, BSN 12,768 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,478 (22% Liked) Likes: 1,484

Sorted By Last Comment (Past 5 Years)
  • 0

    We've been using melatonin a lot more and it seems to help. You might have to up the dosage on it though. We really try to stay away from the other sleep meds and find that they don't always work but cause a lot of other issues. How about aroma therapy like Lavendar? Sounds silly, but what about a warm bath or shower? Has he been assessed for pain? Even minor aches can keep someone up. Tylenol has been effective for some.

    Realizing that what works today or this week, might not work next week.

  • 0

    Was he living at home? Psych evaluation? For anxiety? The elderly definitely can take pain meds. Is he getting an antibiotic? Stool softner? You mentioned no colostomy output, what about that? Is he dehydrated too? Therapy needs to look at him for positioning / comfort.

  • 2
    NutmeggeRN and Mariesmith like this.

    Hmmmm. I'm going to think about this more and then come back to post more.

    To start....the basics...shows up for work on time, little to no call offs, comes in for meetings or completes continuing education/ inservices. No complaints from families or diciplinary reports, completes duties as assigned in a timely maner.

  • 4
    sallyrnrrt, Kitiger, mtjoanna, and 1 other like this.

    It really stinks to be put in this position. You did treat and assess her at the SNF. As long as you charted all of the above and the converstations you had with the family, you should be okay. Was she A &Ox3? If not, the POA would be making the decisions. The POA said to keep her at the SNF.

  • 0

    Another thing that we need is an actual prescription for their controlled meds. The sooner we get this and the sooner we get the med list, the less of a delay.

    We still do good old paper MAR/ TAR and orders (we get them printed monthly from the pharmacy). Since most of our admits happen on the 3-11 shift and the pharmacy quits taking new orders after 5pm, this gets tricky. That and the fact that the drs offices are closing around that time. If we can get the orders faxed to us early, review them with the MD and get them sent over to the pharmacy, we are more than likely able to get them on the PM delivery from pharmacy if we donnot have the med in our emergency box.

  • 1
    vintagemother likes this.


    I've created a special hidden place for supplies for the weekend! I have another nurse that shares this special hiding place and restocks it. After many years of working together, this is the only thing we find that works.

  • 0

    Yikes! This is a messed up situation. No therapy for days? Not OOB? (what about using a lift?)

    I've seen some crazy dc AMAs in my day. Some I kinda agreed with the family. I wouldn't have removed the foley unless the MD ordered it. As for a wheelchair?? They cost hundreds of dollars, so I wouldn't have let them borrow it unless I knew I was getting it back within the hour.

    AMA dc= no meds and insurance won't be paying for the stay. I'd make sure the family know about that too.

  • 1
    suzw likes this.

    I already agreed with sending out the above resident. but I used to see so many unwarrented hospital transfers that I can agree with calling a supervisor or DON before a send out esp if it is a newer nurse.

    I've called drs before when I've had residents with a CHF flair up that might have needed a chest xray and increase in lasix or someome with COPD that might have needed nebs ordered. Doc right off the way is saying "send them to the ER" when it can just be a simple med change.

  • 3
    JustMe54, LadyFree28, and suzw like this.

    20 or so years in LTC and I would have sent him too. YES, we do have stat xray services and pharmacy and could start and IV long would getting that in place take? In my facility it would be more than a few hours. With it being 9pm already the Xray probably wouldn't have been done and then read until the am. Pharmacy would take at least 3 hours (we have an ebox with some meds) and the IV might not be able to get inserted either.
    I love the medics but get a chuckle with how they love to provide diagnosis within 5 minutes. The high temp and sob/ wheezing doesn't always equal sepsis.

  • 0

    If there is an urgent need for safety, I'm calling 911. I try to never let it get to that point.

  • 1
    jsfarri likes this.

    So, with the LOLs above, it looks like this is a problem everywhere!

    Our policy changes. Right now CNAs are to remove any visible matter...crumbs etc from meals. I think housekeeping has a rotating schedule for deep cleaning them. We used to have 11-7 cnas clean them too. As for the lifts...I don't really know.

  • 1
    NurseBri78 likes this.

    BTDT. Don't you just love the super late admits? I see nothing wrong with what you did. If the doc refused to accept the patient what else could you do? I'm guessing the ADM might have wanted you to doctor shop?
    Crazy situation.

  • 6

    It is different in each SNF. It depends on the size of the facility. Sometimes just being the RN on duty makes you the supervisor. ASK to see the job description.

  • 0

    Will the RT be there with you all shift? Its been years since I worked in a facility with vents so I really don't remember much. What are the other skilled residents like? High acuity? Is this 11-7? or 3-11?

  • 0

    I think a STNA is a state trained nurse aid aka CNA?

    I've worked in large facilities with 200 beds down to a 50 bed facility. The politics are everywhere. Seems worse in the smaller one though. If you are a supervisor or manager, stay consistant and fair. Go by the rules, don't play favorites. Don't get caught up in the gossip. It will pull you in and drag you down. Same applies for the staff nurse.