CoffeeRTC, BSN 19,449 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,733 (24% Liked)
Yes, in the acute care..you need something. Most often..pain meds work better than the psych ones (unless you are using enough of it)
bwhahahahah. Some shifts I might have 5-8 residents with qid neb tx (and some prn). you do the math and add on the 20 other residents. I do have to say that I am OCD about checking breath sounds before and after (not always with the chronic copders that are stable) and I like to have them all going at the same time, LOL.yeah it is noisy.
We were told that in order to get credit for the nebs that the nurse needs to be in the room too. As far as the self med rational...easy way around it. Get an order for "res may administer neb tx", get an pt ed form, go over it with the resident and then care plan it all. Bingo! We also have a page in the MAR for the breath sounds before and after, rr and time it takes for the tx.
I dunno, I tend to listen to the families. If they say mom needs xyz, I would go in and assess the resident. I will then use nursing judgment and educate family as needed. A lot of times they might not have complained to the nurse or the family might just want mom to be very comofortable and didn't know that we might have already done xyx for the resident.
I think the OP might be talking about the situations where daughter doesn't want to leave until mom is sleeping or relaxed. If they have dementia, you might need to creat a diversion so that the daughter can leave. Maybe the daughter feels powerless? I've shoo'd many a family member home and reminded them to call when they get home and check up on mom or dad. Talk to them, show them you really do care and are on their side.
I dunno. I've been in LTC for the last 17+ years. I like what I'm seeing now with the change. Granted, most of my residents/ patients are more rehab than LTC, but I'm still dealing with dementia.
I haven't been bit or pinched in quite a few years, the falls and injuries from the restraints have gone down since we got rid of the side rails, posey vest restraints, wheel chair restraints etc. Those vest restraints and hand restraints were horrible...can't tell you how many times I found someone all tied up and a mess.
When was the last time I saw an Alz pt all curled up in the fetal postion with without hand, knee contractures and bed sores??? years!
How about the patient that is soooo snowed they are drooling, need fed, changed etc?
Dose reductions are what kills me now. We finally get a med regime that works and some consultant wants to dose reduce. We aren't even using that much med to begin with. .25 of Ativan is a spit.
Now..it is different in acute setting, I do understand that. If the hospitals would devote some extra money to get extra staff or sitters or the low beds and use some of the techniques that we use in LTC, the agitation, agressiveness, feelings of being out of control etc could be reduced. I know it is easy to give the pill to snow them then do the hand restraints etc so they aren't pulling out the ivs, tubes etc, but in the long run..its just setting them back. Instead..look at why they really need the treatments...its it really necessary?
Sorry...I had to chuckle or LOL on this response. If I had to call the doc with every late med (In LTC) I should just sit at the desk and forget about passing the meds in the first place.
The med was a once a day med..two hours wasn't going to hurt. What was the risk of not giving the med? Patients have appts and are always on and off of the floor. Try calling the doc every time a med is late because of this one.
This is why I think the LPN is stuck in LPN/LTC land. In LTC, she would have to call doc and get an order to give it late, so that if the state audited that chart, they wouldn't get a "ding".
Then...why don't the nurses fill out the reason for the meds? I'm a nurse in LTC and love the idea. I'm not sure what the fuss is about ..if the nurses don't want to fill it out, why can't they ask the docs or NPs for the dx for the meds?
Hmmm...I want to jump in on this one and start off by saying, lets all take a step back.
OP, just wondering..are you a nure or in nursing?
I'm going to say that a lot of what you were asking about just could happen everywhere. It is how the staff are dealing with these issues.
Stuffy room.....a lot of these centers were built years ago and don't have the best AC around. We have a few rooms like that either because of the residnts in the room or the AC itself. We recomend the family bring in a small fan (most COPDers like one anyway) or we will try to move rooms. Room assignments are different than in the hospital. Even when we have empty rooms, they can be bed holds where the family is paying to hold a room or maybe the other person in there could have an infection that they can only be grouped with like patients etc. We really try to accomodate room changes the best we can. Just yesterday I moved around 3 rooms, cleaned them and moved the residents around to make everyone happy. (gotta love no housekeeping on the weekend)
Spilled juice...3 hrs is a long time but hahah, I'm wondering why it didn't dry up on its own since it was so hot. Srsly..since MIL is with it, she could have used the call bell to call for some assistance in changing the sheets. The CNA really probably just forgot about it and it could have slipped her mind to wash her up afterwards (was the juice stain visible?) again..could you remind your MIL to ask for help on this one?
As far as the multiple requests for help looking for this or that........Im sure your MIL doesn't want to be a pest, but the staff probably perceived her as that. They were wrong in acting snotty etc. You have rude people everywhere you go. I always remind the CNAs to make sure they ask "Anything else I can help you with now?" or "I will be back in about an hr to check on you" I'm sure MIL wasn't asking for any help when it was something she could have done herself. I also make sure that things they might want is all within reach..move tray table around etc.
As far as wondering what the "state" would think...did it have the potential to cause harm? (prob not unless she had a dressing on that area or an open wound)..did it cause harm? no...dignity issue? eh..that one might be a wishy wash one...so no..the state can't cite over every spilled item or the delay in getting it changed.
Keep visiting and keep looking after MIL care.
What is bad about LTC?
Having to do more with less...Medicare and insurance cuts. LTCs/ SNFs are having to take mroe complex residents and do more but still get reimbursed the same or less. That trickles down to the staff and resident care. Locking the suply closet for simple supplies, cheaper meals, doing away with certain products or maybe only ordering one type of it (briefs, soaps etc)
I can't complain about our staffing. The only time it stinks is when we have call offs and that isn't always the facilities fault. We really are trying to staff higher.
For 11-7, this sounds like heaven. I norm had 48-50 on 11-7 at one place and at another around 70.
Excellent answer Vegas!
Be creative and think outside of the box. Will he let you or is he able to wash himself in the bathroom or bed bath? Think small too...maybe start by soaking his feet in a tub or wash basin? This will take time to accomplish and trust me, I know time isn't something we all have in LTC.
and how many pages do you have to do?
At my facility, they are now computerized. Should be nice and easy, right? bhahahahahwhahahah. They take forever to do. Yes, it is easier if they've had an incident before since some of the basic info is in the system, but it takes a good 45 minutes to complete them now. First you need to be able to get a computer to use, then it takes 5 mintues to long on then after each section you need to save it and that takes for ever to do....ugh!
That wasn't a fall. If it was a true and actual fall and the PT witnessed it then we would have the PT initiat the incident report. The nurse would only be needed to do the assessment part. Some of our PT OTs are really great about doing their own incident reports too!
The resident kneeling on purpose to pray...I'd refuse to do the IRs. Could you have asked the resident to ask for assist and help them to the floor?
How about this other fun one...if they are in a low bed (even the super low beds where they are 5 inches from the floo) and roll onto a fall mat, we are supposed to do IRs on them. Yeah...fun!
Yes, make sure they really need the cath in the first place. I'd contact the POA to get any suggestions on relieving anxiety (ask if they know what type of meds they've been on or tried for this in the past) Remember that meds minght not help even if you get the orders for premedicating. Sometimes (as the pp stated) no matter what you try to explain to them, it doesn't much matter depending on the stage of dementia, but your approach will matter.
If it must be done, try to get in and get out as quickly as possible..set up your supplies and have extra nd enough help.
I'm from PA too and only have LTC experience. Every place calls things different. I guess in a way it might be similar to an ADON postion...look at the job description and ask them. What is the person above you called?
Just curious..what type of test to they give?
As everyone already stated...that is neglect.
I'm surprised that the family wanted the resident to come back to the facilty after that fall. I'm surprised that the facility didn't make this resident more of a VIP type of resident too.
We have a few CNAs that some res/ families refuse. If that is the case, they normally remind the nurse that makes the assignments or the other CNAs that they can't take care of so and so and that person is traded for someone else.
If you feel like the ADON is brushing you off, go up the chain of command. It might be that the DON or ADM don't know. What the hospice nurse...let them know too.
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