Latest Comments by CoffeeRTC - page 34

CoffeeRTC, BSN 18,604 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,715 (24% Liked) Likes: 1,800

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    Yep, just because they are obese doesn't mean they are getting good nutrition. What about activities or therapy to get them moving a bit more? Second the wound consult too. At that point they might need the surgical interventions then wound vac etc.

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    Your facility should have an emergency box for meds. Us that if you don't have them meds. Best way to make sure you have the meds is to make sure they are ordered or re ordered. If you are regular staff, check your cart on a regular basis and re order the meds.

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    wearinwhite likes this.

    So..we've admitted to combining med passes. Is it "legal"? No.

    I'm lucky in that we've done things at my place to prevent this. Med passess are 9-1-5-9 with the 9 and 5 being the heaviest passess. If we get meds that need to be timed differently, then we do it. (antibiotics/ pain meds etc)

    Remember that you have the hr before and after to pass them so in a sence, if you have those meds that are timed differently you can pass them with you other passess. For example, our coumadins are at 6pm. I give them with the 5 pm med pass. We have it timed at 6 pm so that we have time to get the order changes back from the MD on lab day.

    Since just about all of us have the same issues with getting the med pass done, getting the treatments done, etc...why cant we change the way meds are passed?

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    The OP did state that they are trying things to stop the nausea.

    I remember that when I was pregnant and had hyperemesis and was on meds for it I still vomitted a few times a day. The meds cut it down, but it still happened.

    Make sure your res is rinsing their mouth after each episode. Watch what type of food they are trying to eat. What about something to reduce the stomach acids?

    I remember being so dry from not keeping food down and having cotton mouth and the cracked lips. I used lanolin on them or vasaline.

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    I think in most cases you need to look at bowel patterns. If that person puts out a small one every day and doesn't eat much, then that is okay.

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    I see this in LTC/ rehab too. What about a bedside comode? Or I ask them...what were you like at home? Do you use pull ups etc? If they say they don't have "accidents", ask them why they think they are having them in the hospital? I know they might not need to be told to use the call bell, but remind them or ask them to use the call bell for help before it gets to the point that they need to go so bad and then have an accident.

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    HelloM1M1 likes this.

    This is a tough one. I prob would have wanted to assess the back area while she was one the floor too. A fracture in the back/ spine wouldn't always show up just by looking at it. If it does, then that resident has a huge problem and would probably show pain.
    I took an EMT course in college (got certified as an NREMT-B but never practiced....I kick myself for this now). One of the assessments I remember well and use for falls etc it DCAP-BTLS..deformities, contusions, abrasions, penitrations, burns, tendernes, lacerations and S? I may be off on some of them, but it guided you on what to look for in an incident situation. Of course, you add in other things like LOC, behaviors etc.

    Assessing for a fracture you are going to look at the postioning of the resident, anything look deformed or any visible injury? What about ROM? Normal or painful? Think about how this happend (nice when they can tell you). Did they hit something when they fell or what body part did they fall on? focus on that area. After you do your nursing assessment you are going to report to the doc..sometimes I will suggest or ask for the Xray right then and there if I suspect a fracture or if I'm not sure, I will let the doc know about that too and leave it up to him or her. When in doubt, if something doesn't seem right, I'm going to err on the side of caution and let the doc know something doesn't seem right even if it looks okay.

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    What about CCAC?

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    What about a refresher course or getting a job in a skilled care facility?

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    Quote from Pinkmegan
    What is 'per diem'!!?????
    As needed..some call it PRN staff.

    Normally they get paid a bit more. No benefits but they commit to so many days per schedule or month or are on call for so many days or shifts.

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    1) No matter what you believe, you need to go by what whas charted. All of the residents have rights...if they want to go out on LOA and eat it up, so be it. When they come back, an assessment should be done. After you found the RBG of 591. you should have called the doc no matter what time of the night.

    Same thing for a fall/ xray.

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    Quote from Been there,done that
    Stethoscope? I don't need no stinking stethoscope.

    I can hear rales/rhonci with my ear . I can tell if a patient is in CHF from the door.
    Auscultation is over rated. If I see anything suspicious... I get an x ray ordered.

    That is the ONLY way to tell if it is fluid overload... atelecstasis.. etc.

    Bowel sounds? Nope . Don't need a scope.Take a mini history , visual observation will tell you if .. additional imaging is necessary.

    Heart sounds? Yeah .. right .. like I could diagnose a new murmur.. they don't pay me enough for that. I can however note signs and symptoms of decreased cardiac output.

    Plus.. they are a pain in the neck.. literally when they are draped over your neck!

    P.S. I don't wear a watch either.
    I got a chuckle from this! I agree, but sometimes the slightest changes that start the downward slide could have been picked up if someone just took the stethoscope and listened to them, KWIM?

    Having a one and knowing when and how to use it is key. I might not always know what I'm listening to, but knowing it ain't normal..

    I rarely hang mine on my neck..(EMT training and working with demntia pts taught me that one)..its on my cart, hidden of course!

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    This is a pet peeve of mine. I understand the need to do this for some people. $$$$$ but think about how it, how fair is it to one place when you are calling off or getting sick all the time or coming to work late because of the other job?

    A PP mentioned being able to do this because the other job she was management and had flexible hours...this is great! but for the most part, why do I need to always wait around for my releif nurse to show up because she got caught up at her other job or is sitting in traffic?

    Yeah, I turned this into a ven....sorry.

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    bwhahahah. Sorry, I needed to laugh. One of the duties of the CNAs in my facility (LTC/ Rehab) is to get vital signs. Half or more of them cannot do them without using a manual cuff, pulse ox for the pulse readings. Temp is the only one I do trust when the thermometer is working and the resps....yeah, totally made up.

    How do I know that they are made, we've "taken" all of the equiptment, but the vital signs magically appear in the book. Interesting. Some shifts it is a matter of staffing etc but if you have time to take a smoke break, sit around have the 5-10 minutes to to the vitals. might just be a matter of 5 or so people that need them.

    Bevore there are arguments...sometimes it is a learning issue and I've taugh or helped out with teaching how to do it (how do they pass the cert test?) If it is busy, I will do them when I can...I've worked as a CNA before and many a shift pitch in an always help.

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    Not_A_Hat_Person likes this.

    We do Nursing Home week. Been many a year since they've done nursing week or CNA week.