CoffeeRTC, BSN 16,440 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,618 (23% Liked)
How recent was the surgery? Some people really react bad to the anesthesia...did we know her kidney function?
A nice note is best, but if you want to leave something...think of your break room. Anything small you can get for it? A coffee pot etc?
I always act like it's the strangest thing I've ever heard.
"Hmm, I'm not sure what to think about that. Mary's patients usually say that she's wonderful. I think I'd even want her to be my nurse if I were in the hospital."
They usual start back-pedaling at that point.
Yes...orders in LTC need to be specific and when I do change over or see these incorect orders I fix them with a verbal order/ fax to the doc.
Treatment orders for LTC need to indicate where the wound is, what to cleanse with, if there is a primary dressing..what that is, then the secondary dressing or cover and how to secure it. It should also state how often to change.
Sooo...for this dressing in question...I would think it should be something like this...
Cleanse stage 2 to coccyx with NSS, apply sivercell (we use aquacell Ag) cover with replicare and chage q 3rd day and prn.
This is our standard dressing. Since it only said sivercell..It would have been a guess as to what to do with it or how to cover that...this shouldn't be a guess and I'm willing to assume that you didn't get this in orientation?
You don't say what type of facility this is in (not that it matters much). If it is LTC..you prob aren't doing a head to toe so what the CNAs tell you is what you get for changes in skin condition.
If the order wasn't complete, do what you need to do to clarify it or complete it. Leaving the resident without a dressing on isn't right. All facilities I've been in have a p and P for different types of dressings. If you couldn't find it, ask.
For the most part, cleanse with NSS apply dressing and cover.
Do you have a compliance hotline?
oh...another reason why I don't wear my shoes into the house and take my clothes off asap.
I'm sure you are nervous with it being your first day. Do you have another CNA that you are paired with that can help or mentor you?
As far as the CDiff..all of our waste is treated like it is contaminated. We don't bag it differently for our cdiff or MRSA or VRE residents. Yes, you can double bag something like a cath or colostomy with extra stool, but other than that..right in the reg trash.
Hmmm...What part of PGH? Most 12 hr shifts are more weekend coverage or supervisory.
I'm interested in your responses!
What harm would it be if you just ask the family? On the other hand...if you don't ask/ tell the family, they could be paying a person just to sleep.
I've worked in places like that. Go and finsh it out. It is only one shift. Keep thinking to yourself...I am done after this!!!
LTC is such a small community...word does get around. Even if it is a bad place and people come and go..leave on a good note.
Most centers in my area do on the spot interviews or at least mini interviews then schedule a full one. I second looking at the ratings before you go looking.
The bigger places with around 200 or more beds tend to have an HR person...smaller than that none.
What are DTIs? I've been in LTC for years...never seen this...is is Due to injury?
I'm willing to be they are pressure sores if they are on heels.
Are you just doing vitals and ADL or CNA work? That's probably why you don't have more access.
I'm willing to explain a few things. First off...the CNA could be wrong. Most often they are not privy to the dressing orders. They are the best sorce of info about the residents though and a good CNA is the eyes and ears for the nurses!
Dressing can be changed once a day, twice a day, every shift, every other day or a few times a week. It all depends on the order. Wound healing is best when moiste so a wet wound/ dressing isn't always bad. It probably needed a better outer dressing or could have just needed changed. That said, I would have just asked the nurse. Maybe the treatment wasn't working and needed changed by the doctor.
As far as the nurse changing the dressing. Just because you told me it needed changed..don't expect the nurse to drop everything right then and there.
Good observation on your part. LTCs have a ton of learning opportunities!
They are trying so hard to prevent readmits to the hospital, this could be one of those cases.
After working LTC for a big number of years, I listen to my gut. We can do alot of stuff in house, but sometimes they need to get going back to the hospital.
If the resident/ family wants to go....they go.
How about seasonal affective disorder?
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