CoffeeRTC, BSN 16,210 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,612 (23% Liked)
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?
Actually many dentists give out pain medication after root canals. My dentist gives out percocet 7.5/325 or Vicodin ES 7.5/750 depending on what is going on...root canals, infections, abscesses(and believe me my dentist knows what he is doing). Root canals IMO hurt worse the next day. We all also have difference reactions to pain.
If you are new taking pain medication and it makes you dizzy/loopy/euphoric...take a day or two off.
"protect and enhance" I like that.
I think I get the general gist of the OP that unless most of us literally are not saving lives all the time. (again..generalizing)
I think I've saved a lot of butts in my day
I only have two situations where I did "save" a life. One was by simply assessing someone, finding a lot of mistakes and doing my job...a plugged trach, resp distress. And starting cpr on a young pt in LTC. In both of these sitiuations I was the only nurse around with two CNAs in my building..started care and waited forever for EMS to help. Is this what the OP was getting at?
As far as the PRNS..is it a separate paper or can it be documented with the med? We have blocks right where we sign our intials for pre and post pain assessment scores. That way we don't need to flip around pages. It gets done more often.
As far as 11-7...type up a check off form and give it to them to fill out nightly.
Sad but true there are alot of treatments that nurses sign for but might not actually do.
Cath care q shift...are you doing this or your cnas?
Moisture barrier q shift or prn inct?
Turn q 2 hrs
postition with xyx
I am not putting moisure barrier on each inct resident with each inct episode and I'm not doing cath care and I'm not the one position them in the wc etc.
I do check that these are done and will do them if I am with the resident or in the room.
My facility has these on the TARs that nurses sign out on. It would be nice if the CNAs can sign for them tho.
Since you are new (and I would explain it to the CNAs etc) I would check on those things you intial for at least until you know your CNAs etc.
If he has no POA then he needs to get a guardian appointed. ASAP to make these decisions. Why can the doc just right the order for no cpr if there is no family to make the decision?
This man is totally appropriate for hospice. End Stage CHF is an appropriate dx for hospice...end stage dementia too (if that is the case)
If he has the order for CPR or Full Code then that is what you need to do legally. If you can call the doc fast enough and get an order to stop then you don't need to do cpr.
This and these type of situations need to be cleared up ASAP. It is hard when you are working nights and don't see everyone.
Mr Smith...I am sorry you are having problems. I understand you are upset. Just being in the hospital/ nursing home is upsetting. No one ever wants to be here or signs up for this or one day wakes up and says...I'm going to the nursing home. Let me see what I can do for you now while I am in here and get things settled. As far as insurance....I have no clue who pays for what or how...everyone gets treated the same. I know it is no excuse that we are busy, but it is a reality in nursing. I'd love to spend more time with each of my patients but sometimes I can't. I will be here until 11pm tonite and I do answer call bells. Please give me a few mintues to get to it..we all try to work together but we have 28 patients down here. What can I do for you now?"
Oh..you were a pharmacist? Have you ever read the angry pharmacist blog? I understand retail pharmacy is crazy?
make sure when you leave he has everything he needs and let them know that you will try to be back in xyz time just to check on them.
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