Latest Comments by CoffeeRTC - page 34

CoffeeRTC, BSN 16,989 Views

Joined Jan 22, '03. CoffeeRTC is a RN LTC. Posts: 3,635 (24% Liked) Likes: 1,667

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    We have a program in place that is to prevent the hospital transfers. At first I was a bit miffed with it. It seems like it took the critical thinking part out of nursing BUT it really is a good program for newer nurses or nurses that don't do LTC and would just send the resident to the ER.

    With time and practice, situations like these will become easier. Sometimes the dx that you get for admit are blanket ones....seems like just about everyone gets a DX of dehydration and UTI even when I sent them out for cardiac arrest and was doing CPR on them....Haha but it is for real!

    Other things you could have done was try to get some food (carb/ protein in her) what about the other vitals? What about UTI? When you get a resident with the low blood sugars (or really high ones) try to figure out what was causing it in the first place.

    We have a rather unstable resident with resp problems, IV antibiotics, tube feed...had a really low blood sugar..nurse was getting ready to send her out turns out the tube feed was turned off for hrs and this person got hs coverage and a huge dose of Lantus.

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    Magee had them a few years ago. Not sure if they were hiring new ones tho

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    This is a big problem in my facility. Its a smaller place with 50 beds. 5-6 cnas for 7-3 and 4 or 5 on 3-11. Baths/ showers rarely get done even when we are at the high end of staffing. The only time they are getting done is when the resident/ family asks for it. It is killing me. The excuses are always plenty and what kills me is that I let them get away with it for the most part..if I'm running in circles the last thing I think about is who is getting a shower tonite. I know that is my fault but I rarely get backed up when I counsel or write up cnas.

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    If it was an 11-7 shift..that might be okay staffing.

    I hope you didn't sign that right up! Yes...I do see the argument of trying one prn med to see what works, but 90% of the time in this environment...both will work together to get the right results. Often times it could be agitation and discomfort/ pain. Yeah, the agitation could have been caused by the pain, but treating them both makes sense. Makes even better sense when you are the only nurse for that many people and you already tried the non pharm interventions. The only thing they might be able to get you on is if you charted what you did prior to the meds.

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    Pros and Cons will be different for each person.

    Depending on the shift and type of center expect to be busy for the most part. We have alot of rehab patients and for a 50 bed place we average 2 or so admits a day some days none for a few days then we might get slammed with 2-4. It varies. The stays are shorter now since alot of our residents are rehabing and going home or to a personal care. We see alot of hips and knees too. Wound care and cardiac patients that are in for some cardiac teaching and therapy.

    For those 50 residents we will have 2-3 nurses on staff. 2 that do the meds/ treatments and one nurse that is the charge or desk...makes appointments/ arrangements, deals with doctor calls and orders, rounds with the doc, calls family/ pharmacy and starts on admits/ discharges etc. When we have 3...it is doable.

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    xoemmylouox likes this.

    Awe...huggs. Gotta be hard with the kids. I have that hard time with my LTC residents. You get to know them and the families.....huggs again.

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    Enjoy!!!!! I work LTC too and can count on my hand the "slow days" that I've had in the last year. Man, they were weird...felt like I was missing something but everything and then some was done!

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    Yep...Pittsburgh downtown is expensive, but if you lived in Boston..i think it is cheaper than that.

    The PP hit it on the head with her descriptions. Stay out of Oakland (closest to the hospital...total college area)

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    onyx77 likes this.

    Wow...I had hyperemesis and took the Zofran like candy. Lucy for me it was the po this time around. I did get more headaches this time around and thought it was just from being dehydrated and never really associated it with the Zofran..the fatigue I assumed was just from being pregnant, sick and having other kids. Never associated the two.

    Major side effect in most pregnant women that take the zofran.....slight to extreme constipation (more than a normal pregnant women would have) I've also seen this in a few elderly patients that I give this med to.

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    I've bumped myself down to a CNA or LPN duties when needed. I've worked with other nurses that might not have been able to do the LPN work or CNA work. I was still accountable for the staff and residents at the RN.

    Yes...it makes sence to have to delegate downward? Or that the LPN should maybe fill in as the the CNA or med tech but it doesn't always have to be.

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    So would you do anything different if it was contagious? Is the would being dressed and covered? If it is dressed and covered and not draining all over the place or the resident isn't picking at the would they shoudl be treated no differently than anyone else with a wound.

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    Capecod said it...the LPN cannot supervise the clinical practice of the RN but...she can ask questions.

    Lets say that I as an RN works as a CNA...if the nurse on duty who happens to be an LPN asks me a question about care..."Did you put the barrier cream on Mr Jones or is Mary's splint on?......is she just asking about her residents, supervising me or just making sure that care was done?

    In the OPs sitiation..its hard to know exactly what went on..was that nurse just finding out what care was done or trying to "boss" the RN around?

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    Mully likes this.

    Oh...I bet you were using the pulse ox to get a sat and pulse?
    Always check manually. In LTC alot of folks have poor ciruculation and the pulse ox machines don't work right.

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    Um...sounds like what you did was correct! If you had any "crash cart" like items you could have gotten them ready while waiting for EMS. (our EMS response time is around 2-5 minutes) If EMS gets there before the paperwork is done, just get them out of the facility. You can always fax the papers to the ER.

    Good job!

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    No experience in AL or billing and my MDS experince is distant....
    Does she need more assist with adls? Now incontinant? Wounds? Help with feeding or bathing (adls) different type of meds? maybe injections or blood sugars? Behavior monitoring or any pt education?

    I'd just ask what the specific changes are in the level of care? If she has declined...don't they need to tell you? Do they have any type of family conferneces?


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