CoffeeRTC, BSN 16,754 Views
Joined Jan 22, '03.
CoffeeRTC is a RN LTC.
Posts: 3,629 (23% Liked)
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!
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)
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.
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.
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.
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?
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.
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.
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?
Never, ever approach these residents alone. Even if you need to take the cleaning staff in the room (unless it is a clinical issue) with you...have a witness.
Document word for word what they say and do.
Call your ombudsman. It isn't a sneaky thing to do....they are here for us too!
Call the doc and let them know about the behaviors.
Incident report or what ever they call it in your building
Call the family and let them know about it too (should also be part of the IR)
Go the chain of command too.
I wrote what I wrote not to be mean, but to try to shed some light on a concept which I can't understand. I just can't imagine an employee bursting into tears during a counseling session. Again, in my past life I worked primarily with men, and maybe I'm just not used to workplace emotions just because you're being corrected.
I see it often on here, some nurse running away in tears, or having to pull over on the side of the road so they can cry over a bad day at work. I don't get it. And again I ask: WHY ARE YOU CRYING?
I can see crying from a death or something, I reckon. I work in NICU and have been emotional over losing a beautiful baby a time or two. But from "Hey, you really need to pick up the pace, you're moving much too slowly and aren't keeping up!"? Not so much.
Also, you see lots of cries of "nursing isn't respected as a profession!". Well, do we wonder why, if this is what we're doing when we encounter conflict?
You wouldn't want to be my FB friend, anyway. I post Farmville requests ALL THE TIME.
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?
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