americanTrain 3,728 Views
Joined Jul 11, '08.
Posts: 109 (25% Liked)
Yes they are always skilled, the difference is I have a separate unit for private suites, the dining is separate as is all the activities. We have a wonderful 8000 sf gym for rehab. The ones who qualify for the MSU program have to be willing to do the program at higher levels and be discharge to home usually within 4 weeks. The other rehabers will still go onto skilled unit but a lower level of care and stay longer.
mso819, sorry about the name mix up, it's been a while since I've been on here and they have added the color codes, lol
Thank you Bronze 2, I am really surprised I haven't gotten more responses.
Does anyone know where I can find a good comprehensive test for CNA's who work in Ortho? Our facility is opening a new unit and I'am putting together training modules. I have researched numerous sites and cannot come up with one.
Thanks for any help in advance.
Several larger nursing homes are adding Medical Specialty Units. ( MSU ) This is separate from Skilled Care but more advanced than Rehab where the focus is on quality indicators, outcome measurements and teaching. The core of these programs is individualized and tailored to the patient for education, group and individual therapy with attention to comorbidities and physical therapy to return to maximum functionality. These new units have special programs in Diabetes Care, Wound Care, Pulmonary, Cardiac, Neuro and Ortho., just to name some. I would like to talk to any nurses out there who works in one or has ever managed one of these units.
Do what makes you happy, if they are begging you to come back, weigh out the pros and cons. As a nurse you need to be happy where you are. I drove a commute for 3 years and loved the job until a lay off. Now I work 8 miles from home. If the commute is not too bad, and you might just get a raise; obviously you were invaluable.
Seems to me that the Urologist would have inserted a larger one, not smaller, which they usually do on intervals until the right size fits the stoma. Im not a Urology nurse, and if I'm wrong, I admit. I have seen this in our place too.
Is this resident Diabetic? You may be looking at gangrene instead of eschar.
In our facility eschar is left dry and OTA, with offloading, LAL, etc. The eschar provides protection. Unless there is an underlying infection, which it sounds like may be the case with yours, with erythma, tenderness and warmth, whether there is drainage or not.
You might want to refer to a wound care center , get order for Doppler first to diagnose any circulatory compromise. Eschar will usually dry out and slough off, Iam currently treating one just like it. We first went to antibiotics with no success. No healing after 1 month. Doppler found a 70% blockage. No treatments you do will ever work unless there is oxygen to these tissues. In some cases surgery to create better blood flow is the only way. I hope this helps.
Christy, you are exactly right! I just wanted to hear it from another nurse. There is one particular hospital that refers to us, these patients become our residents and we are supposed to fix their mistakes. I figured it was a reimbursment issue, much like if a patient develops a UTI in the hospital stay, Medicare will not reimburse. Must work the same way with wounds, the paperwork and H&P always states that skin is intact. I assess them as soon as they are brought in the door to find stg 4 to the coccyx, or unstagable heels with black eschar covering the entire heel. Frustration!!!!! Our facilty has to fix these wounds and a lot of the time are sent to the WCC where first visit is 1800. - 2000.00 visit. Wow, now we know where the Medicare money is going to.
OOPS! They did it again! Arggggg..... I really dislike some hospitals who want to say that LTC causes all the wounds.
I agree with the others, get your certification in wound care. Im not sure with a BSN if you have to have the hours or can just take the class. AD RN's have to have 2 years of full time wound care experience before taking the course and test. I started out slowly as a DON and did all the wound care in my facility, then went to full time wound care nurse elsewhere
The first vacc foam fitting is the hardest for me, I measure the L,W,D of the wound bed and calculate in my head about how much I will need, I like to use a separate piece if needed the first time. But I always write down on my cheat sheet the length of foam that I used so that next time the change is a breeze. As the wound bed contracts and gets smaller, so does my piece of foam.
What's the deal with hospitals today, do they not get reimbursed for a hospital stay if the patients develops a wound? When I worked in Med surg, all wounds had to be documented on admission and discharge. We are getting admissions from hospitals where every other person admitted has no documentation or the report says skin is clear. Even in the doctors progress notes! I'm talking about stg 3 and 4 wounds, heels, butts and elbows! Any other nursing homes seeing this unfortunate trend?
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