Latest Comments by Kittypower123

Latest Comments by Kittypower123

Kittypower123, ADN, BSN, RN 3,032 Views

Joined Feb 13, '09. Posts: 138 (66% Liked) Likes: 275

Sorted By Last Comment (Past 5 Years)
  • 1
    NotAllWhoWandeRN likes this.

    Quote from Nurselm14
    I'm have found that working by myself such as a hospice case Manager or home care help a with the sensory overload part of it. I am responsible for my work with very little drama from other nurses. The families we work with are over the top sometimes but with some time by myself at the end of the day i did it for almost 6 years.
    Me too. I scored 22 on that little list. As a hospice case manager, I visit patients where they live. I love being able to see one patient at a time, then spend time by myself between visits. Facilities can be a bit on the noisy side, but I don't have to stay there for an entire shift, just long enough to complete the visit(s) I have there. I also make sure to take a lunch break. I eat and read (or something) and don't think about work. When I worked in LTC I quickly learned to leave the building during my break, even though I just sat in my car. It can be challenging for us sensitive folk, but it's doable.

  • 0

    Quote from NightNerd
    Regarding your concern about morphine: as a hospice nurse, I just die a little every time someone says that morphine kills people. IT DOES NOT. Used appropriately, comfort care measures such as morphine have been shown to actually extend the life of terminally ill patients in some cases. Their bodies aren't being as worn down by pain, and they have a greater quality of life for their remaining time. I have had several patients who were breathing 40-50 times per minute (normal being 12-20) who received morphine (or Dilaudid, or whatever) specifically to decrease their work of breathing. If a patient's goal is to be comfortable at end of life, morphine is often a very helpful tool to meet that goal.
    Amen!! I hate it when I hear "Morphine kills people." Or that hospice does for that matter. Keep getting the word out.

  • 3
    NurseGirl525, OnOn2RN, and AJJKRN like this.

    Quote from nutella
    I and my coworkers wonder a lot lately...
    Granted, I work in end-of-life care and there is a lot of symptom management related to terminal illness. There has always been the group of providers who are very hesitant to prescribe narcotics for symptom management pain and would not prescribe liquid morphine to deal with SOB unless the patient decided to be CMO.
    Pain management is not that easy to begin with if a person has more than the standard pain issues or prior substance use. When we see patients who have a prior narcotic history or are already on high doses they may do better with methadone but many prescribers do not have the experience and do not like to deal with it for example. I had a patient basically screaming out in severe pain because of cancer and the patient had a prior tolerance history with taking up to 200 mg of morphine a day. What can I say? methadone fixed the problem but it was an act to get there....
    I do think that providers need to be more educated about prescribing narcotics and also utilize other medications and methods.
    So well said! So much more education on pain control and narcotics is needed, specially in regards to end of life. I run into the Morphine kills, once you start taking Morphine you'll be dead in 2 weeks, type comments. Thankfully, I work with a doctor who is comfortable with Methadone - works wonders for bone and cancer pain too.

    As a side note, I do my own conversion calculations before I talk to the doctor. That way I can say "if we switch to x drug, the equivalent dose would be y." It helps that I work with great doctors.

  • 5
    sherri64, Kitiger, OnOn2RN, and 2 others like this.

    I just want to put this out there - "Normal" is a setting on your washing machine. Everyone is unique. As others have said, there is no stigma with taking medication for diabetes, allergies, hypertension, sleeping disorders or whatever. There shouldn't be with ADD either. Figure out what works, learn to work the way you need to. Just because someone else organizes themselves a certain way doesn't mean you have to. I get teased a bit at work because of how I do things, but I also get compliments for the results. I laugh with my coworkers (it really is all in fun, we get along great) and keep on doing what works for me.

  • 0

    I've had a few patients with sudden and quickly worsening wounds. Not all were sacral though. The first was actually her heels. I did a full skin assessment in the morning and was called back in the afternoon to by the aide to find both heels had large black areas. I don't recall them being butterfly shaped though. She was gone by morning.

    Another was a gentleman I saw in the afternoon who had several existing wounds. I noted blanchable redness to both hips. He was being repositioned frequently and the care was good. When I came back in the morning both hips had large black areas. He was gone within the week.

    In both cases I had heard of Kennedy ulcers and believed that was what I was seeing. My supervisor had never seen one. I have seen other cases, but those two stand out in my mind. It is an interesting phenomenon and definitely needs more attention in literature and education programs.

  • 1
    softrbreeze likes this.

    I work in hospice too and am going to pursue wound certification. If you go the WOCNCB website and look at the eligibility for the exam, it explains that there are two different pathways. Taking a course and successfully completing it make you eligible to sit for the exam (you must apply to take the exam within 5 years of completing the program). The other option is to qualify through experience. This pathway requires 50 CEs for each specialty (wound care, ostomy, and continence) you wish to test for and 1500 direct patient clinical hours within the last five years (at least 375 within the last year). I am opting to take the course. I am only pursing certification in wound care at this time, not ostomy or continence. You can look at the requirements at Eligibility | Wound, Ostomy and Continence Nursing Certification Board. Hope this helps.

  • 0

    A mass email saying "Thanks nurses! etc." At least it came out at the beginning of Nurse's Week this year, instead of the last day like last year (I think they forgot last year...oops). No reference at all the theme of the week though. From some of these posts, sounds like it could be a lot worse.

  • 0

    That wasn't a suppository!

  • 1
    Kitiger likes this.

    As soon as I finish this assessment I need to change the dressings in rooms 5 and 7, change the foley in room 6, help Susan in with the wounds in room 8, do my next med pass, and finish my charting.

  • 2
    NursesRmofun and LilyNurse123 like this.

    1. Things will never go according to plan.
    2. Lunch is a luxury.
    3. The last hour of the day is the most nerve wracking.
    4. You will rarely get everything done.
    5. There is a fate worse than death.

  • 2
    TriciaJ and NurseLemley like this.

    They're all alive and I'm off at 5!

  • 0

    ...the foley leaked all over the floor.

  • 0

    Hmm...sounds like A-Fib.

  • 1
    4boysmama likes this.

    You can get training modules by the End-of-Life Nursing Education Consortium (ELNEC) at Online ELNEC Courses | Relias Learning

  • 1
    4boysmama likes this.

    Quote from Kijana
    If they can feed themselves they are not appropriate, Also, pts on hospice should have some sort of change every 2 weeks when we do IDG meeting. If they are not changing, they should be discharged. You also have to be careful because if someone reports this to medicare and they infact investigate and find pt not appropriate to hospice, you as a RN can be in trouble with my license.
    That is not actually the case. AZ patients who qualify for hospice meet a FAST of 7A and a PPS of 50 or less. They may still be ambulatory (loss of that ability is further down on the scale) and still feed themselves. In addition, decline is documented over time not just in 2 week increments. A patient with AZ may have times of relative stability with little change punctuated by issues such as recurring UTIs, PNA, and falls. Weight loss over the last 6 months is considered, changes in medications and functional ability, increased in falls, etc all contribute to determining if a patient is still appropriate for hospice care. Good documentation and chart reviews to assess for decline are important in determining continued appropriateness. Ultimately, it is up to the doctor to certify/re-certify the patient. If a potential patient is questionable, it is important to discuss the patient with the doctor, including comorbidities and recent decline.


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