Latest Comments by Kittypower123

Latest Comments by Kittypower123

Kittypower123, ADN, BSN 2,888 Views

Joined Feb 13, '09. Posts: 131 (66% Liked) Likes: 263

Sorted By Last Comment (Past 5 Years)
  • 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.

  • 1
    LilyNurse123 likes 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.

  • 1
    NurseLemley likes 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.

  • 5
    Kitiger, brownbook, Davey Do, and 2 others like this.

    I was watching The Walking Dead and the town they were in was attacked. Not by zombies, by other people. Anyway, a woman is carried into the clinic with a large slash wound to her abdomen. The lady who was the "doctor" (she was actually a psychiatrist, but at least she'd been to med school, right?) says "She's severed her femoral artery."

  • 0

    Are there any hospice nurses in Tucson? We're possibly moving there (don't know for sure yet) and I'm looking to get information about the hospices in the area. Any that are particularly good or bad? Any advice? I look forward to hearing from any of you who live there.

    Thanks!!

  • 2
    heron and LovelyLu like this.

    All the things mentioned above are good points. I think it's important as well to involve the nurses at the LTC in the decisions about changes to POC and/or meds. They know what's going on with the patient and don't want to feel like their being judged, or somehow not doing everything they can and should. We're all on the same team and we need to make sure they know that. They should feel supported, not pushed aside.

    In regards to situations like the terminal secretions, I advocate for crisis care if the symptom is more than the facility can manage. Just because they are in a facility doesn't mean that crisis care is not appropriate. Even if I can't get it approved, the nurses at the facility know that at least I tried.

    I've been on the other side - before I went into hospice I worked in LTC. The hospice nurses that came to the facility from the company I now work for were always great. They made sure that I was on the same page with changes, kept me in the loop with information I might need to know, and tried to make things a little easier for me. I knew that I could contact hospice and get some support when something came up.

  • 3

    Sometimes patients with Alzheimer's have increased agitation with Ativan. Perhaps try Haldol instead rather than in addition to. I've seen Haldol and Seroquel given together work well too. When all else fails, I have seen Thorazine work. Also, that dose of Morphine may not be enough for him. Perhaps a larger dose would help. Dyspnea and pain both feed into anxiety and agitation in this population.

  • 4
    TammyG, softrbreeze, esperanzita, and 1 other like this.

    Hopefully you have a copy of the FAST with you for reference. It's important to remember that you cannot skip an item. Start at number one and continue until something doesn't apply to the patient. Numbers 1 through 5 are one item each. Once you 6, there are multiple items. 6 is divided into 6a through 6e and 7 into 7a through 7b.

    6d is incontinent of bladder and 6e is incontinent of bowel. If the patient is continent of bowel, but not bladder, they would be a 6d. You have to stop there even if some of the 7 items apply.

    7a is no more than 5 intelligible words per day. The words do not have to be appropriate to the context. For example, you may ask "How are you?" And the patient answers "brother." It's a word and counts.

    Keep in mind that this scale was designed for Alzheimer's patients and does not work well with other types of dementia. A person with vascular dementia may rate differently from one day to the next. Also a person with another type of dementia may still be hospice appropriate and not be a 7a. The doctor has the final say on whether the patient is appropriate. Good documentation of all the diseases and conditions the patient has and recent decline is important in these cases.

    Your coworkers, supervisors and hospice doctors will be good resources while you are learning and whenever you have questions. Don't be afraid to ask for help. Wishing you the best!

  • 4

    I'm sorry that your mom is ill. You are going through a difficult time and difficulty in many aspects of life is not unusual. If your mom is not already on hospice, I would recommend getting hospice involved. They will have social workers and chaplains available to help your whole family with your mom's care as well as all the spiritual and emotional needs that accompany the passing of a loved one. They can also help with resources. Hospice can do a lot to help you and your family through this difficult time. Hope you find the help you need.

  • 2

    Just this week I had to talk to the Medicare Part D for a patient. I gave the name, dosage and diagnosis for each non-covered med as well as the hospice diagnosis. Once I had done that, the person I talked to processed the meds and faxed the prior-authorizations for each medication. The pharmacy was then able to fill the meds and bill Medicare Part D. I have to do this every 90 days. It is more work, especially since the number I have to call for each patient is different, but it is doable and the patients are able to get the medications they need.


close
close