pammyf

pammyf specializes in RN,CHPN (Certified Hospice Nurse).

Latest Activity

1. "butter bullets"--narcotics mixed with butter for rectal administration

   pammyf replied to pammyf's topic in Hospice

   Hi Nameste (BTW-I have spent YEARS in India!) I totally relate to you about "hello they are dying....", And as for the glycerine suppositories. Now, that it a GREAT idea! Our hospice is connected to a massive hospital-based center with over 10000...

2. "butter bullets"--narcotics mixed with butter for rectal administration

   pammyf replied to pammyf's topic in Hospice

   They work well. The thing is the FDA has not given it its stamp of approval. Methadone is well documented to work rectally. But not in butter--although quite frankly unless they have a allergy to milk I cannot imagine it being any different then "sur...

3. Loaded gun

   pammyf replied to indianahope's topic in Hospice

   Story one: I had a patient with some sort of civil war gun by his bed. I requested that his family removed it. I was assured they did, but guess what, he used it on himself. He was a very old man and it was so very horrible for us all and most of all...

4. Getting certified in Hospice, what is the benefit to you?

   pammyf replied to ShayRN's topic in Hospice

   I am certified. The test is about 300 bucks if you join the hospice and palliative nsg association....which is about 75 bucks to join...My work place reimbursed me, and they gave me a thousand dollar bonus. But as far as a raise goes: hmmm....I suppo...

5. "butter bullets"--narcotics mixed with butter for rectal administration

   pammyf replied to pammyf's topic in Hospice

   When I give a pill or two of course I just use lubrication from a water based thing like lubriderm. But if a patient has 300 or 400 mg of morphine or 40mg plus of methadone (they are horse pills!) which requires administration then I think about an ...

6. roxanol in neb treatments

   pammyf replied to lesrn2005's topic in Hospice

   Works really well in some cases. Remember to always have patient take po prior to first nebulized administration. There is a potential for a very bad reaction so if roxanol goes into the lungs death can and has occured. Copd pts really like it. The ...

7. "butter bullets"--narcotics mixed with butter for rectal administration

   pammyf posted a topic in Hospice

   Have any of you used butter, which when cold molds like a suppository? When a patient is no longer able to swallow, but still requiring larger doses of pain meds, and when IVs are too costly, I use this route. I mix the pain meds such as methadone (f...

8. A blessing in disguise?

   pammyf replied to AtlantaRN's topic in Hospice

   Golly, when you have to deal with a 3d party such as a nursing home, and the nursing home is trying to look good even though they are negligent of pericare, and dump that on as your responsibility it is quite pathetic. Changing a care plan to increas...

9. Hospice Certification exam

   pammyf replied to Brightonrn1's topic in Hospice

   bummer!! so close but too far! hey, sorry about the red. cannot get out of it! you can pass it for sure after all your experience with it first time around. i know what you mean about the strange questions like cord compression. i think we had th...

10. Hospice Certification exam

    pammyf replied to Brightonrn1's topic in Hospice

    Your 4 years should provide you with a great knowledge base in order to pass. I can give you this advise: Use the sequel to the core cirruculum test questions book. There are about 400 question, mostly multiple choice. Take the time it takes to do t...

11. On A Roll

    pammyf replied to rngolfer53's topic in Hospice

    the Febreeze ritual, along with the lab jacket heist is hysterical! It reminds of the breast feeding years when i would drive down to a lonely river bank to "pump". Lord, what we have to do as hospice nurses! And the milk usually curdled. The only th...

12. Hospice charting (Neg- Charting) ?

    pammyf replied to Joebrown's topic in Hospice

    it seems like things maybe have changed from this interchange. But actually our mission is to help pts. It is just that in hospice we are helping symptoms and the dying process be gentle loving and meaningful in a good way as possible. By negative c...

13. Hospice charting (Neg- Charting) ?

    pammyf replied to Joebrown's topic in Hospice

    Sounds like a linguistic issue. Patients are supposed to be declining; however minimal the decline might be in some cases.The "iffy" patients are the ones that careful attn be paid to negative charting if appropriate. If you focus on the positive the...

14. On A Roll

    pammyf replied to rngolfer53's topic in Hospice

    RN golfer, your letter is really, really funny! Hospice nurses are such a kick! I just started viewing and interacting on allnurses.com yesterday. it is informative and fun and educational! I totally know what you mean about sucking in and absorbi...

15. Questions on Cadd pump

    pammyf replied to Rnmomajmj's topic in Hospice

    hi, the ratio of po to iv morphine is 3 to 1. Subq should not alter the ratio since it is going directly into the blood stream via tissue and not thru the gut (thus the first pass issue is naught) i have worked with many a cadd pump using s...