MelissaLPN 3,032 Views
Joined Sep 1, '09.
Posts: 102 (36% Liked)
I don't really understand this one. I can (sort of) understand the families dropping people off, but why would a nursing home do that? They won't get paid if the resident is not at their long term care facility, right?
Some of those Luer locks can be hard and require a lot of pressure to attach the syringe. I have trouble sometimes myself. My advice would be to take home a syringe and iv tail and practice at home. You can try different approaches with out feeling self conscious. I bet your NS lab would have everything you need. Best of luck!
I have the book and really like it. I don't have time at work to read it but after work or anywhere I am waiting I take it. Very good information and it is well put altogether. I like the authors style and at time it's laugh out loud funny. I recommend it.
Yes. I actually have done that very thing! I have been an lpn for five years in ltc , new RN and new icu nurse. I did have several years er experience as a tech which really helped. So far it's been great. Prior lpn experience did me a world of good. Good luck. Read critical care sites like icufaq.com! It really helped give me an edge.
True story while working in the ED. An elderly man comes in with his wife c/o possible hypoxia with blue fingers which his wife states they consulted their neighbor who was a nurse (I am doubtful she really was) and the neighbor advised them it might be related to low oxygen.
This man worked himself into a tizzy, with ample encouragement from his wife. He frequently took deep breathes just to be sure he could still breathe. When he got to me in triage his fingers were indeed blue,so blue in fact I took an alcohol wipe and wiped it off! Just then the wife remembered she just bought new navy blue flannel sheets.
The part that kills me is they still wanted to be seen by the doctor, "just in case ."
Possible diagnosis I am guessing would be acute indigo -anemia with just a touch of the crazys.
The best things I ever bought were : a book stand to hold up my giant med/surg book, gel highlighters that don't bleed through the page, a smart phone and a drug guide app .
I honestly couldn't do nursing school with out my book stand, it really saved me from neck pain.
I once had a little old lady come into the ER BP 300/150. I know because I did a manual myself!
I also had a guys bg so high the lab couldn't read it, he was on an insulin drip for 5 hours before the lab called with 1700.
I also had a guy fall from a roof, hit his head on a dumpster and sever his trachea, they were able to fish it out of his chest in surgery, I believe he went home.
I say accept which ever job you get first. You do not know if or when you will not only interview but start said job! Sometimes the waiting for people to be done with vacations, call backs and second interviews only to find out you have to wait another two or so weeks for the next hospital wide orientation days, all this takes an incredible amount of time. You want to be working and if you are lucky enough to find something better, just be sure to leave proper notice and that's all.
Ok the setting, LTC, the resident is almost a hundred and her son is not much behind her. Tells me his mother is getting dizzy. I state "yes I know, I have assessed her. The doctor is seeing her in the morning." Son states " I want you guys to check her carbon monoxide ( I think he means dioxide but I didn't help him out) level. It could be too low." He goes on to make some unintelligent statement about some other family member who was on a vent and eventually died to total organ failure r/t catastrophic disease process who just so happen (shock) to have an abnormal blood gas. After explaining the more likely causes of dizziness ie orthostatic hypotension and the futility of a painful blood gas for no reason he states " I am not getting anywhere with you." He goes on to cite her dementia as a reason for a blood gas, his last pearl of wisdom "She is probably forgetting to breathe."
I rest my case.
We have changed our format to some ranges 4-7pm and 7-11pm. Some medications are still at five and 9 but with the ranges along with the q shift it helps. I start out passing the 4pm's and when I get close to 7pm I start passing them all. I have a few that need specifics so I pass my earlies with my people who have 9pm's and then when I come back around I do their 7-11 and 9pm's together. It reduces my medpass by 25%. It would be better to do them all together and reduce the number by 50% but for now this reduction has helped.
In all honesty I try my best to see each person only once. If I have to see you twice it more than doubles the work because now I have to convince you to take another round of pills. When they are crushed it makes more sense to give them one mouth full of disgusting rather than spread it out.
I hope LTC can shift away from the rigid minded med pass that does not allow for living. Heaven knows the residents hate it.
I found my RN clinicals to be a real joy. Outside of having the pressure of having to perform infront of someone grading you, its a nice thing to only have one patient! I definitely felt way more respect from the staff as well as my instructors.
To contrast the two in my LPN clinical I had one instructor who really stressed bed baths and making sure all the trash on the floors of all the rooms was picked up. She herself had little respect for LPN's and didnt try to hide it. However, In RN school we take breaks to discuss theory and assessment and teaching are the focus, not trash collection.
Also I was totally different this time around. I was not afraid to walk into my patients room, introduce myself and do my assessment first thing. The traditional students were still afraid to wake up the patients and did not do their assessments until they were reminded half way through the clinical day.
Overall it it was more enjoyable and focused more on what you do with your mind, not with your hands.
When I was a new nurse I used to document behaviors all the time but a few nurses pulled me aside and said I was opening myself up for liability because I was not including that I did anything that relieved the behavior. For some of my people, all the interventions in the world do not seem to help and the behavior continues.
Maybe the nurses feel trapped by family who do not want the resident medicated but they still act out, then it looks like the nurse is negligent even though she has little say on the pharmacological treatment of the patient. Self soothing techniques only go so far. I feel like I might chart more if I did not feel like it made me vulnerable to a lawsuit.
An example may be " 'Resident crying out " help me help me help me.' Toileted before and after meals. Clothing nonrestrictive. Po fluids and snacks offered. Placed a nurses station for monitoring. Psychotropic drugs given, no adverse drug reactions." Then the resident who is a thousand years old, full code, has a massive MI 3 months later even though this behavior happens every day they will say the resident might have been expressing the impending MI and you as the nurse did not call the MD and have her properly evaluate. While this may seem far fetched this is how I see it.
I have another resident who cries every day. MD aware, no new orders. Daughter is upset but MD wont budge on her treatment. I am the nurse charting she is "suffering" in her daughters eyes but beyond the current treatment, I as the nurse do nothing.
I am open to doing everything the right way but I would like to be taught whats acceptable to chart and what will land me in the courtroom.
I can understand the feeling. I started working towards my RN after graduating from LPN school in '08, I took one class at a time and have done a traditional ADN program ( NO bridge was available). Whenever people would hear my expected graduation date they would look at me like it would never happen, it was too far away! But here I am, I will graduate in 12 months. It still seems far away but its never as far away as when you first start. Slow and steady does win the race. I know so many people trying to " rush" or take the " quickest" route, they either gave up, failed out or just didn't follow through. Don't worry about fast, worry that you need to keep moving forward towards your goal. Good luck, its ok to vent just a little, its a lot of work!
I swear you are probably talking about my resident! I sent her to the ER for the above complaint, gave report to er charge nurse stating that there was a neuro change, after a fall. I send paper work stating she had a change in neuro/pupil response, she comes back.... dx of pneumonia! No one freaking addressed the neuro deficit!! I felt like an absolute idiot.
Yes. Now the adjusted rate may be less than 25% or it may be going too fast ( unlikely but possible) in which case you would decrease the rate. For instance in the case you mentioned due to what ever complication ( bent elbow or something) the rate needed to be increased by 50% to reach the original order, but this would be in violation of hospital policy in which you could only increase the rate by 25%. In the above case, you would probably need to contact the MD to let them know that due to complications the medication had to be given over 5 hours (or what ever it works out to be)
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