Lorrie34 1,670 Views
Joined Jan 25, '10.
Posts: 64 (30% Liked)
Okay, I have to ask if anyone out there has a good way to get Co-Q10 through a g-tube. We have a patient on my unit that gets it and we all end up with an oily orange mess on our hands and stuck in the tube and in the syringe. Not much of it seems to be really getting into the patient.
We are all aware that it is just a supplement and there are no serious consequences to the patient getting sub-optimal doses, but it means a lot to the family that we give this supplement every day.
Any suggestions would be appreciated! Thank you!
Completely unsafe! Not just for you and your license but for the resident as well! I administer my own meds and when I'm doing my pass, if I'm dispensing a med I don't know or can't recall, my med book is in my cart and I look it up before I pop the pill into the cup and travel into the room to administer it...EVEN if the resident has end-stage demtia!
I NEED to know WHAT I'm giving and HOW it will work, if there are parameters on the med or not too! Too many times I have seen in my MAR to give Midodrine with no parameters, or Procrit without the H&H parameters and I have seen other nurses make the unfortunate mistake of giving these meds then without checking those parameters! I recently had an inicident where LPNs with above 20 years of experience were giving Amiodorone to a resident with a heart rate in the 40s!!! OUCH! That is why it is soo important to know what you are giving and what it does.
I would never, never give a med that somebody else poured even if I see the word "tylenol" written right on the pill itself.
It's a med error. If you didn't give what was scheduled and double-dosed on another med, that is a med error. If this was your own mistake, I think the moral action to take is to report it to the DON and let him/her make the call if an incident report should be filled out. Many times, if the medications given and missed were not meds that could result in serious consequences for the resident, the DON will simply give a warning or write up the nurse responsible, without doing an incident report.
We are human and mistakes happen because we can't be perfect all the time. But I believe that nothing entitles us to ignore our imprefection. We learn from our mistakes.
ALF are different because the residents are more like if they were in their own home and taking the meds themselves, and in that case, how many doses would a person miss on their own for different reasons? It isn't the misssed dose that is the issue, rather the double dose that is the concern.
I was an MA for 14 years before getting my LPN. In my opinion, having that experience absolutely helped me get through the LPN program.
I had very strong skills in injections, vital signs, venipuncture, medical terminology, charting, and most importantly, pharm!
I saw many of my classmates in LPN fail out or sturggle with pharm when I excelled right through it, already knowing most of the meds and the usual dosages, side effects, common uses, and dosages.
The only draw-back I could see was those that had the CNA experience were far more skilled with the direct patient care (ie: transfers, bathing, body mechanics...).
Being a Medical Assistant also helps you learn how to deal with doctors. As an MA you work in the office, right along with the doctor, assisting with exams and following their direct orders. Sometimes doctors are a challenge to work with : )
The bottom line is, any medical experience will help you further your medical career.
Good luck to you in whatever path you follow
I pray that those nurses never find themselves in a state that they are totally physically dependant on HEALTHCARE WORKERS to PROVIDE CARE FOR THEM.
I also pray that they reconsider their field of work--FAST. One where they are not assisting anyone in the community would be more suitable.
Shame on them!!
Nursing is all about tending to every patient's needs at all times. Unfortunately, there are many times when more than one resident has multiple needs at the same time.
It DOES get hectic. You have to be able to prioritize and assess. You also need to be organized, and confident and you of course, above all, you need to be calm and caring.
Where I work, sometimes I'm on a floor by myself with 60 residents to medicate. However, that is on the night shift so it usually is fairly quiet. But I always have my RN supervisor on the other floor that I can call if I'm in too deep, and I have wonderful aides that tend to the residents as much as they can.
In a hospital, the ratio will be lower, but that doesn't mean the patients won't have multiple needs all at the same time. A nurse is always needed in several places at the same time. That is why it is so important to learn how to prioritize and organize and do a really good assessment of every patient under your care.
There are so many shifts that I have left the building with tears in my eyes, or have gotten home and collapsed into a deep sleep on my couch with my coat still on, but at the end of the day, if none of your residents died or took a turn for the worse, and YOU survived, you did alright and you have one more day of experience under your belt so pat yourself on the back
Many of us forget, in the heat of the moment, that we are HUMAN and we are doing our best at that moment. In nursing, or any medical profession, it is a CONTINUAL learning process. We will never be prefect. We will always have days where we feel like we are drowning because "people are messy". You can't predict when Ms. Jones is going to get a UTI, or when Mr. Smith is going to have a stroke. But most of the time, once you learn your residents and they form a connection with you, you settle into a norm.
Nursing is hectic, but it is one of the most rewarding careers EVER and I am thankful every day to be a part of it! Good luck to you with whatever you do, and always believe in yourself!!
I'm wondering what school you went to, imanedrn, that you came out into your first job so fast and efficient, full of confidence too... I'm looking into schools and want to go to a top-notch school so that I don't read a post like that on here about myself
OMG, I don't know what to say about those nurse's notes! At the LTF where I work, we have regular inservices on documentation. Our nurse educator even gave us a written test on it for our employment records. She audits our charting regularly. "Nurse's notes should be a storybook of the care provided to that resident" is what she always tells us. When I enter my nurse's notes, I always remember that and I make sure I include all the interventions and if a resident has a specific complaint that sounds like a med. dx, I put it in quotes (like: resident states "I think I'm having a stronke") to cover my butt.
Remembering to make it a "storybook of the care provided" helps me to remember to dot all the i's and cross all the t's in my notes. I describe colors and hues of bodily fluids too! I may have a longer note than some other nurses, but at least when they read mine, they feel like they were there and saw it themselves! LOL
I wish I only had one resident on my assignment--I actually have a handful like that. I spent half of my shift literally running after the one lastnight, pulling him out of everybody else's rooms and restarting the IV that he keeps pulling out of his arm. When we medicate him, he gets worse and manages to get out of his chair or bed and falls every time.
I feel very bad for him, can you imagine how hard it must be to feel so confused all the time and nothing makes any sense? But it is very trying to have to pass meds and tend to 30 other residents while I keep running down the hall after him. It feels like babysitting a 2 yr. old sometimes. He's just everywhere and doesn't stop.
I wish there was a class in nursing school on how to handle resident's that are that severely confused while you manage all the other tasks of being a nurse.
I'm not a fan of chemical restraints to begin with, but the effect they have on him just re-enforces that for me because it doesn't make him sleep, it just makes him fall and get hurt.
Wow, I really feel you there. I just had my first resident die on my shift, my assignment too.
She just took a sudden turn on the daylight shift, and was put to bed and started on IV antibiotics on the evening shift. I came in for night shift and got report that she was not doing so well, but being that it just started at noon, nobody expected her to expire so quickly.
I went in to check on her as soon as I finished report, and I didn't like her respirs. I took my stethoscope to her chest to listen to lung sounds, and she suddenly opened her eyes and looked right at me. I assumed that I had woken her and startled her, so I put a hand on her shoulder and told her it was okay, and while she was looking into my eyes, she took her last breath!
I lost it. It was so unexpected. It was my first death. And it was just the two of us and she was looking right into my eyes, and I had my hand on her shoulder. I was a mess for the rest of the shift, and to be honest, I took the next day off to re-evaluate if I can handle losing patients all the time.
After a few days, another little lady, about the same build as her, moved into her bed. I still get a chill when I am in the room if I'm in a hurry and just glance at her while working with her roommate.
All I can say is, at least she didn't take her last breath alone with nobody comforting her. That is my biggest fear in life for myself, so I hope that I served some kind of purpose to her in that last moment.
I'd like to apologize. I did go on the defense when it was posted that I jeopordized my license. Not every fact was posted in the original thread. Nothing scares a new nurse worse than thinking they could be in trouble.
The fact is that I did act directly under the superivision of that RN supervisor at the time. Every action I took regarding my findings as well as hers was under her supervision. She was the one that called it to my attention to fill out the investigative report for the ADON and she even signed off on it.
In the end, she didn't totally fluff off my report on the resident, it was that she didn't see what I saw that upset me and prompted me to post this thread.
Despite her not seeing the rash, she did stand behind my report to a degree, being that she told me to fill out the report and notify the family.
I'm sorry for getting defensive.
Furthermore, the RN did have me call the next of kin to inform them of the rash etc. I was upset that she didn't have the same findings on her "official omnipotent RN ASSESSMENT". That was my only gripe when I posted this thread. Sorry I ever did now....
Thanks to everyone that replies with SUPPORT. Zak, to you, where do you get that I went "over the RN's head" and reported it? If the LPN finds an abnormality on their assessment, we are required, by my facility to fill out an investigative report for the ADON and to chart our findings stating "RN made aware" which is EXACTLY what I did. The RN saw me fill the paperwork out, she knew I had to! My license is NOT nor will it EVER be on the line for me reporting what I see on patients on my assignments. The only issue I have is with people that are on support forums and are so quick to point out "mistakes" and form judgements without understanding the whole story. Did you really read my thread? Just because I referred to it in my thread as charting my "assessment" does not mean that I charted it as "my assessment". Who is the one with the attitude and issues here, Zak? I did not waiver from my scope. I followed protocol. My RN is aware and has no problems with my charting or completing the required form. Wow. You are on some powertrip here with this.
Umm, I'm not sure how you say that I'm out of my scope of practice to chart on abnormal findings. Maybe you are in a different state? But I am obligated to document if there is a change of condition in a patient on my assignment AND report it to the RN for further action. I do have to do head-to-toe assessments, we were taught that in school. I have worked at another facility since getting my license and they too had us doing assessments and charting. When I say that I assessed the patient, I mean that I took vitals, listened to lung sounds. That is absolutely within my scope of practice as an LPN in my state. If it were not for the LPNs doing the inital "assessment" of the patient and getting the vitals to report to the RN, quite honestly, the RN would never have a clue if a patient is going downhill because they are glued to the desk with all the paperwork and they only manage to get to check a patient when the LPNs tell them something is up and they need checked.
I thought this forum was for new nurses to support each other, but from your reply, all I get is yet another person trying to make me feel STUPID, and like I don't know my SCOPE OF PRACTICE and I'm jeapordizing my license...not what I really needed and you are wrong. I'm within my scope and I'm done with this forum thanks to conceited know-it-all jerks on powertrips like YOU.
It's common and legal. Most facilities (the ones I work at) do it for census reasons. Every LTC facility I have interviewed with admits without hesitation that they over-hire on purpose. They have to make sure if a nurse calls off, takes leave, etc that they are staffed--they don't want agency in their facility. But for as many times that I have been sent home, I get called in on days off or asked to double when the census is back up and admits come all at once. It's the way it goes and the cycles end up making it all flush out in the end. Sometimes, they will let the extra LPN stay and do primary care if she wants to, but if she chooses to go home, she can get paid for at least 4 hours with her paid time off (union policy). I work in PA also.
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