Latest Likes For Anna Flaxis

Latest Likes For Anna Flaxis

Anna Flaxis, ASN 19,998 Views

Joined Oct 15, '10. Posts: 2,813 (67% Liked) Likes: 8,361

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  • May 24

    You're being thrown under the bus.

  • May 24

    Meh, if you can't beat 'em, join 'em.

    "Well, the g-d Fentanyl didn't do s***, let's try some ******* Dilaudid."

  • May 24

    Quote from TNT_RN09
    Cardizem gtt on a regular med surg floor???[emoji15]
    It's a telemetry unit. And Cardizem is not that difficult. It's totally doable on a tele unit.

  • May 24

    I was just curious how others handled this type of situation.
    I am rarely caught by surprise when an otherwise sweet LOL suddenly turns into a raving lunatic. I actually kind of expect it.

    Some potential causes are UTI, constipation, hypoglycemia, sundowners syndrome, a pulmonary embolus, worsening illness, or even just being afraid and feeling helpless. A change in mental status should trigger inquiry into what could be causing it.

    UTI would be one of the more common causes, and constipation can be a contributing factor to UTI due to compression of the urethra by bowel contents, leading to incomplete bladder emptying and thus, urinary stasis. So maybe, your LOL's complaint about being constipated might not be too far off the mark. One of the more common symptoms of UTI in the elderly is altered mentation/delirium.

    Also consider the reason this person was admitted-for pneumonia. Her change in mentation could be related to a worsening of her condition.

    Another consideration is that often, elderly folks with milder forms of dementia compensate well at home in their normal, predictable environment, but once they are in an unfamiliar environment with different routines, the altered mentation is more noticeable. Family members may tell you that "Grandma has all her marbles" or is "as sharp as a tack", but that's in the home environment where she is able to compensate. The hospital environment interferes with this ability to compensate, and so you will see behavioral changes that would go otherwise unnoticed.

    So, to answer your question, how I handle this type of situation is first, I do what I need to do in order to keep the patient safe. Make sure the room is free of clutter, the patient is wearing nonskid slippers, and offer to toilet her. I will offer warm blankets, another pillow, PO fluids or a snack. I will offer a distraction, such as TV, or ask her about her life- her children, pets, where she grew up, etc etc. Once the patient is calmed down and safe, I will take a complete set of vitals, including a temperature; if diabetic, check a CBG; and I will then notify the physician of this change in condition. The physician may want to order a UA, or a repeat chest xray, as her change in mentation may be related to worsening pneumonia.

    I would then document the patient's behavior, the actions I took to ensure her safety, my assessment data, that I notified the physician, and whether any new orders were received.

  • May 24

    ^^ Ugh, Ambien comes to mind...

  • May 24

    Hmmmm, I don't know....maybe a complete overhaul of the health care system?

  • May 23

    You're being thrown under the bus.

  • May 23

    Meh, if you can't beat 'em, join 'em.

    "Well, the g-d Fentanyl didn't do s***, let's try some ******* Dilaudid."

  • May 23

    Meh, if you can't beat 'em, join 'em.

    "Well, the g-d Fentanyl didn't do s***, let's try some ******* Dilaudid."

  • May 22

    Quote from gemmi999
    Is it normal to think I'm doing something wrong is all the other RNs are offering to help? I don't mind people helping when it's time sensitive or critical, but if it isn't I kind of like to do it myself because that's the only way I'll get faster/more experience--by doing it! But last night all the other RNs offered all the time to help (when they were free!) Granted, they each had an orientee who was doing most of the patient care but I kind of felt like they were judging me because (in my own mind) I wasn't moving fast enough.
    To me, this is encouraging. It sounds like you work with a great team. You will get faster, and one day you will be the one offering to help your co-worker who is drowning. Accept the help, say thank you, and return the favor when you can. That's what teamwork is all about.

  • May 22

    Quote from gemmi999
    Is it normal to think I'm doing something wrong is all the other RNs are offering to help? I don't mind people helping when it's time sensitive or critical, but if it isn't I kind of like to do it myself because that's the only way I'll get faster/more experience--by doing it! But last night all the other RNs offered all the time to help (when they were free!) Granted, they each had an orientee who was doing most of the patient care but I kind of felt like they were judging me because (in my own mind) I wasn't moving fast enough.
    To me, this is encouraging. It sounds like you work with a great team. You will get faster, and one day you will be the one offering to help your co-worker who is drowning. Accept the help, say thank you, and return the favor when you can. That's what teamwork is all about.

  • May 22

    Quote from gemmi999
    Is it normal to think I'm doing something wrong is all the other RNs are offering to help? I don't mind people helping when it's time sensitive or critical, but if it isn't I kind of like to do it myself because that's the only way I'll get faster/more experience--by doing it! But last night all the other RNs offered all the time to help (when they were free!) Granted, they each had an orientee who was doing most of the patient care but I kind of felt like they were judging me because (in my own mind) I wasn't moving fast enough.
    To me, this is encouraging. It sounds like you work with a great team. You will get faster, and one day you will be the one offering to help your co-worker who is drowning. Accept the help, say thank you, and return the favor when you can. That's what teamwork is all about.

  • May 22

    You're being thrown under the bus.

  • May 22

    You're being thrown under the bus.

  • May 22

    Thank you for elaborating. This is very helpful.

    Pancreatitis can be one of the more painful conditions, requiring astronomical doses of opioids just to make the discomfort tolerable. This patient may have even benefitted from a PCA (Patient Controlled Analgesia).

    It sounds to me like your unit/facility could benefit from implementing an Acute Pain Protocol of some sort. This way, the doctor could just order the protocol, which gives the nurses a lot of flexibility within a set of parameters to figure out what works best for the patient. It's a win-win. The doctors will receive fewer pain related pages, the nurses will have more tools in their toolbox, and the patients' need for pain control will be addressed. Do you have a unit based practice council, or could you bring this up to your manager for consideration?

    As far as dealing with the (understandably upset) family members, I have a basic spiel that works well for me. First, I offer reassurance that controlling the patient's pain is important to me, and that I will do everything I am able. I explain that I cannot give medications without a doctor's order, and that I am making it a priority to obtain that order. I explain that these are very powerful medications, and that for the patient's safety, I have to be careful not to give too much, because I don't want to kill them. I explain that often, it takes more than one dose to get an acceptable result, and that we have to work together to figure out how much of what drug is going to work without harming the patient. I let them know that some conditions are so painful that it is not possible to eliminate the pain completely- that I could give them enough Dilaudid (or Morphine or Fentanyl or whatever) to kill an elephant and they still might have some pain, and that the goal is to get the pain to a level that they can tolerate- not to eliminate it completely. I might ask "If we could cut your pain in half, would that be an acceptable result for you?", and I make a plan together with the patient and their concerned family to do that. Since I work in the ER, the doctor is right there and so I don't have to page and wait for a response, but I have worked inpatient in the past, and I would explain this to the patient and family: "I am going to page the doctor to find out what else we can try, and it's going to take a little time for him/her to return my call and give me the orders. I can't give you anything until that happens, but I can offer _____________ (warm compress, ice pack, dim the lights, whatever) while you wait".

    If they *still* follow me out of the room and shoot daggers at me, well then, I tried. But usually, when I make myself their ally and ask for them to participate in the plan like we're a team, they calm right down. They're just concerned for their family member, as they should be.


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