mercurysmom 4,383 Views
Joined Jul 25, '11.
Posts: 147 (70% Liked)
When I worked on a vent floor in a LTACH we saw them all the time. The patients were trying to die as hard as they could and we kept yanking them back. Lots of anasarca with the orange peel skin as well, since they ended up with CVL's on IVF or TPN once they stopped tolerating enteral feeds. IVF+anasarca+ KTU = puddles of interstitial fluid. Real, honest-to-goodness puddles.
One poor fellow ended up developing KTU's from the pressure of the linens, and even across the bridge of his nose from his glasses. We continued to pump in the fluids, adjust the vent to (sort of) compensate for lungs that were like stiff leather sacks, and mop up puddles of fluid while his kids stood in the hallway, arguing over who was going to get his house. He wasn't "allowed to die" until they were satisfied that each of them would get their fair share of his estate. I believe TPTB finally intervened during my 3-day weekend off.
My ADN program (1990) had a 75% passing benchmark for classwork and unit tests, but final exams had to be 80% or above, and pharm exams each semester had to be 100% within 3 attempts. The rationale was that we needed to prove understanding of at least 80% of the class material since it was cumulative.
My town's public school system no longer uses letter grades. Report cards list the actual number grades earned in each class in grades 5-12. I can track my kids' progress from home via the school website. I wish I could say that the grade transparency has helped prevent grade inflation, but it hasn't. When the benchmarks are set per "common core" and students are spooned information needed to pass high-stakes tests rather than develop strong foundations in core subjects, unit test grades become a kind of "gastric emptying study for spoon-fed concepts," and the semester grade is simply an academic brown book. How else can one explain why a student can pass high school calculus with an A, yet require remedial college math?
I whole-heartedly agree that experience is the best teacher with hand-eye skills like starting IV's. When I went back to acute care after working at a LTACH full of patients with CVL's, I asked to be scheduled to work in outpatient surgery/day stay for a week. After 3 days I could practically throw the cannula like a dart towards some of these big guys going in for screening colonoscopies. Score! [emoji41]
On a different note, if you have a patient who has long term venous access, ask them where their best (or "least crappy") peripheral veins are if you need to draw peripherally or provide additional access. I have had CVL's continuously for the past 11 years. The antecubitals are totally off the list. Not that that stops people from insisting that I let them try, even though I know what the outcome will be. I have a few "decoy veins" that look good, feel good, but are so scarred that I know that not even the best Vein Whisperer could get anything out of it. However, I have a couple really awesome peripheral veins that few people even attempt because they're felt rather than seen. I'd suggest adding patients with long term venous access and parents of kids with CVL's to the very exclusive "find that elusive vein" club along with IV drug users. Before my own health problems got to the point of needing permanent access, I was amazed by people who knew where to find their best veins. Nowadays, I have a much different perspective. [emoji6]
I would also ask the resident's family about his/her usual showering/bathing routine. I worked in a NH as a NA in the 80's. One particular resident had every single shower marked "refused" for several years. She would only allow a nightly "bird bath" and she had her hair washed and set once a week. She wore long-sleeved shirts and pants every single day, and would wear the same clothes about 3 days in a row. (She wore a nightgown to bed, and carefully folded her clothes and put them in a drawer each night.). She was alert and oriented and required very little assistance with ADL's; NA's only helped her with her feet, legs, and back and she did the rest. She spoke Polish and very little English.
Her son was able to explain everything. She was a Holocaust survivor, and bore unimaginable physical, mental, and emotional scars from her ordeal. Her care plan should have been changed to reflect her bathing and other preferences, rather than documenting shower refusals for years on end.
My LPN program was a hospital program that had included dorms up until about 5 years prior, so a student who was even less than 5 minutes early to clinical was met with gasps and horrified expressions.
My RN (ADN) program had its share of late arrivals, which really blew my mind. Unfortunately, since there are so many nursing schools in my area, there's a major fight for clinical sites, and my school apparently drew the short straw one year when it came to psych rotation. The site was in a hospital a good 70 miles from the school. The school was also famous at that time for being the only college to keep campuses open, even when the local universities with on-campus housing closed. So, one morning I woke up to a good foot of snow with a couple inches of ice on top of that, and left home at 4am to get to my 7am (6:45) clinical. Wouldn't you know it, the school canceled classes...but everyone showed up for clinicals, on time! We worked through the day and had an informal "study day" at the end of the semester. [emoji4]
Ruby, I love you! But I bet you are not really fat, old, ugly, or a biter.
I've never participated in a successful code. However, since most of those codes werepatients like the 92 y.o. vent dependent LOL with end stage everything and the granddaughter who calls the floor to ask when Nana will get better because she watches her 4 young kids for free and child care is sooo expensive that she doesn't even have enough money to go bar hopping more than once a week...
I guess it depends on your definition of "successful."
I agree it must be annoying to have him for a teacher. But think of it this way: he probably had to learn to speak, read and write proficiently in English to be able to get the job. Is he articulate? Compare his English language skills with post-secondary students who speak English as a first language, but have no concept of grammar, punctuation, capitalization, etc. And ask yourself if he's so annoying because he might be right about some things.
If anyone else is interested in grants for home modification, accessible transportation, grants to cover DME, medical treatment, consumable supplies, adult wish programs, medical transportation, or other needs, I can provide you with information.
I'm definitely risking "outing myself" here if this thread pops up on a Google search, but I think it's worth it. [emoji4]
I, too, have a progressive illness. In fact, I'm several years past my "anticipated expiration date." My illness has cost me my hearing and mobility, and I am technology-dependent for ventilation and nutrition/hydration. However, I feel like there's got to be a pretty good reason for me to be here, and I am holding up my end of the bargain by providing support to people in similar situations. Please PM me. I can provide you with resources that could help you and your family during this frightening and uncertain time.
UGH! Quote feature didn't work.
I'd say a lot of it depends on the skill level of the person inserting the foley.
I disagree with the claim that classes are harder than they used to be. Has there been such an enormous change in human anatomy that classes have had to revamp their objectives? When I took A&P in 1990-91, "way back in the day that it was easy," I recall memorizing muscle names and their origins/insertions, names and functions of cranial nerves...exactly the same info that is required in my son's A&P class. I work on contract at the local CC, tutoring D/HH students in everything from ESL to GED prep to 100-200 level gen-ed classes, as well as guest lecturing single classes, 6 week rotations, capstone advising, and more. I love what I do, and I've met many amazing students who have fought their way into programs that essentially serve as tickets out of poverty.
However, a concerning trend I've noticed is that students who attended at least HS following NCLB and high-stakes testing don't always have the basic reading and math skills required per placement exams. These students end up taking developmental English and Math courses before entering 100-level courses, which is fine...until it's not. Students who squeak by with a C in 080-095 level English and math courses will eventually pass into the prerequisites, but they're at a disadvantage before they even start.
In addition, many students who have been exposed to the "chew and spit" learning method that works pretty well for earning passing grades on high-stakes testing may be quite proficient at "being taught," but don't always have the foundation skills necessary for truly independent learning. Obviously, most of the students do develop these skills, but it comes at a steep cost. It's becoming very common for students to take 6 years to complete a 4-year degree. I searched through the community colleges in my state and was unable to find a single direct admit ADN program. My sister and I work at the same community college. She is the director of the [blank] program and has seen students struggle with independent learning, as well. She's received complaints because some members of the [blank] program faculty don't provide review sheets outlining every concept that will be addressed in an exam. (All PPT's are available on Moodle, and she offers open sim lab hours every week. Guess which students show up?). Last semester she had a very angry student complain that she received a B- in clinical because "The CI was only a "B" instructor, so there was no way for her to earn an A, which wasn't her fault!"
The son I mentioned earlier? He has Autism plus a form of muscular dystrophy. He can't write by hand, and he uses a Dynavox or laptop to communicate. Hubby and I have invested countless hours teaching him that he owns his work, both the good and the bad. He's withdrawn from 3 online classes, because he didn't have the self-discipline to complete assignments by forming his own deadlines. He earns A's or F's; no middle ground with him. He's not alone, though. If you're ever looking for excellent info about study skills, pacing, self-learning, social mores in college classrooms, check the MIT website. They've got it all! (I don't know whether I should take that as a sign of encouragement, or feel even more frightened! [emoji33][emoji33][emoji33])
Barking spiders? Love it! 🕷
I have an ileostomy, so gas does what it wants to do, and never consults my social calendar or work schedule before it happens. Pooping and farting into a bag really cuts down on the smell factor. As for the sounds...maybe that's why I work with Deaf teens and adults? [emoji13]
By the way...Deaf people can usually tell when someone's in fart suppression mode by body language alone. And believe me, sometimes it looks so painful that we'd be happier of you just let it rip and felt better! [emoji33]
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