tnmarie, LPN 10,007 Views
Joined: Aug 23, '12;
Posts: 283 (44% Liked)
; Likes: 264
geriatrics, hospice, private duty
Patience. Lots of patience. You have to start with gentle touches with your fingertips on the child's face, gradually moving toward the mouth. Once you can touch the lips, then introduce some textures, like a washcloth or a stuffed toy. When you can touch the child's lips without that head-jerking, anguished scowl, you can start introducing bland, slightly sweet foods just on the lips. You'll know when it's been tasted and found pleasant. Eventually the child will open up a little and you can move past the lips to the tongue. Don't add any textured foods until things like ice cream, yogurt, pureed sweet potatoes and other mild-flavoured foods are tolerated.
Oral aversions develop from a child never having pleasant oral experiences. Suctioning and mouth care are noxious stimuli even for those of us fortunate not to be born early or not to have early ICU admissions. To overcome aversion, the child has to replace those memories with pleasant ones. The process will take a long time and it will be very frustrating but there is hope. So have patience and be persistent. It'll be worth it.
That is a million dollar question! We run into this with older preemies and it carries on when they are older. Is there an OT or speech therapist working with the child?
If you can figure that one out you'll make a million bucks. One of the most frustrating things in peds.
In your state, perhaps.
In my province you are so far off the mark it's funny. LPNs are independent nurses. Nobody signs off my work. The only person I and my fellow LPNs report to is the Charge, just like the RNs I work alongside.
Tell the CNA's that on the 2's, 6's and 10's the resident are turned to face the windows, and on the 4's, 8's and 12's they face the door. That way when you walk the halls you know if patients were turned.
delegate turn and reposition to CNA, when they do incontinent care, have orders for barrier cream, you will get faster, once you know everyone, med pass will go smoother
((HUGS)) we all make mistakes...now learn from it. If/when administration talks with you tell them how sorry you are and what you learned and that you would like to do some teaching project about meds for the staff or new grads....make the negative into a positive.
The whole thing IS due to your choices, etc. Let's avoid using the word 'fault' for the negative connotations. You WERE responsible for this mistake having occurred. That is OK! It doesn't mean you are stupid or anything. The 'fault' thing is so overrated. That's something you have to come to terms with in yourself -- that it is not a huge deal to be 'at fault'. Whatever 'at fault' means to you is what's causing problems. Does 'at fault' mean leper ? Complete and utter failure? Everyone's talking about you now, snickering behind your back?
Mistakes are the whole fault of perfectly good nurses. And those who emit an affectation that they NEVER make mistakes are lying. Period.
Instead of fearing that she'll ask WHY you didn't call to clarify or pass it on in report, TELL her how you came to make the mistake before she asks. Tell her what was going through your head and THEN what you will do next time to avoid making such an error again Beat her to the punch! Always tell on yourself before the manager has to come and get you. I've beat an incident report to my manager, she had no clue anything happened until I told on myself
That's a pretty understandable error. You will NOT lose your license and I doubt you'll lose your job
One thing off the bat -- you have to review the chart before the end of your shift, whether you have time or not. This would have prevented this kind of error.
You made some assumptions and didn't think them through thoroughly before you took action (placing the order for oxy).
When it came down to 'did the nurse or doctor forget to write the order?' just that question ALONE is worth stopping the whole train. Call the doc to clarify. One nurse can't 'hand off' a verbal order to be recorded by another nurse anyway.
In your shoes I'd approach your manager BEFORE you get called in to talk about this. That shows you are taking responsibility. Share how you got confused in report and how the mistake happened, including all the assumptions and poor choices that led up to it. Avoid hinting around that the off-going nurse led you to make the error. Your manager wants to hear that you take responsibility and she'll want to know what you do in the future to avoid making an error like this in the future
You'll be fine. Sometimes the only way to be wary of making a mistake is to make it and then examine what happened.
One time I was transferring an elderly gentleman to his wheelchair. He would go where you steered him, but didn't speak, or look you in the eye, or register people in any way. I had been taking care of him for over a month, and never saw one sign of mental life. As I was talking to him (telling him some dumb story or something), all of a sudden, he looked me in the eye, smiled a tiny bit, and patted me on the shoulder. Then he was gone again. But for just a brief moment, I saw the human being in there. It was pretty inspiring to me. Since that time I have always tried to remember that the meatsacks we are working on are really people It's easy to forget sometimes.
Sounds to me like the son needs to realize his parents are both compromised in their cognitive abilities and take more responsibility.
The triage nurse made an error--apparently she did not know the Ativan was d/c'd either. Ativan and Haldol are 2 different things. I would think that a licensed nurse who is directing you incorrectly would be on the nurse. When you called and explained the situation, it would be up to the nurse to then decide to come and assist and medicate. Instead, she chose to have you assist the wife in medicating the patient. Which was Haldol, the only medication in the box for agitation. (I am assuming...)
In any event, the son can cool his jets as the patient never received Ativan. The triage nurse should be the one explaining as she delegated you as opposed to going to the home herself to assess. And you did as you were delegated to do--which in assisted living or some home care hospice, it is well within the realm of a medication aide to assist the client or the family member in obtaining a med from a lock box to administer in that setting. And it is up to the primary nurse to educate the patient/family on safe administration of their own (or family member's) meds--IN THAT SETTING--it is not acute care, it is not a LTC licensed facility, this is hospice, which can be most compared to assisted living.
With all that being said, OP, you do need to familiarize yourself with the medications as well. So that you are clear on which med the wife needs to be looking for in the box. And not to use the wrong medication name when communicating with the family. The triage nurse could also update the son, and not leave that to you to take on.
Because this is hospice, this patient will get progressively worse. Which could manifest itself in acute behavioral changes. To justify this as a family member who is not on the same page as this, and going through the "letting go" process, family can and do "blame" just about anything. ("They gave him ATIVAN, that is why my usual mild mannered father is now a raving lunatic!!") This is inaccurate information.
Which brings me to--the only thing that you could say is that you called the triage nurse per protocol with an acute mental status change. You were delegated to have the wife give "Ativan". You pointed to the "agitation drug" and the wife poured and administered. You later realized that it was not Ativan, but Haldol. You were just helping the wife look for the "PRN agitation" drug.
There was no Ativan, the patient never got Ativan, and you did not administer anything the wife did, as per protocol.
Should you continue in this line of work, I would be very clear on when you need to have a nurse come and assess the patient, and to begin interventions. I would be very clear on what medications are in the lock box and what they are used for as to direct a family member accordingly, and be equally as clear of your need to have the nurse call and discuss the plan of care with a family member (like the son).
The bottom line in all of this is that as the licensed nurse on call who is triaging issues, the responsibility lies on the licensed person on what is delegated to UAP's.
Haloperidol, trade name Haldol, is a completely different drug than lorazepam, trade name Ativan.
I'm starting to see why there is a problem.
I think at worst, just my own professional nursing opinion, you will get wrote up and a good talking to. You know now to never ever put yourself in this situation. And after you become a nurse, you know to never put another cna in this situation.
Crap on my second to last clinical day a doctor told me to give 45 units of humalog. It was suppose to be 4.5 units. Thank gosh the person was non compliant and ate three Snickers prior.
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