Important things to review

[wecan11]

I need some advice.

I'm a recent LPN grad., worked 5 mo's in LTC and now just started as 1st time Priv. Duty ped's nurse. I am nervous that I am not reviewing what I need to in order to be prepared for these ped's pts. I am a checklist type of person and I don't have a checklist. I want to prepare myself as thoroughly as I can. I've observed/worked 1 day at the clients house with another agency nurse. Our pt. has a mickey tube and I have been assisting in feedings and medication administration.

This is what I have done to prepare. 1) Read over the agency pamphlets on Mickey feeding tubes, On care of Ped's clients w/ Trach's & G-tubes. I have also jotted down notes from the first day as to what needs to be done when for feedings & medication. I need to rewrite to clarify these notes. I've also watched You Tube video's on mickey tube feedings and cleaning.

I should not depend on You-Tube videos for proper instruction. Please let me know what has helped you when you first started. I don't feel very organized and that stresses me. I need to be better organized. I guess I'm looking for good organization tools.

Thank you! :yeah:

[wecan11]

You should have been provided a copy of the 485, Plan of Care, for your patient. It lists the meds and all orders for treatment, care, ADLs, etc. that are required during your shift. Sometimes there will be a new procedure that you can look up, or a med that you are not familiar with. Anything that you have questions about can be clarified by asking the nursing supervisor, the primary nurse who is orienting you, or the family members, before or after you have done your own research. You can get a 'feel' for the case by reading the POC. I once read one and immediately turned down the case. I was able to explain my reasoning to the staffing personnel and we didn't even bother sending me to the home for a wasted orientation visit. You should be given a copy of the 485 before you start each new case. It is your starting point.

Very good explanation! Thank You!:yeah:

[James613]

I know this is an old post, and this might be totally wrong, but wouldn't it be a HIPPA violation accessing the 485 before you are legally are a nurse to the patient? Although, I am speaking in reference to independent pdn direct bill to medicaid, no agency.

[caliotter3]

It is not considered a HIPAA violation because knowledge of the care plan is required to care for the patient. Since the emphasis on HIPAA the past several years, agencies have begun (if they were not already doing so) blacking out the identifying data on the 485 for these "preliminary" viewings and retrieve the copy if the nurse decides not to work the case.

[Kitiger, RN]

For a Mickey, you need to know:

Size: what French, and what cm (how fat and how long)

Balloon: how much water (what range) is normally used in that size Mickey, and how much does THIS child's parent usually put in the balloon. Do they use tap water, sterile water, or distilled water? (There's more than one right way, and you want to do it their way.)

How often do they check the balloon? (Some check the volume in the balloon weekly, some check only when it leaks or looks like it's loose in the stoma.)

Where is the spare Mickey kept?

How often does it get changed? (Medicaid usually only allows one Mickey every 6 months.) I would rather not change it routinely unless you have at least one more new one as a back-up.

Changing a Mickey is easy: it's just like a Foley cath, and easier to put in than a Foley because you can't miss the hole!

[realnursealso/LPN, LPN]

The picture on the top is a mick-ey. I believe you have the two mixed up. A g-tube as we call them does resemble a foley tube, a mick-ey button does not.

[Kitiger, RN]

The picture on the top is a mick-ey. I believe you have the two mixed up. A g-tube as we call them does resemble a foley tube, a mick-ey button does not.

A Mickey doesn't look like a foley, but it does insert the same way, and the balloon is inflated the same way.