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covid related job questions

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by Itsjustaride Itsjustaride (New) New Nurse Student

Has any one working felt weird about putting face masks on patients? Especially uncooperative ones? In psych wards??

Do you put a face mask over the patient when you give a routine nebulizer treatment in LTC facilities? Does it change in emergency rooms?

 I feel uncomfortable forcing things over peoples mouths a little. Any scary stories??

Edited by Itsjustaride
nursing student

kbrn2002, ADN, RN

Specializes in Geriatrics, Dialysis. Has 19 years experience.

The only time I've had any issues was caring for a person with a trach who is by the way a confirmed positive. Putting a mask even lightly over the trach resulted in the mask sucking up against the outer cannula and sticking to it with every inhalation causing some obvious difficulty breathing. Not to mention this person performs self care and had to clean/clear that inner cannula several times while under our direct care.  This of course results in coughing every time that cannula is removed or replaced. If you've never worked with a trach patient let me tell you, it's pretty darn impressive how far those secretions can travel when expelled. 

Even wearing full PPE the entire time I was with this person I am a little concerned about exposure and haven't yet passed into the safe zone time wise where I feel comfortable that I wasn't infected.

Kitiger, RN

Specializes in Private Duty Pediatrics. Has 42 years experience.

I do private duty home care. I've seen trached kids decorate the walls and CEILING of their bedroom when they cough!

I wear a face shield (and mask) when working with these kids.

Edited by Kitiger
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JadedCPN, BSN, RN

Specializes in Pediatrics, Pediatric Float, PICU, NICU. Has 15 years experience.

Nope, I don't feel weird about it one bit.

areason4stars, ASN, RN

Specializes in Pediatric Private Duty AND Child/Adolescent Psych. Has 12 years experience.

At my residential pediatric psych facility even when we had  clients that were positive we could recommend they wear a mask but we are/were unable to "make" them wear one. 

 

 

areason4stars, ASN, RN

Specializes in Pediatric Private Duty AND Child/Adolescent Psych. Has 12 years experience.

On 10/4/2020 at 12:27 PM, Kitiger said:

I do private duty home care. I've seen trached kids decorate the walls and CEILING of their bedroom when they cough!

I wear a face shield (and mask) when working with these kids.

Yes those secretions can get some distance. 

Back when I was doing private duty-  I spent several mins  looking for a passy muir valve  that popped off my patient's trach .. looking all over the classroom floor. I eventually found it IN my scrub pocket still not sure how that happened. 

Kitiger, RN

Specializes in Private Duty Pediatrics. Has 42 years experience.

15 hours ago, areason4stars said:

Yes those secretions can get some distance. 

Back when I was doing private duty-  I spent several mins  looking for a passy muir valve  that popped off my patient's trach .. looking all over the classroom floor. I eventually found it IN my scrub pocket still not sure how that happened. 

Yeah, I've found decorations on my shirt, too.  👀

Missingyou, CNA

Specializes in Long term care. Has 20 years experience.

LTC we cannot force any resident to wear one if they refuse. Even when they are out socializing in the hall which, they do all the time since we can't force them to stay in their rooms. ...and when they wander into the covid unit down the hall they are sent back to their own unit...since the hall doors are only closed off, not sealed, because that's a hazard should there be a fire. Covid positive residents are kept in their rooms mostly because they are too sick to get out of bed...   

It's a mess in LTC.

kbrn2002, ADN, RN

Specializes in Geriatrics, Dialysis. Has 19 years experience.

11 hours ago, Missingyou said:

LTC we cannot force any resident to wear one if they refuse. Even when they are out socializing in the hall which, they do all the time since we can't force them to stay in their rooms. ...and when they wander into the covid unit down the hall they are sent back to their own unit...since the hall doors are only closed off, not sealed, because that's a hazard should there be a fire. Covid positive residents are kept in their rooms mostly because they are too sick to get out of bed...   

It's a mess in LTC.

I don't doubt that at all. Fortunately I left my LTC job in February so I was out just before this started. I know from experience though from previous flu related isolations that there are just a ton of issues in LTC that don't apply to the hospital setting.

First is just the logistics of making it work for the building.  At one point in a previous isolation management was reduced to hanging curtains across some hallways as a barrier which needless to say was less than effective. 

Then the challenge of dealing with the residents. There's always going to be a few with the attitude of just not caring. I've had more than one alert, oriented and ambulatory resident just flat out say "I'm old, if this gets me it's my time." Even more of a challenge though are the dementia patients that just can't understand.

Possibly the biggest challenge facing LTC is the staffing. It's pretty common for CNA's and nurses to work in multiple units and some shifts those CNA's and nurses are covering more than one unit during their shift.  It's also not at all uncommon for LTC staff to work in more than one facility. It's next to impossible in most LTC facilities to keep dedicated staff in separate areas. Even with good staffing there's just not enough staff and LTC is never staffed well.