Do you know your patients?

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I just started a job in LTC. It seems the nurses don't know many of the diagnoses that their patients have. Being a newgrad nurse who is used to knowing each and every diagnosis that my patient has, I feel like it's a must to know your patient Hx. But again I was a student with no more than 2 patients and these nurses have up to 30 patients. How do you manage to know about your patients in LTC settings with a large nurse/patient ratio. Any input on this will be appreciated. Also, what do you think it's important for me as a new nurse to do in order to manage care safely?

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One simple answer...time. I've been at the same LTC facility for almost a year with 120 residents, and I can now feel comfortable knowing almost everyone's diagnoses. You get to know by when situations arise and looking into their charts, or when passing meds you relate their medications to their pathophysiology, and by communication between staff. It takes time, so for now I'd freshen up on care of clients with COPD, CHF, DM, Dementia, and other cardiac issues. Give yourself time!

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Specializes in Gerontology, Med surg, Home Health.

If the person has lived in the facility for a long time, they quite possibly could have 25 diagnoses. You don't need to know all of them. You should know the basic ones...CHF, COPD, Afib....because they can still have an impact on that person's life, but if they had a fractured hip 8 years ago or had their tonsils out 67 years ago, you don't really need to know that.

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Specializes in retired LTC.

Just think about it - those 30 pts probably each have many multiple co-morbidities. It would be all but next to impossible to remember each and every diagnose per pt. One can look probably look at the meds and tx to recognize matching disease processes.

synthroid + hypothyroid

Aricept = Alzheimers

Cymbalta = depression, pain mgt adjunct

Lasix = CHF

digoxin = afib, CHF

Coumadin = CVA, valvular disorders, post fracture

Dilantin = seizure disorder

glucotrol = diabetes

Detrol = overactive bladder

antibiotics = infection

Etc etc etc. And you'll see things that will click, like O2 running must indicate a little COPD or CHF or some other resp issue. A CPM machine helps postop knee surgery. And a PICC line, TED stockings, wound tx, fingersticks, etc - why are we using them?

See what I mean. After a while, you will start to remember those disorders, most distinct, that cause the most problems for the pt. What I always found enlightening was that EVERYONE seemed to have a bit of everything that everybody else has. Fortunately, many pts are pretty much status quo. The first respondent to this thread answered VERY, VERY well.

Just a reminder that we don't do care JUST based on medical diagnoses. To broaden our approach to pt care we do use meds and ordered tx, but we also position, assist ADLS, provide encouragement & praise, etc. That's what our nsg diagnoses & care plans cover.

One thing - learn to rely on your CNAs for normal behavioral, ADL and cognitive status of your pts The CNAs know them best and their information is invaluable. LISTEN to them when they tell you something's wrong.

Things will come together with time.

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Thank you to all for your great responses!!

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You may never know everyone's list. But like the others said you will get hunches and form ideas based on meds, etc.

A lot of my residents have a "primary dx." That is what I try to remember.

Wait until you send someone out and the paramedics ask you their whole health history and their average vitals and their meds...

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Specializes in LTC, Memory loss, PDN.

look at labs

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Specializes in kids.

One thing - learn to rely on your CNAs for normal behavioral, ADL and cognitive status of your pts The CNAs know them best and their information is invaluable. LISTEN to them when they tell you something's wrong.

This!

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Specializes in retired LTC.

Oh so true! Sending out someone when the squad wants every diagnosis and every little med and each surgery since year 1 !!!

Dang! It's in the paperwork!

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Pay attention to what the family tells you. They have known the patient much longer.

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It's tough to remember all the Dx on your patients when you have 30+. You will learn over time many of them, but who has time to read through a patient's whole hx? When I was in nursing school reading through the charts when working on care plans was always very interesting. In the real world you simply do not have the time.

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I am a school nurse at a school with over 1000 students to know health concerns/health history for. Each year, I print a report of the students' health concerns and send a list to each teacher which helps me to remember stuff for each kid, though I certainly haven't memorized everyone's health concerns/history...I realize that's likely not possible for you to do on each of your 30 students during your shift but like others have said, knowing your patients comes from repetition of caring for your patients and reading their charts. My advice would be to take some time before each shift to review main diagnoses and why they're there as well as their meds to make sure there aren't any adverse reactions that may occur when on multiple meds. If/when you have down time, you can explore their chart a little to gather a little more history and over time you'll get it :)

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