There is a man on our Chronic Confusion & Dementia Unit named R. R is incontinent, ambulatory, sexually aggressive (the crudest things I've ever heard someone say come out of this man's mouth!), and extremely combative about 60-75% of the time. He lies in his bed all day, on rare occasions will eat meals with the other residents. He always refuses his showers or baths, and won't even allow us aides to change his briefs or clothes! Most of the time he might go 24 hours or more without a change. His room always smells like a barn because of this, and his bed is completely soaked every time I see him. In my opinion, this man is not getting the care he receives because he does not belong here -- he belongs in a more psychological institution.
On Saturday night, I called the nurse in to look at a red, raised rash I had noticed on his neck. We took his temp, 100.8 and charted. Sunday night, the rash was spreading with water blisters, temp of 100.8 and charted. The next time I worked was Tuesday morning, and this time the rash had spread down his chest and down parts of his back, and around his neck some more. The whole right side of his face was swollen. Just to be on the safe side, I found a box of face masks for the aides in his room, and I set that and a box of gloves next to his bed. I figured soon he would be some kind of isolation, and was kind of surprised he wasn't already. Upon changing his brief and gown, I discovered chicken pox-like spots on his lower back, on and inside his buttocks, and on the very top of his legs. The water blisters on the other type of rash were now purple, like small blood blisters everywhere. Temp was still 100 and some.
Soon every nurse was offering her opinion, and the ADON was convinced it was shingles. No one agreed. The whole time I'm wondering why this man hadn't been sent out yet! Here was a rash that the nurses could not agree on, it was spreading rapidly with a fever maintained, and he was not eating and barely voiding or defecating. I am only an aide, I don't know much, but goodness -- this man has a healthy roommate, it isn't fair to keep him in the same room!
I worked yesterday morning again, and at the very end of my shift, the doctor had finally ordered contact isolation -- gloves, mask, gowns. A few hours later, I was gone by then, he was finally sent out to the hospital. Diagnosed with shingles, cellulitis, and abcesses.
Does this sound right? The whole course of action here? If no one knew what it was, and the doctor had not offered his opinion four almost a week, who are we to say it couldn't have been airborne? I'm so surprised at this situation, but the nurse I talked to today told me I was right to be and that our LTCF has pulled this before -- one woman had SARS on another wing and was never sent out. Wha??
What do you all think?
Last edit by donsterRN on Sep 27, '07
: Reason: edited pt name
Sep 27, '07
First of all I think you shouldn't say you're 'just an aide'. You seem like a caring, intelligent person who wants to do what's best for the patient. You're right. It shouldn't have taken so long to have this man sent out or be seen by a doc. Nurses love to complain about the 'lazy aides' but when you report something to your nurse, she should act on it right away.
Sep 27, '07
This situation had red flags all over it from the start of the rash. Why if there were blisters present did the nurse not call the Dr when they were first noticed? Especially if the rash was spreading so rapidly. This is not safe for the pt or for his roommate.
This doesn't sound like a place I would want to have a family member, much less work at. I would try to find a new place of employment if this is how things are handled regularly.
On the side note here.... be careful with using pt's name. The situation could be described without using the pt's name.........its the whole privacy and confidential thing.
Sep 27, '07
I am an aid too but I do private care and when I try to tell the families or the VNA they look at me like Im crazy but then two weeks later it turns out I was right! It gets so stressful. But then again I love 90%of my clients and their families....
Sep 27, '07
I agree whole heartedly with CapeCod - you sound like you care for your patients and are a valuable part of the patient's care team. You are far more than 'just an aide'.
Sep 28, '07
If this man truly was suffering from shingles and it was covering this much of his body, then he needed a lot more than contact precautions!! I shingles cover more than one dermatome and cross the midline of the body, then they are actively shedding herpes zoster, and the infection is airborne. I just hope that everyone who came into that room, staff, visitors, his roommate are all immune to chickenpox, or you are liable to have a outbreak throughout your facility.
Sep 28, '07
I think the rash should have been reported to the doc asap anyway as it was not a recognised past medical condition. Anyone with shingles should be in a seperate room and it is a common enough condition in ltc for the warning bells to ring. I feel for the poor man. Never be afraid to speak up, you are there for the residents not for the staff.
Sep 28, '07
it sounds like awfully poor assessment and judgment...downright shabby.
it wasn't a situation where monitoring would be appropriate, given the fact he was running a temp.
the most basic of lab work would have shown that further eval was warranted.
you showed intelligence, sensitivity and insight towards your pt.
you can work with me anytime!
Sep 29, '07
First of all, don't EVER say you're just an aide! I've always held the belief that a good CNA is just as valuable to me as my right hand. So kuddos to you on your assessment skills!
I'm wondering why the nurses made those choices. The facility where I work is not one of the nicer places, but there is an unspoken rule --when is doubt, send 'em out -- From what you described, this man has shingles and that can be VERY painful. I cannot imagine what that poor man was going through having dementia and all. He has no way to voice his complaints or the fact that he's in pain.
Sep 30, '07
Thanks for your imput, everyone. I know what you guys mean about my "just being an aide." I say it a lot, but when you stand back and look CNAs have so much contact with residents, more than anyone else, and since this man is such a hassle, I could almost safely say that I've had more contact with him than probably anyone else in our LTCF!
I don't know the system at all, as an aide you don't get much insight to it, but as far as I know, the nurse tried to send him out but the ADON was the one governing it while our DON was gone (our DON was out of town, but she is awesome, our ADON not so much). The nurse I was talking to said that they had a lot of stupid decisions regarding isolated residents (or those who should've been isolated), so I'm guessing she did what she could.
I had the weekend off, so tomorrow I'll see if the resident is back, hopefully healthy and feeling better. How long will it last/how serious is this?
Also, I did replace the resident's real name with the name Roland to respect privacy, but I guess I should've noted that! Thanks for editing anyway, mod.
Sep 30, '07
Wow, there just is so much in your post that is sooo wrong. I think you are very accurate in your judgment that this resident needs a different level of ongoing care. He should absolutely not be allowed to lie in urine soaked clothes and sheets...no wonder he has abscesses!! I believe in allowing residents to have as much choice and power as possible in their lives, but things like basic hygiene etc, needs to be done regardless...that is part of the reason that he is in a LTC facility, he can no longer take care of himself or make reasonable decisions for his own well-being.
Are there other residents that are left in a similar condition?
I can't believe that the nursing staff isn't being more aggressive in their concern for this patient. Is this common as well or do they dislike this guy so much that they don't care?
OK, new subject....are you planning on being a nurse? Because your assessment and concern in this situation puts you way above any of those nurses in my opinion. I would do two things, apply to nursing school and find a new job.
Oct 17, '07
I have been an aide for over 20 years. I do it because I love to work hands on with my resident. We are all nurses in God's eyes. Not just "An Aide" We are all important as a team. Registered nurses to Aides. We all have a part in our residents quality of life. A good Aide is invaluable to the licensed nurse. We are the "eyes and ears" of the nurse, the backbone of the facility.