LTC Nursing Care Sheets

tess0427 · Apr 22, 2009

Hi! If you don't mind may I know which state do you work? I'm still looking for an lpn job here in Virginia & Washington DC.

arelle68 · Apr 22, 2009

I just started LTC about 6 weeks ago. Go in early and organize your shift. Come up with your own "brain" that will work for your unit. Pray a lot. Tell your CNAs what you expect of them. Find out who is overdue for a BM, and write MOM next to their name. Find out who your diabetics are, and line out their accuchecks, insulin and meds for mealtimes. Find out who is on antihypertensives, and get the CNAs to get the blood pressures for you in time for their meds. Keep a list of things that need to be done after meds on the back of your brain. Write the things that can be done with meds beside the pt's name on the brain. (Lois-I have to give her med, and check her foot. I'll write "foot" beside her name so I'll remember to do my assessment when I give her meds so that I'll have data for the alert charting I have to do later.) When you start down the hall, don't just go to do one thing. Think "I could do my assessment for my medicare charting on Sally (grab you stethoscope), give Roger's insulin (med, gloves, alcohol swab)and snack (sandwich, milk), and change Etta's dressing" (skin prep, opsite, Allevyn). Get everything together and go. (Remember to designate someone to watch the front.) If you have skin check, say it enough times to enough CNAs that someone will tell you when they toilet or shower the rsdt.

Think about oxygen. Oxygen is the most important thing. More important than dizzy, frightened, screaming, hitting, and falling down. Oxygen is quiet, and won't scream at you. It will sneak away when you arn't looking.

There will be a few residents who are very frail, and will only be up for meals. Try to schedule their meds while they are up do that they are disturbed as little as possible. There will be residents who will get dizzy on their antidepressants. Don't give them until they are on the way to bed. There will be residents who are a danger to themselves and others when their antipsycotics wear off. Identify those situations, and stay on top of them.

If you get a spare minute (yeah, right!) try to get as much of your alert charting done as you can. Make yourself a LOT of notes, because you will be so tired and stressed (and hungry) by the end of the shift, that you will forget things. Sign every area as you go through the MAR on the last med pass. You won't have time later.

Organize your med pass with your diabetics and frail rsdts with priority, work your behavior issues that you treat with meds around those, and then your more stable rsdts around those.

All of this will take time to get on top of. Be patient with yourself. I still don't have it all together, and won't for months still, but I sure have come a long way in a short time.

Let yourself love your residents. They will die, and it will hurt, but love is worth the pain.