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zofran 5,066 Views

Joined: May 6, '09; Posts: 105 (66% Liked) ; Likes: 369

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  • May 5 '12

    Quote from unsaint77
    So, here is my question to those of you who think MRSA is not a big deal. Would you let your elderly parents or your babies or children sit at a dinner table with someone with mrsa in sputum with no mask?
    Yes. As long as there is no active coughing, or he is good about covering a cough.

    While I applaud your zeal and enthusiasm, I'm a little bothered by the fact that I haven't seen any mention of regard for this resident as a man. HE is not MRSA. HE is a person and you are coming into his home. Isolating him and treating him as if he is some kind of menace for carrying an organism that a good portion of the population harbors seems to exceed diligence and cross the line into disgust.

    Look at what the CDC has to say. Read the policy and procedure for your facility. Speak with someone from infection control. But never lose sight of the fact that this is a human being you are talking about.

    If he needs reminders about covering a cough or washing his hands, please, learn how to do this without being insulting or giving him the impression that you think he's unfit to have contact with other people.

    When HIV and AIDS were new and beyond scary, some folks thought that infected patients--including babies and children--should be treated like lepers and made to live in separate colonies. Thank goodness, the panic and hysteria eventually died down and wiser heads prevailed. Unfortunately, a lot of hearts were broken on the way to universal precautions.

    I hope you can find a way to temper your vigilance with wisdom and respect.

  • May 5 '12

    Quote from unsaint77
    So, here is my question to those of you who think MRSA is not a big deal. Would you let your elderly parents or your babies or children sit at a dinner table with someone with mrsa in sputum with no mask?
    Yes, I would and have, I even *gasp* lived with someone with MRSA in their sputum and slept in the same bed. As long as the person is not coughing uncovered and is washing their hands there is no risk to people around them.

    There are people walking around everywhere with MRSA, your coworkers, your children's schoolmates and likely even your doctor.

  • May 5 '12

    Quote from saint 77
    The following is from an article from MRSA Topic MRSA

    "Furthermore, asymptomatic (ie. non-infected) MRSA carriers can easily pass this bacteria on to others through direct contact or even just by living in the same environment. This is especially scary because while your immune system may do just fine dealing with 1,000,000 MRSA bacteria per square inch in your nose, your 80-year old grandmother, 6-month old infant, or cancer-fighting spouse may not be so lucky. This is exactly the reason why initiatives are popping up all over aiming to have all patients screened for MRSA prior to admittance into hospitals. There are simply too many immunocompromised patients, too much movement, and too great a risk within those walls to allow free passage of bacteria living silently on unaware carriers."

    There are many immunocompromised patients in nursing homes. Do you not mind getting the bug from someone who has MRSA colonized, just because the pt is not having an active infection? I don't think so.
    The reason patients are being tested/screened prior to admission is to document the pre-existence of MRSA so that if the patient gets MRSA the hospitals reimbursement isn't penalized. There ARE different requirements/recommendations for long term care versus acute care. But think about it..... do you wear a mask for CONTACT precautions?

    This is this man's HOME even if he is in a "facility". He isn't a leper and isn't highly contagious in a communicable way. He needs to be treated humanely and respectfully. Those other residents are at more risk from the staff and visitors bringing in flu and other viral illnesses that this man walking with "known" MRSA in his sputum. We all have staph just some of it is more difficult to get rid of than others.

    "Next time, I am going to escort the patient back to the room and have him eat meals in the room. If my supervisor gives me hard time, she just going to have to write me up".

    Making a patient go back to and stay in their room, without an order and just cause, is a form of restraint and can be considered assaultive. That, can get you fired and put your license in jeopardy.

    I applaud your dedication and enthusiasm but......I would choose
    your battles wisely.

  • May 5 '12

    What do you think the guy's going to do, spit on people? He should cover his mouth if he coughs. Geeze Louise.

  • May 5 '12

    There are people that walk around with MRSA everywhere. Many nurses if cultured would be positive. If the MRSA is in his sputum then as long as he isn't coughing and there is meticulous hand washing he is fine. MRSA is not an airborne organism.

    The CDC provides information about Health Care-Associated infections. I have provided you links.
    CDC - Long-Term Care Settings - HAI
    CDC - Prevention Tools - HAI

  • May 2 '12

    Must keep mouth shut. Must keep mouth shut.......

  • May 2 '12

    I am a "pro-choice" person and I am a nurse. I believe that the consequences should be explained to the mother (possible death for her and her baby) and then let her choose, just like I believe a mother should be able to choose to remain pregnant or not. It is her body, her child, etc. If she has been given the consequences she is an adult and can make a decision (even if I necessarily don't agree with it, it's not my child, body, or life) and she has to deal with it.. (bring on the hate from people who wanna tell everyone else what to do) Patients deserve to know their options and consequences of each option, and be allow to make their own decisions when competent, that's the only ethical solution.

  • May 2 '12

    What is your opinion on this? It sounds like a homework assignment and I think you will get more discussion if you start the ball rolling yourself.

  • May 1 '12

    Your comments come from your emotionally distraught heart, and I can appreciate that.

    They do not particularly relate to nursing.

    Your father's "medically-induced coma", to use a lay term, was continuous sedation ordered for brain rest or some other rationale. Nurses administered that continuous sedation.

    I'm sorry that the interventions "mean nothing to you" and that all you've taken away from a month-long up close encounter with critical care was that you only want nurses to "advocate". We do advocate - including sometimes opening up discussion on whether or not the plan of care and the prognosis driving it need to be altered.

    Wishing your dad a recovery that meets his expectations.

  • Apr 30 '12

    Quote from uniquenurse
    In single person check during blood transfusion, the transfusing nurse is solely responsible should he/she commit errors. Therefore he/she must be extra careful in checking the blood products, checking patients, vital signs monitoring and all other aspects of transfusion. This would certainly minimise errors and near-misses. Any views on this? Thanks in advance.
    This reads like a homework question.

    How about you tell us your views on the statement you provided and we discuss it from there.

  • Apr 30 '12

    thread is 2 years old. Hopefully, OP is already a nurse!

  • Apr 30 '12

    Umm....ok only bc I just completed the first of a 4 day rotation on OB and I am still a student, and this sort of happened but more related to C-Section...

    1. Do you have a Nursing Dx text? Ours is "Handbook of Nursing Diagnosis: Application to Clinical Practice" (Carpenito-Moyet, 12 & 13 Ed). Either that or go do to get a reputable nursing diag. text. This will line out for you by body system/functional health pattern currently approved NANDA diagnoses.
    2. If your pt isn't poopin' and it's been a while (longer than facility expectation), its an actual diagnosis that comprises 3 parts: Diagnosis, related to....., as evidenced by: XXX.. For Example: Constipation related to immobility secondary to acute pain, caesarean section AEB lack of bowel movement or flatus. Alternatively, "Constipation r/t episotomy pain AEB client states, "I can't push, it hurts too much to poop" and lack of BM for 3 days."
    3. If your pt is just a few hours or so out of surgery, then it's likely a "risk for" Dx as in: Risk for constipation r/t lack of peristalsis secondary to anesthesia, immobililty, etc. NOTE! In RISK FOR diagnoses, you have NO "AS EVIDENCED BY (AEB)" because you suspect a potential diagnosis based on the situation (but you have no real signs/symptoms...yet!). WHEN you get actual s/s, then it can become a true Nursing DX (See #1 above)
    4. And lastly....oh do i FEEL YOUR PAIN, I struggle/struggled with this A LOT!....I found that looking for the broadest NDx then allowed me multiple interventions that could be used to further refine NDx as pt care progressed.

    Good Luck!

  • Apr 30 '12

    I dont like walking to the linen closet or supply room and then get there and totally forget whats needed...that patient that needed, is on the opposite side of the floor too....


  • Apr 30 '12

    You'll be having a good day... in a good mood... on a roll...everything falling neatly into place... and someone will say "Gee, isn't it QUIET tonight?"
    Ah yes, the QUIET jinx! Never ever ever says its been a quiet shift unless you are home, have your feet up, and a glass of wine in hand!

  • Apr 30 '12

    Gotta preface this by saying I work in a 60 bed, privately owned ALF that is 100% Alzheimer's/Dementia care. We don't have unit clerks, but we do have an administrative assistant who answers the phones, pushes the button to let visitors in and out, etc.

    The phone will not ring, visitors will not show up at the door, and the fax will not go into overdrive..... UNTIL the admin asst goes home for the day... then all of the above will happen simultaneously.... during dinner.... when someone has just fallen... and you're trying to complete your 5pm med pass.

    You'll be having a good day... in a good mood... on a roll...everything falling neatly into place... and someone will say "Gee, isn't it QUIET tonight?"