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Discussion

Need help understanding

I am a LTC nurse of one year and I am having issues with understanding some rationales behind some orders. I have an elderly dementia resident who recently fx there hip and under went surgery which in turn led to an illius. They spent a total of 2ish weeks in the hospital and upon returning it showed they had lost ~16 lbs. They started daily weights and dc'd tge residents exelon patch and started supplements. Resident isnt really wanting to eat and the family requested the exelon patch to be restarted. The PA restarted the exelon patch and changed the weights from daily to weekly. The facility is freaking out. They called me asking why we changed to weekly weights and why we restarted the exelon patch. I explained what I knew. I understand why they are concerned about the exelon patch, because common side effects are weight loss. I'm not really understanding why the daily weights seeing as how the resident doesn't have CHF or a compatible disease process. Can someone please help me understand the rationale for a daily weight for weight loss?

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    LTC facilities are fined/flagged by inspectors for patients that show significant weight loss. Thereby management is hyper about any weight loss. Daily weights would show a trend of loss, but to me that is over kill. Issues like neglect come into play when a patient shows significant weight loss. Has the Dietician been consulted? Have any supplements such as Ensure or Magic Cups been ordered for the pt? The weights should be taken into account from the point where the pt. was discharged from the hospital. We always accounted for the weight loss from hospital stays and started our own records based on that weight loss----thus the weight loss in the hospital did not count. Is this a computerized program that automatically flags when there is a 5% or greater weight loss? That was what drives reimbursements etc. So, in short, the manager was most likely upset that the epsilon patch was restarted due to the correlation with weight loss, and tracking the daily weights would show if there was any improvement etc. Is there a way to track how much the pt is eating per meal? We had a tracking system that the CNAs would chart what percentage the pt was eating. Also, if the family can bring in food it might help the pt's appetite. Most alzheimer patients have some appetite loss which results in weight loss, it is not always a reflection of the nursing care. Has anyone talked to the family about palliative care??

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