new to ltc - any reading recommendations or other suggestions?

kbrn2002, ADN, RN · May 13, 2013

It is hard to give specific advice without knowing what type of facility you will be working in. Is it strictly LTC with a variety of DX or is it a dementia/memory care facility. Or is it a combo LTC/short term rehab? Is it a small or large facility and how well staffed is it. Also which shift will you working? Every shift has it's own unique requirements. Best advice for now is hope for good and reasonably thorough orientation but don't necessarily expect it. LTC is notorious for a short orientation period. I have been in LTC for 15+ years so if you have specific questions feel free to PM me and I will do my best to help answer them.

As far as the dialysis component, unless your facility is somehow connected to the dialysis clinic those patients will go to out patient dialysis. Very basics for in facility care is being familiar with their dietary and fluid restriction orders. If their meds are crushed give in apple sauce, not pudding as pudding is high in phosphorus. Look for signs of fluid overload, especially on the last day before the next run. These residents should be on daily weights to help with monitoring for fluid status. Know the post dialysis complications to look for. If you are working when they leave for dialysis and need to give meds become familiar with which meds are removed during dialysis and make sure they are not scheduled prior to a run. If necessary get those meds scheduled post dialysis. This includes cardiac and BP meds as BP can drastically drop during a run. There is usually some kind of communication book that goes back and forth with the resident so both dialysis and your facility are updated on order changes, labs, etc. That is all I can think of off the top of my head, but again if you have more specific questions feel free to ask.

Best of luck in your new job!!

pinkiepieRN · May 13, 2013

It is hard to give specific advice without knowing what type of facility you will be working in. Is it strictly LTC with a variety of DX or is it a dementia/memory care facility. Or is it a combo LTC/short term rehab? Is it a small or large facility and how well staffed is it. Also which shift will you working? Every shift has it's own unique requirements. Best advice for now is hope for good and reasonably thorough orientation but don't necessarily expect it. LTC is notorious for a short orientation period. I have been in LTC for 15+ years so if you have specific questions feel free to PM me and I will do my best to help answer them.
As far as the dialysis component, unless your facility is somehow connected to the dialysis clinic those patients will go to out patient dialysis. Very basics for in facility care is being familiar with their dietary and fluid restriction orders. If their meds are crushed give in apple sauce, not pudding as pudding is high in phosphorus. Look for signs of fluid overload, especially on the last day before the next run. These residents should be on daily weights to help with monitoring for fluid status. Know the post dialysis complications to look for. If you are working when they leave for dialysis and need to give meds become familiar with which meds are removed during dialysis and make sure they are not scheduled prior to a run. If necessary get those meds scheduled post dialysis. This includes cardiac and BP meds as BP can drastically drop during a run. There is usually some kind of communication book that goes back and forth with the resident so both dialysis and your facility are updated on order changes, labs, etc. That is all I can think of off the top of my head, but again if you have more specific questions feel free to ask.
Best of luck in your new job!!

Sorry; I feel like such an idiot for not posting details. I feel like a fish out of water. I'm used to a 26 bed locked unit of voluntary/involuntary commonly dual diagnosed young and middle aged adults. I'm in for a learning curve, I know!

I'm going to be on 7-3 FT, as well as every other weekend. The facility is 110 beds. Average patient load is 8-14, depending on acuity. It is a combo LTC/short term rehab. Of note, it was also mentioned that the facility has seen an increase in bariatric patients. Some patients are on tube feelings or have g-tubes, which is completely new to me. Medications are packaged and administered in blister packs.

My facility is connected to the dialysis center.