New question... is anyone else frustrated by this?

Hellllo Nurse · Dec 14, 2003

Shoot! I just typed a long reply, re: my experiences w/ dialysis pts in LTC. Got the "no thread specified" message and my post was lost in cyberspace. Will try again later!

nursefiggy · Dec 16, 2003

I'm with you! Some of our NH pts were getting milk of magnesia and mylanta. (Yikes!) Another big problem is they don't remove their gressings between txs. I have had them to come back after the weekend with skin breakdown around the access due to the tape that was left on and clottede graphs! The smell when you take the bandages off can be terrible! I check their MARs agianst our computers for med changes and there is always something like "check dialysis access for thrill and bruit", it is always signed but the dressing is in place. So frustrating! So i am writing up a some orders and will get the docs to sign it and am faxing it to the NHs. It will say soemthing to the effect of remove dressing with PM meds. We also have pts with Ks of 6 and 7.

CoffeeRTC, BSN, RN · Dec 16, 2003

I'm always checking this board to gain more info for my pts (I work in a LTC facility) I'm not going to lie and say this doesn't happen in ours. I have been to no sucess, trying to get our dietary staff and CNAs to adhere to all the dieatry restrictions. SOme times I just feel like beating my head against the wall. I've let the DON, RD and administrator know that these residents aren't getting the ordered diets. Half the time the kitchen tells me that the dietary manager isn't ordering anything special and this is all we have One time I even wrote and incident report up for each of our residents and each wrong meal and they laughed at me..... Sometimes it is our residents and families faults...they refuse to eat withing their restrictions, however I always let the doc and dialysis ctr know this.

Please educate these nurses in the nursing homes... a lot don't realize the importance of the diet and med restrictions..(I get a lot of blank stares when trying to educate).

As far as taking the dressing off... I was told NEVER touch these unless they are soiled or look like they need changed. Please let me know... what you mean...what and when should we change them...

Do you have any good websites for any info that I can share with my fellow nurses in LTC

Thanks:D

Hellllo Nurse · Dec 16, 2003

Michelle126's reply is similar to what I wanted to say on this topic.

When I worked LTC, I did not know a ton about dialysis pts, but I did know they should not have certain foods like bananas, potatos, tomatos or OJ.

When I saw pts routinely getting these items at one LTC, I spoke to the DON about it and was told "We are having a lot of trouble keeping dietary staff. I don't want them to keep quitting, so I can't add anything to their duties right now. Most of them can't speak english or are illiterate, anyway. So, they won't even be able to understand or follow renal dietary restrictions."

Can you believe this??!

At another place, I had just started as the nursing supervisor and noticed that none of the dialysis pts were following renal diets.I told that DON, and he made up a dietary waiver form and had all the renal pts sign it.

This form stated that the pt refuses a renal diet and that the facility is therfore not responsible for providing one.

This is another "can you believe it"!

Yet another story.....

When I worked as an RN Consultant for several adult day care centers, I noticed that one center was providing all the dialysis pts w/ the same diet as all the other pts... Breakfast usually included milk, OJ, a banana and fried potatos.

Nobody I spoke to was much concerned about it.

This was in a sub-tropical area and many pts brought in oranges from their own trees and all the pts ate them. The center owner told me "Well, they are going to bring in their own food and eat what they want, anyway." I told her, yes, but if we provided a correct diet, and documented that each dialysis pt had had dietary teaching, that we were then not responsible for any related adverse reactions. If we did nothing, we would be responsible. This was a very law-suit happy area. The owner agreed to provide dialysis diets.

I have always assessed grafts/fistulas for thrill/briut, was was also instructed never to remove a dressing from one.

Now, that I work dialysis, I know better.

jnette, ASN, EMT-I · Dec 16, 2003

Thanx for the responses thus far.

I guess it's not just in my area, then. Sad.

Michelle, I appreciate your input and your efforts, how I do wish there were more of you out there ! :)

While we only have less than a handful of LTC pts., some of these are there only temporarily for rehab purposes... and are not by any stretch of the imagination "one foot in the grave".

In other words, these pts. still have good quality of life, families who care about them, patients who are alert and intelligent and willing to comply (at least as much as any of our other patients)...

Yes, ALL these patients (LTC or not) have a difficult challenge with their dietary limitations... not easy at all, and I know I would certainly "rebell" now and then as well !

So it's not like the patients don't care, or don't know the difference. THAT's what makes me so angry about this ! They DO know, and ask US why the NH brings them these foods !

It's just like no one over there gives a hoot. Perhaps there needs to be more communication from the NH administrator down... ESPECIALLY to the kitchen and dietary manager ! Then on to the nursing staff...

The dietary mgr. doesn't need to be ordering anything "special"... that's just IT ! Just don't give them the things they AREN'T supposed to be having ! Heck, give them grape juice instead of OJ ! Y'know? Is that asking too much? How about a tuna sandwich instead of peanut butter or tomatoe and cheese sandwich?

I'm not sure how to bring this about.. how exactly to intervene...?

Yes, we have asked that the patients' bandaids be removed before bedtime.... but it never happens. We don't use "dressings" (other than catheter dressings, and those are to be left alone, as we change these ourselves), but the bandaids are to be removed and not left on for 48 hours ! Too much moisture, too inviting to the bacteria buggies. These accesses are these patients' LIFElines, for heaven's sake ! Usually our patients will remove them, but do sometimes forget, and this is where the nursing staff and/or aids come in.

I just wish there were more INTEREST in the patients' wellbeing... in their overall CARE... I thought that's what nurses and cnas DO ??????????? :confused:

Why would they not care about these things? I don't understand.

I would LOVE to do something like a bi-annual inservice at these nursing homes... for those nurses/cnas who truly do NOT know, have never been informed...(shame, shame, nurse manager/administrator!!!)

Then again, I wonder what the response would be... would I get the same blank stares you mentioned, Michelle? Would I be wasting my time? Would they just nod their heads, then conveniently forget all about it ???

And then, if it CONTINUED to be a problem... I know how irritated I would get. Things like that make me ANGRY.

Not ignorance.. if you don't know, have never been instructed, fine. I understand... that's why I'd like to educate them.

BUT............ be educated... let me go over there and spill my head and my heart... then laugh or roll those eyes as soon as I'm out the door, and you wanna see someone turn into a Tazmanian Devil.......... !!!

It's just not right. It hurts me for them. They deserve proper care just as they would in a hospital or anywhere else.

The nurses, aids could even educate the visiting families when they bring harmful foods to the patients....

It just doesn't have to be this way... and shouldn't.