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billssisbeth

billssisbeth

Home Health Field Nurse/ Reiki Practitioner
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  1. billssisbeth

    Private Messages available after 15 post

    Thanks for looking out for us!
  2. billssisbeth

    Borrowing Narcs in LTC, ok?

    NO WAY!!!!!! I would RUN from that place!!!!! They are violating multiple Nursing Practice Standards and Federal Laws! Narcs are serious business hence the fact we must sign our lives away when using them. Narcs are tracked and I for one know too many DEA and FBI officers to mess with "borrowing" a narc from another location or patient! "Oh btw Agent Joe what are the federal standards for using one person's meds on another....?" YEAH RIIIIIIIGHT! There'd be a black SUV in my driveway the next morning... LOL I would sign and circle the MAR with a note stating med unavailable at this time. THen write in the nurses narrative note the same thing documenting how much was in the elixr bottle. I might even call the Dr. for a one time order to give the patent a reduced dose until the new bottle of elixr was obtained. or an order for the narc stock box to be opened and the right dose removed. But I suppose the DON or the ADON has the key... LOL Let the ADON get her toosh out of bed and come put HER license on the line! I'd be fired the next day, but would still have my license!
  3. billssisbeth

    "Rewriting" Home-care flow sheets

    I have a Documentation Ethics question.... I have been asked multiple times to rewrite signed nurses notes that were perfectly legible... either a water "spot" or stray pen mark was the reason I was asked to "rewrite" it. Nothing was unreadable or omitted. My employer wanted to destroy the original. I kept them from doing so by saying "see original document" on the signature line of the regenerated note. I have looked into this per my State Board of Nursing...but there is no definite outline as to whe a Note should be "redone" if soiled, obliterated or marked on AFTER the authorized signature is in place. Does anyone have ANY ideas about this? And I need resources to back me up.... Thanks. Beth.
  4. billssisbeth

    Care Plans

    Where I work we refer to-- http://rncentral.com They have care plans that you can print up and use. We use these because they are standardized and simple. Also, there are MANY valuble resorces at Barnes and Nobel Book Sellars and Borders Book Stores in the Medical Reference section.. granted some of these will cost you 35 to 50 bucks but they are well worth it if you do allot of different care plans. Good Luck! Beth.
  5. billssisbeth

    Roaches are going to drive me out of home care!!!

    SOME DAY I'll learn to type!
  6. billssisbeth

    Roaches are going to drive me out of home care!!!

    I must have it great.... I work in an upscale CLEAN home in a NICE St. Louis neighborhood.... BUT A couple of years ago I worked for an agency that sent me to a tennement apt downtown... in the room of the baby I cared for an outer wall was missing covered by a BLANKET and ceiling was supported by 4 4x4 posts....... mind you we were on the SECOND FLOOR!!! On my arrival the family ROTWILER charged me with a slathering grin and a deep throaty Grrrr.... I backed away from the dog and stepped on a pile of discarded taco bell and burger king bags which a ZILLION Mark McGwire baseball bat holding-- home run hitting sized roaches jogged out of.... Then th ekicker.. the baby roaches were platint "tag" IN and ON the vent and it's tubing circuit! I stayed long enough to call my supervisor and tell her to call Rankin Jordan Children's home for IMMEDIATE transport of this child to their facility for it's own protection. She refused. I called Social Services next.. waited an hour for them to show up. They saw the house af\greed with me and then they removed the child and I went home. three days later the baby was BACK in that hell hole.... :confused And get this..I got a write up for insubordination and I got removed from the case for being too "uppity". :chuckle Go Figure. :chuckle :
  7. billssisbeth

    Emergency Measues criticized by Pt's mother.

    Well I'm NOT alone!!! I Feel SO much better... I have a few more stories about this family but... they are better left unsaid.. LOL If I didn't LOVE this kid I'd be gone in a heart beat.. LOL Go Figure. Beth
  8. billssisbeth

    Emergency Measues criticized by Pt's mother.

    Whew... I'm NOT ALONE! LOL
  9. billssisbeth

    PEEP valve with a CUFFLESS trach?

    This "kid" is 20. He is Guillian-Barre Syndrome and "forgets" to breathe while he sleeps. He also has "bad days" where he never does get weaned off the vent for the day. Usually thick secretions are the culprit. We do 4 full rounds of MANUAL postural Drainage on him a night. Mom won't let us use the new "Vest" she feels it "plugs " him up. Can you say FRUSTRATION?????
  10. billssisbeth

    PEEP valve with a CUFFLESS trach?

    THANK YOU!! I feel much better!!!
  11. billssisbeth

    PEEP valve with a CUFFLESS trach?

    Can some one please explain to me the value of a PEEP valve with a Cuffless Portex 5.5mmID Pediatric Trach? I thought that PEEP was only used with CUFFED trachs? This pt. is on a LP10 with .650 TV 0.8 insp time, HP 55, LP12, PEEP set at 4 but actual end resp readings are always 0.... Can anyone give me "insite" as to why this may be? Pt. Mom is clueless. I work nights and Dr. won't call me back.
  12. Ok here we go again... New case different story but same old stuff on a different day... It is 0400 am... working with homecare pt I notice that the vent circuit is leaking somewhere. I can't find the scource... Pressures are hitting 10 at best and the low alarm sounds like Beethoven's Fifth.... No vent circuit ready in the closet... bagged pt and grabbed stuff to make new circuit,... continue to bag pt using Knee with gentle pressure and never missed a beat while I cut pieces off and applied pieces to the new circuit...Had that buzzard together in less than 90 seconds.. like Vents are my living.. I cannot count how many of them I have changed circuits on the last 10 years... I was taught if you don't know the exact scource of the low pressure CHANGE THE CIRCUIT! Better safe than sorry. Feeling rather proud of myself I told aforesaid pt mother what happened,,,, " Oh well I have NEVER had that happen to me" and "Oh this piece is backwards"...( forgot to turn a inhalation tube right side up) GEEE! SHoot Me! Well get this... the PEEP on this circuit ( mind you we have a CUFFLESS trach here) is set a 4. Mom notices on a test lung that PEEP is hitting 8. I got yelled at for having it set too high... I was accused of turning the PEEP up to "blow" his lungs. I NEVER touched the dang thing. I too checked it with the lung not 5 miutes before she walked in the room it was hitting 4. Ok... am I out of line in being angry??? Am I being over paranoid because 10 years of vent experince are being sliced and diced. :( :mad: After she walks out of the room I get the old circuit and tear it apart peice by peice. I found out the Exhalation valve had split down a side. When I showed her that a bit later like 30 minutes ago she said that was impossible"I have NEVER in my life seen that happen"... Now tell me am I crazy or can wierd things ACTUALLY happen that a pt's family hasn't seen before??? Well I'm open for diplomacy and rason so Shoot.... Beth
  13. billssisbeth

    Calling all HH Nurses, roll call

    Ta Dah! It's Beth! LOL. I have been in HH for 10 + years. I LOVE it. I give ONE to ONE care, I am respected, cared for and I go to the "enth Degree" for my clients. I Chose Pulmo as my specialty and know a variety of vents, trachs and specialized pt. care. I have specialized skills that some "In House Nurses" have stood by in amazement as I handeled situations they would call RT to fix. I love my job. I love knowing I am trusted to work in people's homes and having to be independant and self sufficient. Before I got into Home Health I was very afraid of accepting total responsibility for a patient. I used to depend on other nurses to help me accomplish tasks, but Home Health has forced me to become more educated, more multitasked and organized. I wouldn't go back to "In House" Nursing for a Million bucks a year!!!
  14. billssisbeth

    How much Verbal Abuse should a nurse take from a PATIENT?

    :kiss TO all of you. Shortly after starting on the case we changed doctors. We found she was on conflicting meds ( Old Nursing Agency gotthe orders!!! UGH!) AND she has been Diagnosed with Alzhiemer's Disease by the new doctor. I informed him that she was on antagonistic drugs and we changed her med profile. With in a week she had become a totally different person. Now instead of getting rid of me she doesn't want ANY other Nurse to care for her. This is creating a problem because she is still very hard on all the other nurses. I have spoken to her and she is getting better. Thanks For Your Support!!! Beth
  15. I have just started a new home health care case. My client is a well to do person and treats the other nurses and myself like DIRT... Constant verbal abuse is a norm from this client. We have been called the "w" word for prostitute, the "s" word for loose woman, the "B" word for female dog and worse. the last shift I worked this client pulled my hair, slapped at me, sniped, spit and was totally "with it" during every episode. This client's tounge is like a two sided razor and I'm needing advice on how to Doctument the abuse with out being personal, catty or unprofessional. HELP!!!!
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