iamarn

Have you tried the thin duoderm spots? have had luck with them before.

Hello. Our scheduler actually keeps up with these dates...unless someone has been in the hospital and they come out within 5 days of cert period and then the nurse is responsible for checking these dates to do a ROC/RECERT same day visit. We are also using laptops that put these dates in for us.

I too have had inservice from KCI rep who stated that adaptic was fine to put under foam. Had one pt. that without adaptic it took 3 hours to remove foam due to adherence of foam to wound bed ana painful removal. No adverse affects from using adaptic. wound looks great!

Yes, this is the norm for me, but I am the only fulltime RN working out of the office. It is getting really old too. Since I paid per visit, the money is good for all the OASIS but I am beginning to feel as if it is not worth it. I usually drive over 100miles in one day and almost am never done before 4:00p.m. (even starting at 08:00a.m.) due to drive time (which I am not paid for). By the time I pick up my kids and come home it seems as if I only have time to do paperwork. My poor husband and children feel so left out. I really enjoy home health but all of the time it is consuming is really starting to drag me down. I guess I feel the same as you.

Hello. I have been a HH nurse since September 2006. The office I work out of is fairly small. There is only a full-time LPN and me and a PRN nurse that work out of the office. recently our census has increased. We currently have been under the director of another agency about 30 miles from us and we have clinical manager in our office. Since our census is up, the company has decided to make our clinical manager director of our office. They have offered me the clinical manager's position this week. My Clinical manager spoke with me about it and stated that usually they wouldn't offer a clincal manager's position to someone who was fairly new to HH but I caught on to all the OASIS quickly that they think I am capable of doing the job. She couldn't tell me about pay b/c she stated that she had never done field visits for the company that we work for, she came in straight as a clinical manager but she thought that it would be a pay cut for me to take the position. She said that they wanted to offer me the position before looking outside the company. I told her I would let her know in the next week. I like my patient contact but all of the paperwork that I am having to do at home is getting really old and also the fact that I drive over 100 miles everyday. Does anyone know the salary range of a new clinical manager? Any advice would be greatly appreciated also. Thanks in advance!

Hello. I guess I am just coming here to vent. I started HH back in 09/06 and have really enjoyed it. This past Friday was probably the worst day I have had so far in HH. Of course, it had to be Friday 13th. I started the day with 9 1/2 pts (counting admissions and oasis d/c'd). I told my clinical manager that there was no way that I could do all of these due to driving distance and time taken with pt. (3 of the pts. were wound vacs). After getting that taken care of, I was on my way to see pts. My fist pt. was an admission and he had a wound vac. Man had an extensive history and really liked to talk. Took my almost 2 hours to do admission and wound vac dressing change. Go to next pt. who is a female who had a brown recluse (sp?) spider bite 2 years ago and infection keeps having flare ups with infection from the bite. About 2 weeks ago, she was referred to another surgeon who is approx. 1 hour from our town. The surgeon debrided the poor girls hip where she was bit. Her wound measurements are 23x12x7cm. The doctor only gave her Lortab to take for pain which I always call before going and tell her what time i will be there so she can take her pain pill in time for it to work before I get to her home. She was also sent home from hospital with PICC line and is On IV Vancomycin and Maxipime. When I get to her home, she tells me that she did not take her a.m. dose of Vancomycin b/c it made her chest hurt, SOB, and hurt in arms and legs. I call infectious disease doctor and get all of that taken care of. Then I start on pt. dressing change. She is on wound vac. we always line the whole wound with adaptic to ease the removal of the black foam. Even with the adaptic, it is excrutiatingly painful for pt. She is crying and yelling the whole time I am trying to remove dressing. After 1 1/2 hours, I finally get dressing out. Redress everything with foam, drape, and T.R.A.C set and turn vac on. The sucking down is also painful for pt. So, I proceed to call surgeon's office to see about maybe getting some pain medicine to push through PICC line before dressing changes and maybe decreasing dressing changes to 2xweek d/t pt. not being able to tolerate. Of course, I had to leave message for the doctor/nurse to call me back. That visit took me over 2 hours. So, I head to next pt. home which is 40 minutes away. Get there, he is also on wound vac to heel. He had an apligraft placed Monday, 04/09/07. MD orders were to remove vac dressing down to steristrips (which were put to hold apligraft in place). When I got to home th pt. states, I noticed early this morning there was bleeding coming out from around the dressing under the drape. I proceeded to take dressing off very carefully, guess what? when I removed dressing, steri strips were stuck to drape and the whole apligraft come off with the dressing! There was supposed to be vaseline gauze over steri-strips to prevent this. I don't now if when the nurse at the wound center put vac on on Monday if she didn't cover the steristrips with vaseling gauze or when pt. started bleeding it loosened the steristrips from skin. I called wound center where pt. had apligraft placed and spoke with nurse. Nurse was kind of snappy and stated "Dr. ________ is not going to be happy". I proceeded to tell her that there was no way that this could have been prevented. She wanted my first and last name and phone number so he could call when pt. come back in on Monday, 04/16/07. Called and spoke with another nurse in office who has done home health for years. She states that she has never seen a doctor put a wound vac over apligraft. Have any of you? While I was in this pt. house the nurse from the surgeon's office called me back on my cell, but I didn't get the call because my cell wouldn't get signal at home. By the time i got ta place where I actually knew that I had a voice mail, I tried to call nurse back and office closed!! I then proceeded to my last pt. home which was an Oasis d/c which went fairly well. Then I came home to do mounds of paperwork. What a day!! Sure hope next week is better. Sorry, for the long post. Really would like to know if anyone has seen wound vac placed over apligraft.

Well, I did more bloodwork on my pt. today. His BUn is 23 and Creatinine. His estimated GFR has dropped from 65 last week to 59 this week. I think I am going to just call his nephrologist tomorrow.

I understand that my pt has a decrease in renal function. My question is what is the normal estimated GFR after renal transplant. Is it normal to have a reduced estimated GFR 10 years post-transplant? Thanks...

Hello. I am a home health nurse and need some information on estimated GFR after renal surgery. My patient, 62 years old, had a kidney transplant 10years ago. He recently had a toe amputated and has had a MI in the last 2 weeks. He underwent heart cath and was found to have 5 blockages in his heart. The doctors are delaying surgery d/t the pt. having MRSA from the toe amputation. The pt. came home with PICC line and is taking abx daily at home via IV to get rid of the infection. I drew blood work on him this last week. His creatinine was 1.2 and his BUN was 23. His estimated GFR was 65, which shows him in Stage 2 Kidney disease, showing kidney damage and mild decrease in GFR. For a healthy kidney, the GFR estimated is 90 or greater. My question is does having a kidney transplant effect the GFR estimated or is my pt. losing function in his transplanted kidneys? Any info, would be greatly appreciated. Thanks.