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Kymmi's Latest Activity

  1. Kymmi

    Tube Feeding Question

    Very good question and the reason most nurses say to do it is the usual "thats what I was taught" however there really is no rationale that makes sense to me anyway. I will explain my reasoning and I would be interested if someone could explain why my reasoning isnt right other than its what we've all been taught. Lets say the feeding is running at 40 cc/hr and I am going to lay the patient flat for a 2-5 minutes turn/linen change...the stomach will already have tube feed in it that hasnt absorbed yet so therefore even if the feed is turned off there is still a chance that whats in the stomach could cause aspiration. Now if you were to tell me that its been turned off for 30-60 minutes prior to a turn that I could understand because the feed has had time to absorb. Nurse2033--your reasoning makes sense to be because you are thinking ahead of possible things that could happen that would cause the patient to be flat for longer than 2-3 minutes so thats a good rationale. HamsterRN---Im curious to hear your strong rationale because even if the feed is off while turning there is still stomach content that could cause aspiration. I did have someone explain to me once that the reason we do it is not so much to prevent the stomach contents for being aspirated but that there is a chance that the actual tube could migrate into the lungs while patient is supine and therefore that would cause the feed to flow into the lungs...now that makes sense however if we go with that logic that would mean we should check placement of the tube each and every time we reposition the patient.
  2. Nurse156---first off I apoligize if I offended about the AA analogy..that wasnt my intention...I was just trying to come up with a way to express that someone might not know someone else is in the hospital but they see the name as they walk past the board....I do not know how the meetings are run but thanks for the info. Second ---I totally agree with all your points because I've asked the same thing about the non private rooms, ER and so forth and I have never gotten a good answer (from adminstration) about why those do not violate privacy acts but I did ask about the names on the board because a few years ago we ended up having to remove the boards from our ICU and it was explained to me by the powers that be just as I explained it here. So I dont totally get what makes one a violation and another thing not I was just answering based on what I was told by those in higher places. Once again I apoligize for anyone that I might have offended when I referred to AA...I was NOT attempting to offend and I guess it was a bad example to use.
  3. I understand why you'd think the way you do about anyone being able to call and ask if so and so is in the hospital but think about this situation. Mr X is here to visit Mrs X and as he is walking past the nurses desk and he notices the board says Mrs. XYPSOET is in room 404. Now the last name XYPSOET is not a common name and Mr X knows someone with that last name. He now knows that Mrs. XYPSOET is a patient where as before he did not know because he knows her from a AA meeting he attends but doesnt know her as a friend because they really arent friends....he just knows her....so yes....if its easily visible to people other than hospital personnel who have a right to know that info it is a violation.
  4. Kymmi

    Question regarding Humalog insulin

    My first comment is 555 is NOT normal for anyone. I understand that you are saying that 555 is what this patient usually runs but its apparent that her current insulin coverage isnt working. I would give the entire 6 units that is ordered before lunch as ordered. If it isnt given the way it is ordered then the MD needs to be aware and give a order to only adminster half and give it after lunch which I doubt he would do. If you have no orders to change the dose or the time then it must be given as ordered otherwise that is considered practicing medicine without a license which is a major violation and very risky to your nursing license. Now that I explained that part I would highly recommend someone contact the MD to let him know that the sugars are running very very dangerously high so that he can make adjustments to the insulin dosage. If the MD is not aware of the current trend of sugars and the insulin dosage isnt addressed I could see big time trouble heading for this patient...its only a matter of time until the patient goes into DKA. Also glucoses that high will effect the kidneys, cardiovascular system so even though your supervisior/instructor or whoever says that they are "normal" for that patient just remember they are NOT normal for anyone so they need to be addressed.
  5. Kymmi

    Vent about work

    Its been years and years since I've worked LTC so Im sure it has gotten alot worse since then but I do remember that there is a OMSBUDSMAN ?(spelling) number that you can call or anyone can call including family members to report unsafe or inadequately staffed facilities. Im also fairly sure it is annoymous. If you've gone to management and voiced your concerns and they do not seem to care and you truly feel it is unsafe I think that's what I'd do...make that phone call. Also if you are being asked to stay to finish work without getting paid for it then the Department of Labor would love to hear from you. Like I've said its been many years since I was in LTC and Im sure its not gotten better and Im also sure its gotten worse and will continue to get worse. I think the only hope is if nurses and CNA's begin to step up all over the country and start reporting unsafe practices but unfortunately that doesnt happen often enough...most are glad to have a job and do not want to risk losing it and others feel there is nothing they can do and they find another job and move on. I know our elderly are the ones suffering and I also know that if the time comes either of my parents need to be in LTC I will be one of those noisy family members that everyone complains about because that seems to be the only way to make sure that adminstration makes sure proper care is given. I know its not right but its a reality that in this day and age its all about who makes the most noise as to who gets the proper care. Management bends over backwards to make sure families think the facility is superb and the patients with no family or family that doesnt make themselves known are the ones left with minimal and/or inadequate care. I DO NOT blame the nursing staff for this because when there is only so much that can be done in a shift and most of the time management does not understand that because they have not attempted to do what they ask the staff to do so they are clueless as to just how much time and staff it takes to provide care to the patients.
  6. Kymmi

    Being Tired at work - How do you cope?

    If you are truly that exhausted all the time I'd be careful about chalking it all up to nightshift work. How are you on your days off? I know that for the past 2 years I've noticed I've been more and more tired even on my days off. There have been times that I'd literally sleep 24-36 hours straight only getting up one time or so to go to the bathroom. Times that I would sleep 10-14 hours and a hour after getting up I'd be needing a nap. I finally after several times of complaining to my primary MD went to a sleep specialist and had 2 sleep studies done which were abnormal. I did not have sleep apnea but I did have another sleep disorder which causes me to not go into the restoritive sleep stages no matter how long I slept and I also went into REM sleep very minimum. I started on Provigil and it has made such a huge difference in my life. I now feel refreshed when I am awake. If I do not take the medicine then I will sleep and sleep and not feel like I've slept at all. Its just a thought and Im not saying that that is what your problem is however it is worth looking into and getting a sleep study done to be sure there is not a underlying problem that is not related to nightshift.
  7. Kymmi

    Yelled at a patient

    SWS RN and Paul (I believe) I have to say dont worry about who's sitting there saying ***whatever about your witty remarks/comebacks to each other because I for one found comic relief in them and we can all use that. I must say Paul I did the same as SWS RN because I too was drinking iced tea and when I read the comment about continuing and Alzheimers I choked on my iced tea...I dont know why but I found that extremely funny. As far as handing out the AMA form I have no problems doing that to patients that are truly needing it. If I have a patient that is alert/oriented and able to make their own choices I do attempt to convince them to stay. I will remind them why they are here and what could happen if they leave and after that they are adults and can decide to do what they want to do. No one (other than the car salesman) ever begs me to stay so I can continue to annoy them. Sometimes I think that we as nurses attempt to feel responsible for everyone and everything and its those times that we have to remember we are not responsible and if someone choses to go AMA thats their choice just like the alcoholic or the drug addict that comes to us for treatment....we do our best to care for that patient and we hope that possibily we might be able to provide care and teach regarding the effects but if they choose to continue it is not our fault.
  8. Kymmi

    Yelled at a patient

    Ok Im agreeing along the same lines as SWS RN. Ive been in nursing for a long time so I would not have even done as much for this woman as you did. I would have explained to her once that the MD would be in to see her and at that time the MD would go over her test results. I would have informed her ONCE from a nursing standpoint what I was going to do as far as her plan of care was concerned. It is not within your scope to discuss test results with the patient...that is for the MD to explain and diagnosis with. If she continued to express that she doesnt understand why she has to be there or voice that no one will let her go I'd politely (of course) explain that she is not a prisoner and that no one is forcing her to be there. If she feels there is no reason to be there than she can sign the AMA papers and go on about her merry way. I'd of course ask her why she came to the hospital in the first place if she thought there was nothing wrong with her that required treatment. I would NOT give in to her attention seeking martry behavior. I wouldnt have called the insurance either. I would have told her to make the phone call...she apparently was capable of making phone calls and who knows that might have tied up her time with the insurance company and the doctors office would have gotten less phone calls from her. :) I know there are a lot of sick people that require our attention and care and I would never deprive anyone of that however I also will not force my care onto you. If you want to leave AMA or just cant understand why were "forcing" you to be here then leave but spare me the drama because I can better use my time to save someone's life. Just as there are very ill people there are also those people that seem to think they are dying constantly and really just like the drama and attention that goes along with being in the hospital.
  9. Kymmi

    Impossible patients/pt. family members

    I know you probably dont even know how much a EKG costs and it is not your place to tell her whats in the chart but why did you refuse to tell her what doctor ordered the EKG? I would have told her the doctor that ordered it and then told her you do not deal with billing/insurance issues and that you suggest she speak to the MD about test results and chart content.
  10. Kymmi

    high bun/creatinine

    RN-Cardic.....the uuuummmmm really? response was to the OP question and not my response right??
  11. Kymmi

    What happened to make him die?

    Are you saying his PCO2 was 93 and his PO2 was 72? Doesnt really matter actually even if I have the numbers reversed with a PCO2 that high patient was bound to not last long. He might have been aspirating the pudding into his lungs which would have made the PO2 level drop but even if he had been NPO with blood gases like that esp after wearing Bipap there really isnt much hope to help other than intubation but he was a DNR. Sounds to me like his heart was not getting enough O2 and therefore he went brady and passed so in conclusion of my long explanation.....NO you did not cause his demise it was nature and time for him to move onto a peaceful place. The fact that this is on your mind and you are concerned tells me one thing though.....you are a very caring and compassionate nurse and he was lucky to have you to care for him in his final time on this earth so when the thoughts you are currently having start kicking in please remember this instead.
  12. Kymmi

    high bun/creatinine

    Sounds like one to me. This OP's nick is CCUnurse but I ponder that because any CCU nurse would surely know the answer to all of the above questions. For that matter any nurse should know all the answers to the above questions.
  13. Kymmi

    Question on background check

    If that would hurt peoples chances of getting a job there'd be alot more people without a job. Seriously though they do do credit checks at some places but they are looking for more than a outstanding paid off debt thru collections of 100 some dollars so my answer is absolutely not and dont worry about it any longer.
  14. Kymmi

    Doctor's orders drama

    Ok...I do not work LTC so I dont know if that makes a difference but my thought is I would have done what you did....why make double work for yourself by faxing one set of orders and then another set of orders. You faxed orders and the physician signed them....he should have read them before he signed them so if he wasnt ok with the orders he should not have signed them. I know people are going to say that the MD's don't always read the orders before they sign them but that's not MY fault....I do not sign my name to anything without reading them first. I might have a different viewpoint if you told me you changed a insulin dose or a cardiac med but to change a stool softner from 2 to 1 a day is not going to have a fatal impact on the patient. I still stand by the fact the MD should read it before he signs it but I guess I would just take more precaution if the med was a med that effects a major system however bottom line is if he signed it then you've got your orders legally.
  15. Kymmi

    They must think we are stupid...

    Pamilia Im pretty certain that the OP did not tell the patient to save time and put a gun to her head and get it over with however I disagree with your thoughts for the most part. Patients need to be held accountable for their actions and health issues. I agree that patients need to be treated with respect and not ridiculed however I seriously doubt the OP belittled the patient. I do hope she did some teaching regarding fluid intake, disease process, treatment which I would imagine the patient has had numerous times in the past however the patient chooses to ignore her responsibilities and chooses to do as she pleases instead of owning her own part in her treatment. So many patients feel that they can do as they please and then have the nurse or the doctor "fix" it and make things better and they fail to own the fact that it is their actions that matter most when it comes to managing their disease. I understand that diseases occur and alot are not preventable however most are manageable with proper medication, diet, exercise and lifestyle changes. Alot of patients that suffer from chronic illness and sometimes even those that suffer acute illness seem to have developed the idea that they will do what they want to do and then have someone else fix it then they get mad when their condition worsens and attempt to blame the medical field for not treating them properly. Until patients are held accountable for their actions in their own healthcare treatment we will continue to have the patients who feel they have done no wrong and its all the medical personnel's fault their disease worsened. Im not saying do not respect patients but they need to know their responsibilities....I am not cold hearted and I do not lack compassion I just chose not to allow my patients to do as they please and not take responsibility for their actions. You are responsibile for your actions as a nurse and you are held accountable for any outcomes that happen due to those actions....what if you did something you knew caused harm but your manager didnt want to come off as lacking compassion for you and therefore did not make you own your actions..what would happen at that point? Its the same principle...we are all responsibile for what we do and what outcome occurs. If you chose to treat your patient without holding them accountable and just allowing them to do as they please and let you deal with the consequences then are you really doing your patients good or harm?