nurseebol

Lividity plus CPR equals desecration of a corpse to me

I would really like to see the actual "law" or an example as otherwise it's lip service IMO

I have heard of mobile crisis units, not sure if they would come out. The latest they are concerned about is her going AMA and she is not able to do that with her mental status. Then we are to call the ER and police and have her admitted. Kind of ironic that is when we are to do that.

We have a resident who really needs to be psychologically stabilized. She came to us homeless. She has angry outbursts and has latched on to another resident, making her incredibly uncomfortable. She can be found staring at her while she sleeps, kisses her all the time, and tells her that she loves her and "was raised by her grandma and would never hurt her" yet she paces in the room and talks about killing people. She throws things and sometimes won't let the nurse in the door. The resident spoke to me and I was able to manage a room change after I wrote a statement. The resident was discharged but sadly the son gave a false address and she came back. She has medicaid and I fear this may be part of the problem with getting her a psych stay. We are not trained to deal with her behavior. She has hit staff, and thrown stuff at us. She refuses insulin and asks for snacks all the time. I believe if she were stabilized on psych meds, we could then manage her better. I once called the doctor and asked if I could send her to the ER and he said no and to have her seen by the docs here. The docs here ordered a small amount of risperdal po, which she sometimes takes and sometimes does not. I believe she needs a dose of IM decanoate to get started. She hears voices also. I realize these drugs are now "taboo" in the elderly, because of recent studies, but what are we to do? How do we keep our residents safe? We are not trained on this and I feel helpless, sad and frustrated. When I tell my bosses, they say they say to do our best. Sometimes I feel like I should call someone else, but who?

Well done

I am a WOCN student, working for a hospice while I study for the wound care cert. I have a paper, which is the first for the course. I have the requirements below. We are not to repeat back the assessment, but provide what other questions and assessment we would do in this role. To me, it seems like it will be quite monotonous, like " I would assess history of previous ulcers, assess nutrition, etc". I have been taught that this is poor writing. My question is the wording on this. Would it be prudent to request examples of other papers even if they are different assignments to get an idea of what she wants? I have taken graduate level courses toward my MS in education, so I don't know if I am overthinking with the whole way they graded or what. Any input is appreciated. Thanks. I have a scenario as follows: Mr. Brown is an 80 yo gentle man with COP and Parkinson's. He lives at home with is 78 year old wife. He recently has had several falls and spends most of his time in a recliner chair. He refuses to sleep in his bed. He in on continuous oxygen. The home care nurse consults the Wound Care Nurse as he has developed pressure ulcers. He has a 3x3 cm superficial open area in the coccygeal area with 90% pink granulation tissue, 10% slough andminimal amount of drainage. On his right heel, he has 1.5 cm intact serum filled blister. The left heel is red with a 2.2 cm nonblanchable area. The following criteria must be included in order ot achieve apassing grade. 1. Pt physical assessment and medical history 2. tx plan 3. id products/devices used and rational for use: -wound care -pressure redistribution 4. develop a pt teaching plan 5. id desired patient outcomes Style and format list of references (use the required reading) typed, double spaced clear, concise language; correct spelling maximum length: 4 pages Provide your answers as the CWOCN consultant, DO NOT REPEAT BACK The provided assessment, but what other questions and assessment would you do in this role. FOllow the grading criteria 9on the next page) to successfully complete this assignment.

I know I asked about this before, but my question here is very specific. We have actually opened the dialogue about this benefit, here at my hospice, which is a huge step forward! I am told that it is beleived that continuous home care is not required to be provided. I have looked through CMS standards and some OIG reports and can not find anything stating specifically that "all 4 levels of care must be offered". I wonder if someone can provide a link to this type of wording. I realize the benefit only should be used when appropriate.

I usually go to nursing homes and independent living. I have a very kind team leader, albeit a little mousy. But anyway, I once took a home patient as they were close to home and I live far away. We usually don't take them that far, but we did; It was 2 miles from me. I offered myself night and day, and his symptoms were bad as far as agitation and the doses of meds he ended up on were really high and wouldn't touch him. Boundaries. That post was the best. We all have nasty bosses and political crap. You are out in the field most of the day so hopefully you can get around that. But setting the boundaries will make it so much easier. It may take a while until your census turns over and you can start anew with new patients, but it will help. But if you cannot pull yourself out of this rut you MUST take a leave. You will not make it otherwise. I find myself questioning the meaning of life all the time after taking this job, but honestly, I think it is just from turning 40, a little mid life crisis. I love my job and I know that once I get through my "existential crisis" I will be better for it. Right now I am listening to "Conversations with God, an uncommon dialogue" . Neat stuff. I pray alot. Maybe you need a new company. Start looking.

We have a small hospice, not considered inpatient because it is so small. But we have 6 beds and 1 nurse, 2 aides

Is your charting software relatively new and easy to use? yes 2) Software company (McKesson, Cerner, etc)? Suncoast 3) Are you using laptops, ipads, or android pads? Nurses use laptops, aides use blackberries 4) Are you connected to your software via server or does 'the program' reside on the laptop and require database synchronization? server, but we can synchronize too if we want to chart offline 5) How's your internet connections? Fast, slow, erratic, unreliable? fast

I understand. We are cutting back supplies and what we provide. Now our referrals are down. They want us to help "market". I think they have a double edged sword here. The facilities want low air loss mattresses for risk of skin breakdown, not actual...they won't provide unless there are 2 stage II's or higher. Crazy!

Not the norm around here. However, there are some hospices that do, just not many.

Btw we never paid for antibiotics or any drug not related to hospice diagnosis

I am relieved to not be alone. Problem is, out hospice is supposed to be "the best " it is out slogan. Our reputation has been good. But yet when people need this service they are referred to respite. Luckily we do have a small inpatient center that is nice. We are good with E kits. They r getting funny about supplies and I get that. But sometimes it is a bit much. We cannot order a special mattress unless they are already broken down. I am going to approach them about this because it is illegal and I know they don't want this to get out widely among the staff. I do t understand why they don't try to do it cuz the reimburse rate is pretty high for it. They are sending me to class for certification and once I start I have to stay for 2 years. I think that will be a good time to mention it as I will be less disposable lol. I am on a quality improvement committee and that will be my opportunity to ask for "clarification about this benefit I heard of"

I have a patient with intractable terminal agitation. The family does not want to use respite, as they want to keep them at home. They do not want to hire caregivers because of liability concerns. They trust us-hospice. However, I am told we do not have the manpower to provide continuous home care. From my research and talking with a few others I found out that this level of care is SUPPOSED to be offered (see quote from about.com). I feel as though this family should have this benefit, but if I open my mouth I will lose my job or have some type of issue. I love my job, but this is weighing on my mind. The guilt is horrible when I leave, but I have to go home to my family. I have considered staying for several hours on my own time, but this isn't how it should have to be. Any thoughts or suggestions? I know if I told this family about this, they would raise the roof to have the benefit, but I am sure I would be found out as putting them up to it, so I don't want to do that either. I value my job, and I can't risk making waves for the sake of my family, but I feel like my integrity is taking an nosedive. "If a patient develops physical or emotional symptoms that aren't easily managed with routine care, continuous care may be an option. Continuous care provides more intense care in the patient's home environment. A nurse and/or a home health aide will remain in the patients home environment for a minimum of 8 up to 24 hours per day to administer medications, treatments, and support until the symptoms are under control. Some examples of symptoms requiring continuous care would be unrelieved pain, severe nausea and vomiting, severe shortness of breath, anxiety or panic attacks, or a breakdown in the primary caregiver support system. Continuous care is considered a short term level of care and is reevaluated every 24 hours"