RNDYN2CU

Thanks Aimeee! I ordered it via your link! BIG thanks!!!

There there! Yes, when unsure, call one of your comrads, chances are 9 out of 10 times? The experienced nurse you consult will concur with your action plan. The cognitive breathless ones will panic!!! It's one thing to sign on to Hospice and ideally believe you accept the "no 911" but I can only imagine or have actually witnessed the last minute decision made by the patients or family members to make that desperate call. SOmetimes they need to go through it one or 2 times before they are done with the denial. Yes, it can be part of the disease acceptance process. And we guide them through it. ANd after an E.R. episode with subsequent failure of course, because they arrive at the same impass... is a good time to review the hospice plan of care, and repeat the mantra:" I Will not call 911, I will not call 911..." Hey, and the Wal Mart thing? TOTALLY understand!!! I had a pt with a med error re-capped on the SNF orders that wasn't caught immediately, no harm no foul, HOWEVER: It shook me UP!!! I mumbled allllll day that day,,,,"I will become a Wal Mart Greeter" It's a trend. There is spiritual rewards to Hospice nursing. Chances are, if you caught the bug, you belong here. Hang in there!

Thanks Aimee. I had him on Ativan 1mg q 4 with Roxanal 10 mg q 2 and he died peacefully tonight. PEACEFULLY!!! I am so relieved. I reeeeeeeeeeeaaaaally thought he would be a fish out of water, but the meds eased the air hunger and agitation. Sometimes I wonder why we admit someone for 36 hours, and then this: A good death. I am continually sobered by the honor of being a Hospice Nurse.

I admitted a pt from CCU last night to transfer to a snf to live out his days. 72 yr old, he was tired of the Bypapp breather. I felt it in-humane to take it off. It was removed prior to transport. Luckily the MD gave me the comfort meds to assist his transfer. He made it through the night. Any thoughts on this?

Thanks doodlemom... You know, I had him on Ativan 1mg q 4 but he had 2 falls last week so we are in that limbo of sedation and relief -vs- falls... I have him in the room closest to the nurses station and front door where he ambulates with the walker I got him ( I am so proud, he did not resist the walker, what a trooper!) to go outside to smoke. I am trying to keep him ambulatory as long as possible and explained to him that he may have to settle for some discomfort in order to ambulate and when the "time" comes, he will be in bed probobly on the cadd pump. Is the btp dose you refer to for the whole day? So like 10mg q 4? I want to bring the ativan dose back to 1 mg q 4 because he had much better relief with this but also the falls... Thanks for the advice.

I AGREE!!!! I embark each day with a fresh attitude and eager to see my patients, knowing I can help and problem solve! I am NEVER bored, so I have found my home! Yes, a lengthy admit or needy family can throw a wrench in my well oiled plans, but that's what the team is for!

OMG!!! My case load is 17-22, with an LVN and I help with admits and take b/u on call one weekend a month and b/u every monday night and and and...well, I DID get a $3.00/hr raise last year because our RN's were dropping like flies... but for some crazy reason? I love my job 90 percent of the time... Well it was 17 patients for a long stretch of time (like 4 months) and we FINALLY got an admit nurse, but sometimes there are more than 2 admits in a day you know? And when my case load grows we have growing pains, but thats nursing.. All in all, we give quality compassionate care and folks often want us back for another patient, I just feel REAL bad when I become too busy to give them the personal care they called me back for! But thats nursing. so each day I endeavor to tackle it again and so far.... it's still jiving. I love hospice. It's a job I can really make a difference in peoples lives which is why I became a nurse. THese posts are so theraputic. Phew.

Dilaudid via CADD pump for pain mngmt may work...

Hello Hospice Nurses! It's been a while since I've posted... I am looking for advice on how I can anticipate the needs of my patient with Liver Ca. He only recently entered a convelecent hospital i work out of, he has a hx of dependency (oxycodone) so his pain meds wear off quickly. He was started on ms contin 90 mg Q 12 with roxanol 5 mg sl q 4 for BTP. We increased to 120 mg q 12, same roxanol 12 days later. He's on lactulose tid, has ativan 0.5 mg q 6 prn. His ascites has increased 5 cm in only 6 days, poor guy, and he is cognitive of his plight. The nurses at the skilled nsg facility are aghast at his morphine dose and schedule, and I have educated them. Yes, I have a wonderful medical director to guide me, but it is through my interpretations of my patients symptoms that she is cued. Any advice on what to watch for and what he may need and what i am in for if you have ever had a pt with this diagnosis? Thanks

we have two M. D.'s and they alternate IDT's. Our primary MD is wonder woman, truly, has a compassionate busy geriatric practice, in fact I switched my dad over to her and he loves her... and she NEVER turns down a request, is on call 34/7, yeah, it must feel like 34/7, and I love her to pieces. Our other MD has a thriving practice, in fact when my son was in town on a college break, 20 years old, he split the heck out of his lip goofing off with a skateboard, clean up to his nostril... no insurance... Dr. J.... stiched him up for practically nothing, by the way my son went on PRICE IS RIGHT 4 days later, catch him on 9/21, thats all I can say... golly I am rambling like a manic depressive off lithium HA HA HA any who.... what was the question? OH... sounds like you have a dudd of a doctor.

LVN got fired. thanks for the outlet. I grew up a LOT last week and really gre into my RN Case mnger big girl boots! YEAHHH!!!

I have only had one patient on it and this was per insistance of a family that eventually revoked and were real wacky, god bless em', and NO my patient didn't seem to get any relief, the ativan/roxanol deal helped more...

These responses are healing. This forum is worth ten therapists. T.Y.

You have NO idea how much your words helped me.... like salve on a wound I kid you not. I am having a real rough patch with my co-worker and just trying to keep up and while i am plugging one leak over here,all be darned if another one doesn't spring up over there!!! I saw all of my patients 2 weeks in a row and did two admits, the Idt book and turned my notes in in a timely manner and did the schedules and all 19 direct visits with my home health aids... and it apparently wasn't enough...I couldn't or chose not to back my LVN up when notes of visits came up missing and she pulled a tood. TOmorrow we confront with the DON and I hate confrontations. It's her mistake, I have to remember that, I feel she wants me to back her up in a lie. I know she could be pulling more weight and since this is my first experience, I have no comparison to know what real teamwork is like in the Hospice environment. I am doing my homework so I know what it should be and get that for myself and my dear patients. I really want to stick with this until I iron out the bugs and feel the rhythm and stop sweating the small stuff,, but I am still trying to figure out what the small stuff is. It's really helping me grow the heck up as an RN, and it's due time. So thanks again for the words of encouragement.

:monkeydance: Any suggestions on courses available to be a beter Hospice Case Manager in Cali? Thanks