jerseyRN

Call back if you need to. They have some amazing pharmacists picking up the phone. Call back until you get one of those.

Hey RNkitty, Sounds like you're ready for a break.... even though we've been through it all before, it's probably the first time for the family you happen to be seeing that day.

Need to take issue with your rule of thumb about sx not being "normal" if they're not seen in healthy people. The dying don't look like healthy people. Noisy secretions are normal at end of life. We reposition the patient, treat them with atropine etc, and assure the family the secretions don't disturb the patient as much as they distress the family. Along with the other s/s of active dying, talking about what to expect and why these sx develop helps.

sounds like you are assessing and doing all the right things for your patient, and also that she is actively dying. Tell the family the disease is taking their loved one, and the goal now is to keep her comfortable as this natural process progresses. Tell them the disease is going to take this lady no matter what action they or the hospice team or anybody does, and do they agree that the goal now is to make her comfortable, and do what we can to ensure she passes peacefully? If so, that is what the medication will do. Assure them that the hospice will give no more medication that is necessary to keep her comfortable. And remind them that the hospice will be there for them when they need it.

I agree with previous posters. It sounds like an ominous turn. Remember the goal of wound care is comfort at this point - keeping her clean and dry, and medicating for comfort. Mouth care for comfort/ relief of dry mouth. Glad you have hospice coming. They can reinforce these issues with the NH staff so you don't have to. Use the hospice team as much as you can for not only your grandma's comfort, but also for you and your parents.

ps- one thing I wish was different is there's limited opportunity to commiserate with other students. There is a part of the discussion board where you can post anonymously - allegedly. Nobody used it. I wanted to discuss content and instructors but didn't find a way to do that.

I started this semester with the Nursing Informatics course. It was a lot of work, but do-able. I was disappointed in that the course was more about following APA style than Nursing Informatics. The instructor was nitpicky and more concerned with form than content. I'm registered for a Leadership/MGT course in January and hoping it will be better. Two courses at a time is a lot to tackle, especially if you have a life.

You could contact NHPCO or HPNA and see what they say. Who employs you and this director RN? She must have a supervisor. Maybe you should seek out that person if you can't approach her directly with your concerns?

I love my little Maglite super-bright flashlight (under $10). Bandage scissors. And I have never have enough pens! Be sure to have some chocolate in there.

We wear street clothes, business casual. Would rather be able to wear scrubs ... hate getting dressed every morning, especially when it's >100 degrees as it is this week. We also are prohibited from wearing open-toed shoes or going without socks or stockings. Ugh, it's hot.

OK, let's get this straight - over 50 is not "older". Over 70 is "older'. Don't take my denial away from me! We all know it can be an effective coping mechanism....

Well, hmm. What to do? I think I would be sure to document very carefully... especially about the contradictions in her self-rating of pain and her behavior, such as reporting her pain is better, she's sleeping more, she laughs with caregivers, etc. I would also be noting the adjustments made in her pain meds and dosages. I'd get the lock box and count the pills. I think I would have a straightforward conversation with the patient about all of the above. I would tell her I want to act as her advocate and do everything I can to make her comfortable, but I also have to rely on my own experience and judgment and assessment skills, and that I won't participate in providing her with more meds than needed to control her pain. I would keep the SW coming! After all that if she continued to report pain of 10, I would increase her dosages. What is her dx, BTW? Good luck. What a vexing case.

Yes, I wondered about this case too. Not to say limiting her meds is the wrong action, because I didn't see the patient and don't want to backseat-drive my colleague's instincts and decisions. But I wonder: What about increasing the MS Contin to 90 mg q12h (compensating for the QID Lortab), and tweaking the anxiolytic to either Valium 5 mg q 6-8h, or lorazepam 1 mg q4h (depending on pt preference)? I agree, if she's asking for it, and is terminally ill, she needs it. Try to manage it in a way that gives her what she needs in medically appropriate dosage and schedule. Nobody on hospice should have to watch the clock. Not that we should turn a blind eye to abuse, but we have to be willing to give pts the benefit of the doubt.

We're required to wear street clothes ("business casual" is what I do). I'd prefer to wear scrubs because it's easier and tax deductible, but it's not the policy of my agency. I wouldn't choose a lab coat... they always strike me like an affectation ("I have a lab coat, so I must know what I am doing"... I remember having to wear them in nursing school so we wouldn't look like the neophytes we were).

Oh, Leslie, sorry for your losses, and sorry you encountered such an emotionally inept doc at such a sad time. Personally, no matter what the loss, I find no comfort in, "It's a blessing." No matter the circumstances, I can't imagine it ever feels that way to the next of kin hearing of the death for the first time.