LPN2RNBSN

Thanks. The patient was only nauseated for about 5 or so minutes,then disappeared. Any suggestions. not sure how to look up policies.

Is the FMC policy the same in all units? The one I work at part time we do 200? But no one can tell me the cause of a patient having terrible nausea and sweating about five minutes after blood returned? any ideas? Never happened before in five years of dialysis.

What specifically is criteria in determining bfr when returning blood? What causes the patient to be extremely nauseated, sweaty about five minutes after return of blood. Have not seen this before. thx

What is standard bfr for return of blood? We had a patient who became extremely nauseated and diaphoretic (slightly) about five minutes after return of blood. never happened to him before..

Carmping, according to our neph can be due to electrolytes and acid/base changes during dialysis .. also, to send a patient out about dry weight, esp one w/ cardiac problems, can be trouble... also, some doctors like to 'challenge' patients. but then when patients are dehyrdated their hgb goes up then there is the problem of identifying if their epo needs to be decreased, etc. alot goes into this. dont think just about edw.

Confused.. if the doctor is ordering something pre dialysis to prevent cramping then doesn't that defeat the purpose, so to speak. When pt cramps that is indicative of something ie too much fluid removed?, therefore, if patient does not cramp, one could be pulling off too much fluid and you might not know? what about cramps after dialysis for several hours? Alot of doctors like to challenge patients?

I would be concerned about my license esp with only 8 months experience. Doesn't the regulation stated one year to be in charge, esp if you are the ONLY RN? This can cause the unit to be cited by the state should there be a complaint either by someone or anonymously... then, for sure they would act to obtain sufficient staffing.. one would think?

First, I would suggest that you put yourself in the patient's shoes. It is not easy for patients, no matter how long they are on dialysis. Even a few minutes outside their normal routine of getting to unit and being put on can have psychological effects. I am not sure I could do as well as many of our patients - dealing with dialysis. As far as the RN is it possible to ask her why she told a patient a certain thing? What specifically does she say to patients in lieu of policy?

what are standing orders for other FMC units.. is range of patient's K+ level and what bath should be used?

Delana, thanks,. FMC has a policy re conflict resolution.. Patients that are educated do have questions when they note a staff not conducting effective infection control practices, or doing somthing on their machine that is not correct, etc. I was more curious about FMCs policy regarding the patient conflict process that which was initiated bythe networks with help from industry. my understanding is that this is for the violent patient, abusive patients, etc and not from those with true issues surrounding care. social workers in units are really not true advocates of patients for they are being paid by those they are advocating about ie if pt has complaint about someone etc then sw goes head on ... also,,, the reality is that the sw is paid bythe company and often will not take side of patient, so to speak, just human nature.

what about those patients who have true concerns about some staff not being adequately trained especially in dealing with potential emergent situations, etc.. who is responsible, per policy of unit, to address such.. care plan, etc contract etc.. although why would a contract be needed if a patient has complaint about staff being able to provide care within safe practices?

This is scarey reading all about training RNs. Do these companies not care about patients. If someone (RN) is interested enough to work in this area then the companies should provide adequate training. I wonder how many patients die due to those who are providing care and do not have enough training? This is scarey. FMC has a 12 training for RNs but still new RNs need to understand in order to problem solve esp . Goodness. Isn't the RN also suppose to supervise technicians? who is aware of medical comorbid problems/conditions and how to intervene? I always thought the RN. Wouldlike input from others on units in S.Diego. Am thinking of moving there again. Although the one unit I am at the northern LA area is not bad.

You all need to keep in mind that there is good and bad in all hospitals. If you want to know how their care rates you can go to the Dept of Health Services and ask if there have been any complaints, look through the file and get an idea. Although JCAHO gets complaints also, DHS mostly does SNFs and other providers like dialysis.

We all know that the administration of Epo is in the media's attention now. Much has been written, including Medicare revising what they are doing with Epo.. Also, several months ago the House Ways and Means Committee convened and questioned many about the usage of Epogen. I would encourage you all to read the information. Also, there is a great website that has it all. www.assndialysisadvocates.org This is a patient advocacy organization and they have facility surveys on their site - not all - but many.

Both units I am in part time have been talking about patient-provider conflict and something about the ESRD Networks? any input? What does your unit do when they have patients c/o issues about staff, care they are receiving or staff not being trained enough? FMC? DaVita? Who does what in cases like this? Clinic Mgr? Regional Mgr? Area Mgr? S.W.? Seems as if staff are not focused (as I was taught) on true needs of patients and many see them as what I have heard stated 'cash cows". problem patients.. I have seen management in one unit not even address specific concerns related to training or lack of with certain staff. Seems they just do not want to hear it.. but is this not dangerous for the patient.