sphinx

Sometimes I feel like certain stronger odors are clinging to my nose hairs, lol!

I was in a similar position a few years ago. Except I did D/N and wanted D/E. meanwhile night shifts became harder and harder and rotating just made things harder. I was so stressed and was then diagnosed with RA. I *did* get. Note from my doc saying I can't do nights as it was affecting my health. Unfortunatly it is the institution not the unit that is required to honor that. I was told to transfer if I needed to go off nights but I wanted so badly to stay in my area that I drie my health into the ground. Even cutting from 36 to 24 hours didn't help. I eventually went on disability for 6 months. My doctor told me it was not a good idea to go back I it meant working even night rotation. It was not allowed to apply for transfers while out on disability so I needed to forfeit my position, get cleared to go back and only then apply for transfer. Because these things don't happen quickly I went several weeks without pay before I found a suitable position. I hope things work out better for you!

We cleanse with saline and use Allevyn Gentle Border change Q 5 days and prn. Technically with a skin tear with no drainage we can put on only a tegaderm but I have never liked tegaderm on skin tears, they tend to pull on the open areas when removed. Our facility does not generally use steri strips either, although I've used my judgement and applied them when it really seemed appropriate.

it is not part of a chain :)

I am in New York state :)

hi, i did a search about acuity based staffing tools but didn't find exactly what i was looking for. i work at a nursing home with around 700 beds. most are general ltc, a few "locked" units for severe dementia, a comfort care unit, and my unit which is rehab. our facility does not currently use any type of staffing tool. typically they go by census alone. compared to when i started a few years ago, staffing has really deteriorated. if our census is low, they float one of us to another floor. now sometimes that is appropriate, but others it is terribly unsafe. for example if we get a few new admits, some hoyer/readistand or 2 assist patients - that isn't taken into account. also we occasionally get some patients with dementia who never really progress in rehab but are kept on the unit far too long. that's a bad mix with rehab folks, and we are not very well equipped for dementia patients, not like on other floors at least. also, on dementia floors they may have wanderers but who are safe to stand and ambulate. if they are on our unit they may or may not be cleared to be up yet (too weak, partial or non-weight bearing, etc). we have constant call lights, which is not always seen on other floors. because our floor is the smallest unit, going by census is often leaving us in a hard position. we have increased number of falls when not properly staffed, and patient satisfaction is in the toilet. i feel powerless when we don't have enough staff and call lights are not answered in a timely manner, or if someone is in pain and we aren't able to address it right away. i do evenings and the house supervisor is stretched thin when there are fires to be put out all over, and speaking to angry patients/family isn't high priority. i am not a supervisor, manager or admin. i'm just a floor nurse struggling to care for my patients in a safe and caring manner. most nights i am too busy to chart (other then the med book) until i sign off, and i usually get out at least an hour late, up to 3 1/2 hours late. i have no decision as to whether or not to implement a staffing tool, but think that instead of simply moaning about it, perhaps i can offer up a suggestion. so i am wondering if anybody has a tool they could share? i'm looking for practical advice, not a "reality check" sort of response or group commiseration. (i get enough of that with my coworkers, haha). any tool that uses more than just census would be helpful!

It really just depends. As a patient myself, I try not to mention it. I have found that once a Dr knows I am a nurse they change towards me......they will talk to me as a professional, when that is really not what I need. For example, when I was being diagnosed with RA, my doctor talked as if I knew it all.....when in fact, up to that point I don't think I'd worked with very many RA patients at all, and only had a broad knowledge. On the other hand, knowing the kind of work I did helped when I had to go on disability, and when deciding on medications (whether or not I could handle self injections). So it's a toss-up! When I was a student I was still with my ex-husband who had many health problems. I made it know I was a nurse and they often would let me stay in the room when otherwise they might not have. But that's it, no real special treatment. Although last year my mom had hip surgery and had complications landing her in the ICU. She told everyone there I used to work in the ICU, which actually helped.....they had decided to place an ART line and my mom was freaked out and scared. She was a former nurse, but had no ICU experience. She wanted me to stay while they did it and at first they said no, but I explained that I knew the procedure, where to be out of the way, etc. They let me stay and I comforted my mom on the opposite side of where they worked, kept far from the sterile field, etc. On the other hand when she got to a floor she also told them I was a nurse and I think they sort of slacked off when I was there, letting me transfer her and stuff......but with my arthritis I have restirctions and can only do so much these days. So instead they had me pestering them at the desk. I was also hard pressed not to reset her IVs when the alarms went off...CAN'T.TOUCH.NOT.MY.JOB!

The question is, *how* to get them dry? We tried several other things before this, and they all left her legs a sopping mess. The profores really have helped her with her edema, it's just the moisture is such a problem.....yesterday they looked a little better, but not enough. Her legs are so big and oddly shaped I can't imagine any stocking fitting her, and in the past we've tried comprilans and ace wraps and they both start to fall down very quickly. If you have any ideas how to dry her out, I would appreciate some tips.....

I am still experiencing problems with this poor woman. PLEASE BEAR WITH ME, this is long, but I have a story.....I am so frustrated. She was actually doing quite well for a while. We stopped any kind of dressing such as aquacel, lyofoam, etc. We started using only the mesh that comes with the profore, then doing the wraps. Previously, we'd just been tossing it, because "oh we never use that". It's like no one even really knew what it was. I'd looked up on the profores website and read a bit and suggested we try it and was totally worried it would backfire.....but she comes in for the next dressing change with dry legs! This did well for a long, long time. Then she started having problems with her left leg bumping against the side of her wheelchair, and this eventually happened after a shower while her wraps were off. That area became infected, so we went to the aquacel ag again...it made her legs sooooo much worse! Then we tried just lyofoam. Even worse! She began having large macerated areas again. So finally I said we need to go back to the mesh and profore alone, which we did, and again the legs dried out. We then discovered that the woman seemed to have very sensitive skin, and using any kind of lotion on the dry skin ended up with weepy, macerated areas, and wound cleaner made her skin slough off, and soap was a problem too! We went to just plain water in the shower for her legs, and saline on the non shower days. She dried up again. Then.....the mesh started sticking to the dry areas, as if her skin was a little moist, dried up, then adhered and were hard to take off. No matter how careful we were, even just spraying the mesh off with water, the areas became irritated. So boom, we put xeroform on those areas, as well as the mesh. Soon we were using large amounts of xeroform. Then she was unable to come to the clinic on a Monday and dressings were not changed for 5 days...when we took them off her legs were terribly macerated..again! So back to the aquacel ag under the mesh, then the profores. Legs got worse. So again I talk to our NP and say please, lets try just the mesh again, it has dried her up before.....so we do, and her legs are still macerated. It's awful. No matter how much you try to get her legs dry before applying the mesh and wraps, it's impossible...she drips fluid onto the barrier pad we put on the floor! I am at my wits end. For whatever reason, she has become my "special project". Another co-worker and I have always taken extra interest in her, but she was let go with 'downsizing' and while my other co-workers are caring and competent, they certainly don't worry about her wound care on their days off, lol! Please, if anyone has any suggestions, I would love to know!

I have to laugh because when I was still in the hospital, they were doing this stuff-a good 2+ years ago. They had some outside company come in and inservice the entire staff. They didn't have the hourly rounding, but everybody, I mean everybody was taught the line "Is there anything else I can do for you-I have the time". My coworkers and I thought it was the funniest thing in the world, like yeah, right! I have loads of spare time! Can't ya see me sitting around with my feet up eating bon-bons? We'd pass each other in the halls and say that, with a wink wink, nudge nudge. That was around the same time we were told that if we ran into anybody who needed help anywhere in the building...let's say,directions-we were not to merely show/tell them the way, we were to physically *take* them wherever they needed to go. Um yeah. I run down to the candy machine to get my sugar because I have no time on a 12 hour shift for a real break, yet I can't give directions to someone how to get to the gift shop, I have to take them there? Sheesh! The majority of the people could easily understand directions as the layout was pretty straight forward, not too many places were confusing to get too.

Well, she comes in Mon, Wed, Fri.......Monday and Friday are her shower days and she showers and they sprays her legs with a hand sprayer. Afterwards they dry with a towel (pat dry) and loosely put an adult brief on her leg just for the trip down to the clinic (it's aides doing the shower and they can't do any type of dressing). On Wednesdays she just comes to us and we just cut her dressings and go from there. Even when she showers I usually use would cleanser to clean her up. I don't put any lotion on her calves or anywhere the wraps cover. I mentioned to my coworkers giving her more time to dry out between the shower and coming to us. But they pointed out (rightly) that she is pretty dry after the shower, but starts to weep between then and when we start her dressing (we often do other stuff with her before hand, as she gets nebs, BG check, bloodwork, etc). You mentioned manual lymph drainage. I don't mean to sound stupid, but what is that? We were using Aquacel AG at one time but our NP changed to plain Aquacel. I'm not quite sure why. We also put lyofoam over the aquacel. Is that helpful?

Well I've been on the "other side" plenty of times, but never had to wait an unreasonable amount of time, and when I or my loved one had put on a light at least someone would pop their head in to make sure we were not in serious trouble...or answered over the intercom if available. Except once......I was in the ED and the IV in my antecube started causing me great pain. I put on my light to tell the nurse and ask to have her change it. Believe me, I hate IV sticks, so for me to want to be stuck again, you know I am hurting, lol! Now what got me is that I literally waited ONE WHOLE HOUR with my light blinking and not one person checked to make sure I was ok, either over the intercom or by peeping their head in. It didn't have to be my nurse, it could have been a tech, or another nurse...all they had to do is make sure I wasn't having something like, oh...crushing chest pain or something..... I was unable to get up and find someone either...I was there for excrutiating hip pain and could not walk without assistance. After an hour I was crying out of sheer frustration! The husband of the woman on the other side of the curtain heard me and went out to get someone. My nurse came in and said that she was busy and I should understand because I am a nurse too! I told her I understand being busy but where I work we don't leave call lights on for an hour without making sure our patients are at least ok! To make matters worse, when the IV nurse came, she first refused to move my IV saying the one I had still worked. I told her I didn't care, that it HURT. I was quite upset by this time, crying, etc. I asked for my regular nurse to come in, and when she did she told the IV nurse to go ahead and change it because I was causing trouble and being a pain! They must have told my doctor that too, because when he got there, he came in and told me he heard I was giving the staff a hard time! Huh?! But I have to say, any experience I have had as a patient or a family member of a patient has helped me become a better nurse. My ex-husband was very ill when I was in nursing school, and those experiences shaped me and made me the caring nurse I am today. If I am busy I am honest to my patients, but I don't leave them twisting in the wind, not even making sure they are ok.

We have a patient who has profore wraps......she has venous stasis, but her legs are like none I have ever seen or come accross. She struggles with edema, but is also simply overweight. Her knee and just below her knees are very dry and bumpy. Below the legs go from weepy to dry, depending on whatever. She used to have comprilans wraps, tried ace, they all roll down very quickly after putting them on (mostly due to the way her leg balloons out just below her knees). We have tried several dressings below the wraps and are currently using aquacel and lyofoam to the wet areas. If an area is ok, we leave it. We were doing her profores twice weekly, but her hygeine was horrid and we needed to shower her more, plus one of her legs developed cellulitis. So now she is changed Mon, Wed, Fri....showering on the Monday and Friday. So basically what we have is aquacel, lyofoam, light layer of kling to hold it on, then the 4 layers of the profore. Some times you take off her dressings and they are saturated and smelly. Other times, the aquacel has dried out so much that you have to be careful not to rip it off along with her skin. Either way, my coworkers blame the profore. I almost wonder if it is instead, the dressings we are using. The profore has really helped the edema...they only slide a little bit, hardly at all, compared to the ace or comprilans which practically fell right off. She can't wear Una Boots, as she is allergic to one of the ingredients. Anybody have any thoughts?

I was just throwing that out in the ring, not thinking it as a primary cause. I only mentioned it because it is not widely known, and that it can be "reversible" by stopping the offending medication. I don't know about anyone else, but I tend to find Norflex, in general, to be a pretty weak muscle relaxant. It tends not to make you as drowsy as the others though. Flexeril tends to be stronger, but can knock you on your rear......of course, if you are already in bed..!!! Those are just my own *personal* experiences though!

A lot of times UTIs have no symptoms at all. Although the elderly often show behavioral changes. Sometimes if the urine smells nasty and there is no UTI present, if you change the bag, the smell goes away. The cleaning should help, but I'v found that sometimes there's nothing quite like a totally new bag!