amanda1229

I figured this was the best place to ask the question. I'm in nursing school and for one of my classes, we have to make up a scenario for our fellow classmates to read and solve, like a case study. I have ideas, but I don't really know what would happen from beginning to end with my patient. My "patient" slipped on the ice and hit her head, lost consciousness. Her boyfriend brought her to the ER in his car. I want her to be out for the entire car ride and long enough in the ER to be hooked up to an IV (would they do this for a concussion? Since it could be anything, really? And would it just be fluids?). Would she have long-term damage if she was out that long? As long as she was breathing and had a pulse, is that common? For people to be out that long? I know afterward that they might do neurological exams -- would this follow the q15 mins x4, q30 mins x4, q1h x4, et so on or are they different? Or do they differ everywhere? Are scans mandatory or only in cases where they're symptomatic? How long are they normally in the hospital? Would it be realistic for her to be discharged the same day as long as she was asymptomatic? Just in case it needs to be said, this is merely for a school assignment and there will no profit made or anything with this. :)

I have been thinking about making a change, possibly moving to Chicago (I live in Iowa right now). I'm a CNA and have only started some of the pre-reqs for the nursing programs here. Are there any good community colleges in Chicago or close by that anyone knows of? And would it be difficult to get a job as a CNA at a hospital or a nursing home in the area? Thanks. :)

I'm trying to get a hospital position as a CNA, so I'm in the same boat to some extent... But right now I'm volunteering there, talking to all of my nursing professors and looking for connections, asking for specific people, talking to the people I work with at my LTCF, mastering any skills I need as an hospital aide that I don't as an LTC aide .. good luck to us both I suppose. :)

I agree, I think male pericare is so much easier. And I'm a female! It's only because, really, who uses eight washcloths to wipe after they use the bathroom? So this whole lengthy procedure involving eight corners, etc. is INSANE to me. Makes sense, but so annoying! The worst thing I've ever seen was, when performing male pericare, is a HUGE wad of yeast-like buildup when pulling back the male's foreskin. I had seen it before in female pericares, but I was just .. oh, it was just weird, and it was so much, I was shocked.

I want to start practicing VS more often. I work in a LTCF where CNAs don't do VS, but I want to be prepared for nursing school next semester and I'm also applying for hospital CNA positions and I've heard that's what you need to know how to do. I need a nicely-priced bp cuff and stethescope, what's the usual range? Any better place online to get them?

I didn't read all the responses, so I may be repeating, but this can't go on. What if the resident could call sexual harassment on your sister, which seems like she'd have a case? I'll just say it -- ick. Most of the time, unless it's a larger woman, she should be able to do peri cares if she can feed herself. We're supposed to encourage it anyway, so next time tell your sister to say, "Okay, let's clean up now," and hand her the washcloth. And, of course, the nurse needs to be charting on this every time. It's no different than when we have male residents say the same things -- OF COURSE all the CNAs go running to the nurse and tell them about it, but it's just strange when a female resident says it! Unless dementia is the case, I don't really allow any of it, I don't have to be harassed or accused of sexual harassment one day. I tell them it's not needed and that I'm only trying to clean them up, and that the supervisors will be notified. We had a male resident who was a little person, and he had to hop up onto the toilet because of this. In the process he would always pinch his scrotum with the toilet seat, and one day as the nurse came to put some ointment on the wound, he said, "Hey that feels pretty good, it's been a while." The nurse was disgusted, as she should be, and threw down everything and said, "[Greg], that's really gross, and trust me, that's not what I'm here for." This resident is totally with it and everything, he just gets inappropriate at times. The nurse said she wouldn't have left the resident if it weren't during the day with other supervisors there, but instead just told them about it later. But our administrator did talk to him about it and he apologized to the nurse. But it was totally uncalled for and I don't blame her for getting upset -- we're performing a service and we don't have to be harassed while doing so, we're busy enough!

It seems weird that you can't mandate organ donation in your will, as if it's just another property you're leaving behind, hmm. I know that when I die, anyone can have any part of my body they wish. I think it's such a waste and crime to BURY parts that may work perfectly and can save someone else's life. Thanks for replying everyone. Since the incident with Herbie, I've been finding out more about which residents are full codes or DNRs. My next topic of debate is people with Alzheimer's. Most of them are full codes because of the family. What do you think of this? Because the person's wishes can change every five minutes in severe cases, I think it is best for the family to make the decision. And, I think, if I had this severe of Alzheimer's, I'd want to be a DNR. But most people can still recognize their family. There's a resident where I work, we'll call her Jo, who can still recognize her husband (where as other women are looking for husbands who are years and years younger, you know). But because of her status and disorientation at other times (when I would change her on third shift, she would get combative and resistive), I guess she's a DNR, her family doesn't want her to live with that confusion. I don't know, I would just think it would break my heart to have my husband be a DNR just because at night -- when I'm not there -- he's different. Huh. Thoughts?

In an LTCF? Here's the basic rundown of my day as a CNA in a LTCF. 6:30-8:00 - Arrive, dress, check & change, and get-ups for every resident. Make sure they are groomed properly, have their dentures in or glasses on if needed, teeth brushed, and sat at the breakfast table. We are really lucky if we are on time everyday, because between close to thirty residents (eight of whom are Hoyers, and four of whom are confused), it's a LOT of work, sometimes I show up closer to 6:00 just to make it to breakfast on time! After each resident is up, we also make all the beds (which adds about ten minutes total onto the breakfast prep time, it sucks!). 8:00-9:00 - Feed residents. At our facility, we currently have close to twenty assisted feeders. Some of whom are confused, and two are MR, so they need COMPLETE one-on-one feeding assistance. We also have a bed-bound resident who one of the aides needs to feed, and she is quite difficult to feed. Breakfast is busy, but we have to get food and liquids down everyone (it's obviously important) so it can be a struggle sometimes. 9:00-9:45 - Check and change, strip, and lay down every resident. I was taught to leave no clothes/briefs on below the waist for any resident (unless independent, obviously) but I've heard other facilities don't do this for dignity reasons -- which I can see. But it's just to help eliminate skin breakdown. 9:45-10:30 - Since everyone (except those who don't lie down, on my wing only a few) is in bed, we are answering a lot of call lights, toileting residents, getting showers done if the bath aide isn't working (which is usually seven or eight showers, ten to fifteen minutes each). And, again, you can see where time is a restraint there. I usually use this time to get some of my charting done, too. Charting for a CNA at my LTCF includes BM charting for every resident, restraint record logs, and behavioral and assistance charting for a few residents. We also take our fifteen minute paid breaks at this time. 10:30-11:30 - At 10:30, while still answering call lights and toileting residents, we start checking and changing the residents, and getting them prepped for lunch. I usually let me aide partner go on break at 11:00, and I continue to answer lights, toilet residents, and get them prepped. I also get up a couple of Ax1 residents, or all depending on my partner, before I take my lunch break. 11:30-12:00 - When I get back from my lunch we finish getting our people up, which goes by SO much faster when they're all prepped! We get them up, groomed, and out to the table. We're usually RIGHT on time or a few minutes late for lunch at 12:30. 12:30-13:30 - Everyone eats lunch. This is usually the better of the two meals. Everyone likes a meal at noon, I mean, really -- I wouldn't want a complete meal at breakfast (juice, water, milk, coffee, eggs, bacon, toast -- geez!) Not that I don't understand WHY they get the big meals, but still, that's a lot for someone to force down your throat. 13:30-14:00 - Once again, everyone is laid down, checked and changed. 14:00-14:30 - The day gets easy after this, I chart, take down trash and laundry barrels, ask my independent residents if they've had BMs during the day (do this do this do this! Don't let residents who don't need suppositories get them, not fair, too many aides are too lazy to do this). I also might visit with some residents, or if I have time, do things like paint their nails or massage their arms and hands (esp. if I'm on our Alzheimer's unit, there's more time for things like this). I report anything to the nurse I've noticed during the day (unless it had to reported immediately) and give her my outputs for any residents with catheters. I really, really love my job. Even if I have to get up at the a$$ crack of dawn, it's still exciting to go to everyday. The only bad thing is the time schedule is so delicate, unless third shift does a lot of prepping residents for breakfast (I usually get everyone dressed and prepped when I work third), then you can easily fall apart. If there is a fall, it is pretty much guaranteed you will be late for the meal. And when you're late, the administrator or DON and ADON will complain and you will hear about it -- but it's their job, so I don't fuss about it. But I do love being a CNA, and when I get my LPN and eventually my RN, I will be sad and miss it, you have so much contact with the residents. Just remember to stick to procedure, your coworkers will not use gait belts because it takes too much time, but just do it anyway. You don't want to get fired. Don't do Hoyers alone. Don't do Ax2s alone. Read the care plans and know them well, know your residents well so you can personalize their care, ask their family about them, etc. We had a woman on our Alzheimer's unit who could never explain to us why she was so uncomfortable and so upset -- until her granddaughter randomly told me she was NEVER barefoot or plainly dressed at home, and when I implemented that into her care, she's been happy ever since. Family will be a great resource. Also, remember to choose a shift you will be happy with, you have to happy in healthcare or else you won't be the best giver of healthcare (and so on, yadda yadda, but it's so true). Whew, long post!

Hello all, I've got some questions today. I'm a CNA and nursing student, and my goal is to eventually be a L&D nurse. I've been working for about five months in LTC, and I only worked there so I could actually take the exam and get my certification, since all the test covers is LTC practices. I hear everywhere that Med-Surg experience helps a lot, so I figured I would apply for CNA positions in L&D or Med-Surg units at the local hospitals. What do the CNAs at your Med-Surg units do? Is it really different from LTC? I don't live near any rural hospitals, so if your answer covers one of those, it probably won't pertain to me. I really like the hospital setting, and working in a hospital has always made me really excited (even though I've never been an employee, I've been a hospital volunteer for so long and still get excited walking through those hallways!). Plus, if I do in end up in L&D, from what I hear Med-Surg experience is a big plus. What kind of patients do you see in Med-Surg? What is the work like? Is it a really busy day? Did you like your job as a Med-Surg CNA? Thanks. :)

My absolute, hands-down worst fear upon starting in a LTCF was skin tears. I thought moving any resident was going to result in a big ol' foot-long tear down their limbs. Because of this I moved so slowly, and so cautiously, I was always behind. Over time I realized that these residents are not made of tissue paper! I am still gentle, but you can get things done smoothly and quickly with experience. And, of course, with the extreme skin alerts, you know how cautious to be and you aren't afraid to take time where it needs to be taken. With any fear in this field, you'll get over it with experience. Although memberes and poop never scared me, my other fear is one I haven't experienced yet -- vomit. It's not that I mind seeing someone do it, it's the smell of it and having to clean it up that make me cringe. I'm bracing myself for flu season! I think the thing you have to remember is that when you're taking care of male pericares, always ask if they want to do it for themselves, it'll save you a step and it helps them take care of themselves more, which is always the goal at a LTCF. And with poop episodes, always always always remember that sadly it is so much harder on them, and that they are probably embarassed out of their minds every time it happens. I get so mad when I see other aides make faces and noises and "Ugh, disgusting" or "You need to tell me when you need to poop!" to these poor residents that have simply lost the ability! Just remember that and you'll become so much more comfortable with it all. Good luck!

I love working in my LTCF, and I've never worked in an ALF. But from what I hear, an ALF is so much easier. The problem with my LTCF is the level of care needed by all of the residents, and how much time is actually allowed to do it in. On my usual wing, there are twenty-seven residents. Of these, there are only three independent people who don't need help or encouragement for ADLs (there are a couple other independent residents but they are badly confused and need lots of help, just not for transfers). The rest include five Hoyers, and other Ax1 or Ax2s. Usually this wing has one or two aides for all of them. We have about an hour and a half to get all of these people dressed, groomed, hygienically taken care of or else we are in big trouble by our superiors. What needs to be done does NOT get done. It is hard to spend about ten minutes with each resident, when it reality, 1.5 hours among a little over twenty residents leaves you with about FOUR minutes. It is just not possible. This is my frustration with the LTCF schedule. Not to mention that on our CCD Unit, we have to get people up by 7:30 (only gives me an hour to get all of these people dressed and ready!), out by 9:00, down for an "hour's" nap by 9:30 AND UP AGAIN AT 10:00 FOR A MANDATORY SNACK. So screwed up! I don't mind constantly moving and working and doing my job, it's the complete lack of intelligence and common sense that went into making this stupid schedule. Plus, I don't care what anyone says, not EVERYONE in LTCFs need to lie down between every meal, or lie down at the end of every meal to the start of the next (sleep, eat, sleep, eat, sleep, eat, sleep). But, anyway, I imagine and hear that it's different in an ALF and therefore recommend trying one of those instead. Rant over!

I love our activity staff. They always have fun things for the residents. We have a really good director who must have been here for a while, because she just knows every resident so well. She knows which residents to pull aside for certain activities, like some who love to cut out paper decorations to put around the center, or the ladies who just love to fold the towels for laundry and have the morning coffee and juice afterward. It's so great. And the best thing about an activity staff is having some insight into the residents' prime years -- knowing old folk songs, or discussing parenting tips they must've used, or talking about pop culture icons, etc. all while playing Bingo, or playing old card games, singing along to old Elvis, or whatever. My heart is with activities for our CCD Unit, though -- I really love the idea of incorporating their memory and past life with little activities. Especially music, it seems almost every little old lady on our unit loooves to sing, and even a few of the men. When we all gather for church on Sundays, the song may be sung at five different tempos, but it's with such heart and passion you can't help but get caught up sometimes!

After being a LTC CNA for only four months, I am officially sickened by people who support this! We had a new admission Friday evening. I'll call him Herbie. Herbie is confused. He has a foley, colostomy bag, g-tube, and constant o2. He has a PSA because he frequently tries to get out of bed, and he uses his call light to request the bedpan (even though he clearly does not need one). In report, one the leaving aides told me to take a look at him -- I've never seen so many hookups to one person, having only worked in LTC so far. Our rooms don't usually look like small hospital rooms! This poor man was just lying there, sweating -- the DON and I were actually worried about him. We stripped him of his gown, pulled the blanket down to his knees, pulled his privacy curtain and just had a fan right in front of him. It barely helped. The DON and I were talking as she helped me repos. him, and I simply said, "I could never live like this, and when I get older, I'm going to make that known to my family." The DON told me that Herbie was a full-code and had all of this because of his daughter. And she told our DON that she was "happy to have him out of the hospital, and excited to have him home one day, on his feet and back to his old life!" I almost choked! Herbie could barely speak. And when he did, you could barely make out anything he said. In fact, the only things I heard him say were "hi" in response to my introduction, and "no, no" when I replaced his cannula that he took out. I cannot believe that some people are still full-codes and we're pulling out all these stops to save these 90 or 100 year-old people! When the body starts to break down, in my opinion, you can only go so far before someone just has to rest in peace. How can these little frail old ladies who are just bones still be full-codes? Do you really want us to perform CPR on someone when we know it will just break their bones in half? All of this just hit me like a train with Herbie. Not to mention he has such terrible circulation problems in his legs, they may as well just not be on his body anymore, and for the better. I just don't understand, are you trying to make someone live forever, or just more comfortably? When it gets down to it, perhaps science could just make us live as long as we'd like, all these things Herbie had are just the start of it -- can't eat, void, defecate, or breathe properly? We have the fix! What's next -- mechanical organs or limbs, artificial fluids or tissues or whatnot for people turning 100something? I went home and talked to my boyfriend's sister, who works in the same facility, about how disgusted I was with it all. She agreed 100% and told me Herbie had died last night. The worst part -- his daughter thinks it was somehow the facility's fault, as if we made some crucial error. He had labored breathing the only time I spoke to him. We all knew he was on his way, and as soon as he wasn't skilled, they wanted to talk to the daughter about hospice. I think it's just a shame that he went on to live like this, that he couldn't have gone sooner, perhaps when he could still have memories in his mind, or feel a little more like a human being, and not just a body on auto-pilot.

Thanks for the sites, guys. :)

I've posted about looking for a job as a CNA in the L&D unit nearby, and hopefully being a RN there, too someday. Does anyone have any good sites on hand that have a lot of info (conditions, abbreviations, examples, whatever) about L&D, labor, baby, pregnancy health I can use to catch up on? Thanks!