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NurseAlwaysNForever

NurseAlwaysNForever

Hospice, LTC

Content by NurseAlwaysNForever

  1. NurseAlwaysNForever

    Mid-Shift Shower

    All names have been changed and some words are misspelled for pronunciation purposes and curse words have been changed or left out. She talked about dances they would be going to, hay rides, walks along the river, school and other things like that. We would often ask her questions about Chuck and she would in turn tell us the stories about Leroy. She was just kind of stuck in the Leroy years and had seemed to have forgotten her husband almost completely. Nellie didn't think she was so 80ish, kind of more like she was 16ish and she hated showers. She would yell and would also often become very combative. One day while giving her a shower in the rolling shower chair she became upset and started in yelling, "Get that water offa me you fool. I'm gonna call the sheriff. I don't want no darned pneu-monia." I told her we had to get her all prettied up for Leroy. This was something we often said and it usually eased her and she would be a little more cooperative, however this day she screamed, "I'm a married woman, you wanna tell my husband that? You tryin to ruin my honor?" I quickly apologized and told her that I had meant to say Chuck. She replied, "Who the heck is Chuck?" I didn't know what to say, so I continued with her shower. "Listen hear, you get that water offa me, my daddy will get you for this." I explained that he had fully given permission for her to have a shower, and that we were almost through. "My daddy don't want me warshed by no preverts." She would occasionally swing out and try to hit me, but nothing too bad or too violent. I said, "I promise I'm not a pervert, I'm a nurse and I'm trying to get you cleaned up." She nodded her head, "Yeah, that's what they say ain't it?" At this point I was finished with her bathing and needed to rinse her off. I explained what I was going to do. She allowed me to rinse her off, and honestly, I thought she was finally okay with the shower, so I proceeded to rinse her hair. I was very careful not to get any soap in her eyes. As I was finishing, she grabbed the shower sprayer out of my hands and pointed it directly in my face, "Let me wash the filth offa ya, you sinful heathen." I attempted to get the sprayer from her, but she began swinging it frantically. I stepped back, right into a puddle of soapy water, and flat on my butt I went. She began to sneer, all the while spraying me with the water. Every time I would try to get up, I would slip right back down. Finally, I crawled backward to a semi dry spot and was able to use the toilette to stand. I stood up, sopping wet and pulled the emergency light, and then slowly made my way through her arcs of streaming water to cut the water off. (Why didn't I think of that first, I wondered?) She threw the sprayer at me and I hung it up. I told her I was sorry for giving her a shower, but I had to get her clean. We both sat there for a moment, then I grabbed a towel and gave it to her. She began drying off, I began sopping water up off of the floor. I kept wondering where my help was. I had pulled the emergency light some time ago, and I could hear it beeping. "Well, ain't ya gonna get me decent now that you've had yer fun?" I proceeded to assist her with drying off and dressing. I sat her in her w/c and began to wheel her out of the shower room. At this time one of the male nurses came to help me. I looked up at him, and he was almost busting at the seams. I looked around, through my water splattered glasses. There was water everywhere. He didn't even ask if I need help, I guess he could tell I was a little flustered. "Sorry, lunch break." He said. I cut the emergency light off, and Nellie said, "Sheriff, I need to press me some charges on this here prevert. She done poured water on me for a Leroy and a Chuck. She gonna trade me, put me on the market? My daddy ain' t gonna like this one iota. Look at her, what kind of operation is she a runnin'? She got one of them red light houses?" He couldn't contain his laughter any longer, however he did manage to say, "Let's go work on that paper work, Ma'am we've got some spare clothes in a closet out there, why don't you get cleaned up." He then proceeded to wheel her out into the hall. Her all the while telling how I had taken advantage of her virtue, him trying to hold in his laughter, but failing miserably. I came out behind him, soaked to the gills and began walking down the hall to the extra clothing closet, wondering why I had volunteered to do this shower. I slipped in my haste, and was sprawled flat on my back, this time with many witnesses. As I got up, several people were laughing, I looked down then and realized I was wearing white scrubs and pink polka dotted panties. I couldn't get to that closet fast enough.
  2. NurseAlwaysNForever

    I need advice and pointers. Also an inspiring video.

    My boss recently challenged us to be a Johnny. You must watch the following video to understand what that means. It was very inspiring and touching. Do any of you have any ideas of how I can be a Johnny, not only today, but everyday as I take care of my hospice patients. http://www.stservicemovie.com/ Thanks.
  3. NurseAlwaysNForever

    Young Hospice Nurses

    I have been a hospice nurse since I was 25. I had only been a nurse a little over a year. I have been in hospice now for over two years and don't want to ever do anything else. I don't think the age or experience is what really matters. I think it is the passion. You either have it or you don't and to be good at hospice, you have to have it.
  4. NurseAlwaysNForever

    leukemia with nosebleeds, any advice?

    We use sterile lubricant with O2, works great. Also, discourage any picking, hard blowing, etc. Make sure he is not taking any aspirin products or other thinning agents.
  5. NurseAlwaysNForever

    Tremors

    I have seen patients receiving Haldol have tremors. We give them benadryl for that and it helps.
  6. NurseAlwaysNForever

    Nurse Suzy-Q to the Rescue

    Here I am moseying down the hall taking care of business. VS before dig, crush so and so's meds, not the Dilantin capsule though, put it in a bit of applesauce. Flush the peg. "Med pass for you." "Open wide, here you go." "Now swallow." "Big drink." "Swallow", "good job". "Accu check time," wipe with alcohol. "Just a small stick." Blood sugar 270, sliding scale. There we go, time for breakfast. Everything was smooth. A-okay, right? All of a sudden I hear the fire alarms go off. My heart jumps out of my throat, flops on the floor and stops... What do I do, I am frozen in a panic. I can't move. What did they say in school? What was I trained to do in this situation? RACE... Remove, Activate, Close doors, Extinguish. Remove, Activate, Close doors, Extinguish. PASS.... Pull, Aim, squeeze, sweep.... Pull, Aim, Squeeze, Sweep. In a sudden burst of pure 100% adrenaline, I slam my med cart shut, lock it and make a beeline for the fire alarm control panel. I am running full speed ahead. I notice the area that is blinking and make my way there, hollering back at the aides to check every room and shut the door after they do so. I don't smell any smoke, I don't see any smoke, but what the heck is going on? I decide to be prepared, that's what school taught me right. I grab the fire extinguisher and continue on my path. I'm chanting over and over in my head. RACE... Remove, Activate, Close doors, Extinguish. Remove, Activate, Close doors, Extinguish. PASS.... Pull, Aim, squeeze, sweep. PASS... Pull, Aim, Squeeze, Sweep. What am I forgetting? I know I'm forgetting something. I'm racing up and down the halls, looking in rooms, closets, bathrooms. Nothing. I see Nellie calmly leaned against the wall and instruct her to go to her room. She shakes her head no. I signal to an aide to deal with her, while I go about attempting to save the nursing home and all of my residents. Nurse Suzy-Q to the Rescue. RACE... Remove, Activate, Close doors, Extinguish. Remove, Activate, Close doors, Extinguish. PASS.... Pull, Aim, squeeze, sweep. Pull, Aim, Squeeze, Sweep. This continues for several minutes, the tension in the air thick enough to choke. Everyone getting a little nervous and upset. Me, I haven't found the fire, my residents are at risk, do I evacuate? That's when I hear the sounds. The fire department sirens. I run outside to meet them, extinguisher in hand. "Sir, I can't find the fire. I can't find it...." his reply, "We've got it." I watch them sweep into the nursing facility and make their way to the fire control panel... They are pointing and then turn to look at me and grin. "Ma'am, it looks like you've got a real big problem... Maybe an arsonist...." My heart falls, plummeting to the ground, if I take a step, surely I will be walking on it... They see the look on my face, as they head down the nursing hall. Why can't they move any faster? Am I gonna have to do this myself? I follow close behind and see them pointing to my little Nellie. Sweet ol' Nellie, right? NOT. She won't budge from her spot against the wall. The fireman asks her to step aside. She yells, " I ain't a-goin' no where til you get this noise outta my ears." The firemen try to move her to the side and she covers them with a stream of spit. Finally, the fireman reaches behind her and runs his hand down the wall behind her back. I see him messing with something when suddenly all is quiet. My ears are literally humming from all of the rackets of the siren... He looks over at me and says, "Seems someone pulled the fire alarm, ma'am." We both glare at Nellie who says, "It's hot in here." RACE... Remove, Activate, Close doors, Extinguish. Remove, Activate, Close doors, Extinguish. PASS.... Pull, Aim, squeeze, sweep. Pull, Aim, Squeeze, Sweep.
  7. NurseAlwaysNForever

    The Day You Died

    I knew you had been declining. I had even talked to your daughter about your "transition". She had been in denial and didn't really want to hear about the dying process at all. Were you already gone, was I too late, had I failed you and her both? All of these thoughts raced through my mind. As we entered the room I could hear you breathing, deep ragged breaths. I wasn't too late, I could still help you die comfortably as you had so often made me promise. I squeezed your daughter's hand and told her I would see what I could do, she nodded and said thank you. Upon entering your room I found you lying flat on your back, you were pale gray and clammy, I could see you grimacing and you were very restless. Immediately I rolled the head of your bed up to 30 degrees and applied O2 at 2 liters per minute. In your nightstand, you had a bottle of Atropine Ophthalmic solution 1%. I gave you 2 gtts sublingual, as well as 10mg Roxanol SL for the pain. I also gave you a breathing treatment with Duoneb and 10 mg of Roxanol with a mask. Halfway through this treatment your respirations eased and you finally became comfortable. I took your vital signs. Your heart rate was fast, your blood pressure low. Respirations at 12, shallow. Oxygen level was 82%. Heart irregular, thready. Lungs coarse bilaterally. Foley, scant amount of tea-colored urine. I looked at your feet then. I don't know why I always save that for last, but I do. I saw it there, the hard evidence. The dark purple coloring I saw creeping it's way up your legs, almost to mid shin, was my confirmation. Your pinned earlobes and fixed pupils further told of what lay in your future. The breathing treatment was through and I removed it, however, left the oxygen in place. I whispered in your ear and promised you that I would not let you suffer and would keep you comfortable. You were resting so I took your daughter into the kitchen to talk with her. Before I could say anything, she asked me if you were dying. I looked up and nodded my head. She fell into my arms, sobbing. She didn't want to let you go, you were the only parent she had left, the only family since her son had been killed in an accident. I held her for quite some time as she sobbed, soothing and consoling her. I guided her to a chair at the kitchen table and we sat and talked she cried, my eyes teared up and I snuck when she wasn't looking to wipe away my tears. We talked mostly about you and about the things you had taught her. I told her how close we had become and how much I had learned from you as well. I thanked her for this wonderful opportunity. I fixed her a cup of tea, peeked in on you. You were still resting. I offered to call a chaplain, she refused. Gently I approached the topic of your passing and I explained that your body had become so frail and weak that it took every ounce of energy you had to even breathe these days. I explained to her that you had told me you were ready to see all of your family "on the other side." I explained the benefits of dehydration at this time as a natural painkiller, explained that your heart rate was beating rapidly trying to overcompensate for everything else going wrong. Explained that your kidneys had started to shut down. I told her that more than likely your heart would continue like this until it gave out and then the heart rate would start dropping and eventually stop. We talked about the mottling on your feet as well. She said, "It's really it, isn't it?" I slowly nodded my head yes. She decided then that it was your time and that she didn't want you to suffer anymore, said she didn't want to be selfish and keep you here. She looked up and said, "Now what?" I said, "Is there anyone you want me to call, anyone you want here with you?" She shook her head and said, "No, all we need is you." I smiled and hugged her, "Okay, now you need to tell your father these things you have told me, he can still hear you and he needs to know how much he means to you." That's all it took. She came to your side and climbed up in the bed next to you and told you all of the things you had taught her and how much she appreciated them. She told you how much she loved you and respected you. Then she told you she needed you to go check on her mom and her son. You squeezed her hand then and a tear slid down her face as she kissed you on the forehead. You didn't have any more pain or breathing problems and as night approached she kept falling asleep next to you and then startling herself and waking up. I finally got her to lay down on the couch. She hadn't slept at all the night before. She made me promise to awaken her if I thought you were going to pass. She lay there sleeping fitfully, you remained peaceful. At 2130 your respirations had slowed to 6 per minute and you were having longer and longer periods of apnea. Gently I awoke your daughter and told her that it was almost time. She sat by your side, your hand in hers and began singing. "Amazing grace, how sweet the sound that saved a wretch like me." I joined in, holding your other hand. After amazing grace, she started singing, "I'll fly away to that home on God's celestial shore." Her voice sounded like an angel. I can only imagine that as Heaven's Gates opened to let you in that the angel's joined her in welcoming you home. As you took your last breath she held your hand and ran her fingers through your hair over and over again. After your last breath, you were still,10 secs.......20 secs..... no breath.... 30 secs.... 40 secs...... I listened with a stethoscope, nothing. I felt for a pulse, nothing. I looked at your daughter and told her you had gone home. She cried, but not violently. I removed the O2 from your nose and turned off the concentrator. Together we changed your bed linens and gave you a lavender-scented bath. She said you loved lavender. We brushed your hair and put your dentures in. We folded the sheets down and placed your hands folded on top of them, she kissed your forehead again. Smiled and said she should have put on red lipstick when she did it to make her mom mad. I called the police department and they sent out a deputy, called the funeral home as well. They arrived and took you to the funeral home. Your daughter is doing alright. She had a tough time at first. If I could tell you what happened in the last wondrous moments of your life, this is what I would have said, but I can't, it doesn't work that way. I do know that you would have been proud of her and the way she handled things. And as far as promises go, I kept my end of the bargain. When it comes my time to go, just stand on the sidelines and root for me at the pearly gates and make sure I get in.
  8. NurseAlwaysNForever

    Head Bugs

    On this particular night my patient, I'll call him Ray, approached the nursing station with his headphones in his ears and his big black glasses on. You know, the kind they give you after you get your pupils dilated. He wore these, with cotton balls in his nose to keep the "bugs" from getting in. Ray had only been at our facility for about a week. He knocked on the desk and I asked him if he needed something. He said, "Do you think you can get these bugs outta my head?" Ray was schizophrenic and had a lot of other mental disorders. He often talked to aliens, bugs, etc and said that they told him to do different things and were trying to invade him. This had been repeated time and time again in his h&p. I explained that he didn't have any bugs in his head and encouraged him to watch television. Several hours passed with no further mention of the bugs, but just as soon as I thought we were passed it, here Ray came, running down the hall with his hands clenching his hair, and him frantically rubbing the top of his head. "They're everywhere, they're everywhere! I feel them crawling all over me. HELP. HELP." Of course, I saw no bugs. I tried to calm him down, and explain that there were no bugs on him. An Ativan and 45 minutes later and we were doing alright. I'm thinking things are only going to get better from here. I began charting the events of the day when the nurse aide hollers for me to come down the hall. I quickly make my way to Ray's room where I find him sitting on the toilet naked with numerous empty bottles of cologne, some of the house keeper's disinfectant, and baby powder scattered on the floor around him. He had poured it all over himself, coated it with baby powder and then wrapped his head in toilet paper. The smell was awful. He looked up and smiled, "I'm gonna kill 'em." Again I explained that there were no bugs "in" his head and we assisted him in taking a shower. He seemed to calm some after his shower and I resumed my regular duties. Continuously thinking about how awful it must be to truly feel like your mind had been invaded with bugs. My heart was beginning to break for this fellow. I got him a cup of hot chocolate and made my way down to his room to check on him. He was working on some "protection" from the creatures in outer space. I sat down and talked to him for quite a while. As I got up to return to my desk, I looked at him and said, "Ray, I'm so sorry. I can't imagine how you must feel going through seeing these bugs, hearing these bugs, and feeling these bugs when no one else can." He said, "Well if you'd quit talking so much and look in my hair, you'd see them." So, I did, more to calm and comfort him than because I actually thought something was there. I parted his hair with a comb and almost jumped right outta my skin. This man had the biggest head lice I had ever seen with huge scabs all over his head. This is what he had been trying to tell me, and me, blindsided by his h&p had just assumed he was "crazy". I shook my head and said, "You're right, you do have bugs." He screamed and began hitting his head over and over again with his hands, "Don't let them in. Don't let them in!" He jumped up and took off running. So, I guess he wasn't talking about the lice, strike 2 for me. I went after him and was able to get him to calm down enough so that I could explain to him that he had head lice and that we would be able to get rid of them. He wasn't buying it. Lots of explaining, role-playing, and some Lindane later we were no longer lice infested, but Ray was permanently traumatized and wore a bandanna on his head from then on out. And he lovingly called me the "Exterminator."
  9. NurseAlwaysNForever

    What a Nightmare.... (Humorous)

    Finally, I realize that I have dried tooth paste on the side of my mouth. I excuse myself and wash it off. While doing that I realize that my hair is still in the pony tail that I put it in before I went to bed. Oh joy. I wet my hands and run my fingers through it, pull it up in a bun and return to my meeting. What a wonderful day, eh? At least I was minty fresh. Meeting is over and it is time to get busy. I hop in the car and start heading to my first patient's home when I hear....... Yep, you guessed it. Ding.... Ding.... Ding..... The low fuel light is blinking. I pull up at the gas station and go in to pay for some gas. Guess what else, I don't have a wallet on me. Embarrassed I rush out of the store, jump in the car and head to the house. Once there I find my wallet sitting on the kitchen table. I grab it and head back out to the car. I am silently whispering a prayer that I can make it back to the station, and just ahead of me I see the gas signs. 3.89, 3.89, and the farthest one away, 3.79. Me, being the tightwad I decide to head to the lowest priced place I see. I go to turn into the parking lot and the car dies. Out of gas... I'm halfway in the turning lane, halfway in the oncoming traffic lane. Car won't start, luckily no cars coming. I get out and get the car going enough to "coast" the rest of the way into the parking lot. Go in to pay for my gas and they won't accept a 100 dollar bill. I'm almost in tears. Finally, I give the cashier my 100 dollar bill, tell her I am going to fill up and to give me the rest in lotto tickets. Heck, the day couldn't get any worse, right? I get my gas and head to my first patient's home, not there. Lotto tickets are sitting in the passenger seat, completely forgotten. Head to my second patients home. Assessment is done, visit extended d/t pt having a lot of complicated family dynamics. The day is already getting better, yeah right. Arrive at the local nursing home to see 3 patients. No problem there. The day really is getting better, until as I'm leaving the nursing home the DON stops me to let me know my pants are on inside out. I laugh it off and give her a brief rundown of my morning so far. We share a nice laugh, I go into the restroom and turn my pants right side out. Hey, no problem. I return to my first patients home and do a visit. They are upset that I hadn't arrived early that morning. I offer no explanation, just apologize. We finish the visit on good terms. No problem. I give the pt a lotto ticket to scratch, it's one of his favorite past times and my version of a peace offering. As I'm leaving all I can think about is my bed. I just want to crawl into it and pass out. I pull up in my drive, thirsty, hungry, tired. But I scratch the tickets. Won 5 bucks. Hey, it could have been worse. I could have lost it all. As I'm walking into the house I get a call. My patient won a load of money off of the ticket I gave them. Yeah, that's my luck and I could just kick myself in the butt..... Beep...... Beep....... Beep...... Beep....... I roll over to hit the snooze button on the alarm clock and then think twice after the nightmare I just had. I'm up and outta bed at 5 am. I double check after I brush the teefers. No toothpaste mustache, comb my hair, check the pants. Grab the wallet off the table, and when I got in the car I had 3/4 of a tank of gas. Hey, this was gonna be a good day.
  10. NurseAlwaysNForever

    I'm Leaving You Here

    I had never intended on becoming a nurse, however, that is the direction that God sent me in and I have not regretted it ever since. I loved the nursing home and getting to know all of the patients and their families. I never had grandparents and they all just kind of filled the gap for me. Each of my patients was like an extension to my family. Every time I had a pt that got put on hospice I would get so angry at the MD and would feel that they were giving up on my pt. I didn't want to "let" them just die. How dare they? I just didn't understand the benefit of hospice at that time. After working at the nursing home for a year I had an ethical conflict with the current DON and decided at that time to quit. I submitted my two-week notice and she politely told me that they would not need for me to finish working it out. I went home and balled my eyes out. I felt like I had lost a large portion of my family. I had no idea what I was going to do, where I was going to work, or how I was going to pay my bills. I prayed day in and day out for God to send me in the right direction and vowed to not even apply for a job until I felt that it was the one he wanted me to apply for. After church one Sunday I received a call from a friend of mine who's father was a supervisor at a local hospice and she informed me that he was very interested in hiring me. I told her I would think about it, and I did. I felt a very strong urge to do it, but couldn't help but think that God must be laughing at the time. Me, do hospice? Was he crazy? I couldn't fight the urge and did apply for the job. They gave me a lengthy test full of questions that I had no clue how to answer. Miraculously, I only missed a few. I was hired and went through the 3 days of orientation before I was assigned my caseload. My first hospice pt was a Lutheran minister in his 50's with Brain CA and the only warning I got was that he would try to convert me. I arrived at his home, rang the doorbell and waited patiently for an answer. I was so nervous. What did I say to this man who was dying? How did I talk to him? Do people realize how often they use the words die or kill me in a conversation.? "Oh, I could just die" or "That kills me." What if I slipped up and said it and he got offended. What if I made him sad? At that moment the door was answered by a middle-aged man with wire-rimmed glasses. I introduced myself and he invited me in. I will call him Joe. Joe offered me a seat on his sectional and he sat down as well. He didn't even look sick really. I explained I had to get his vital signs and ask him a few questions. He allowed this and everything was in normal range. We shook hands and I started to leave. Joe touched me on the shoulder and said, "You know I'm dying and I know I'm dying. It's okay if we talk about it." I apologized and explained that I just didn't really know what to say and that I was sorry that he and his family were having to go through this. His only reply was a hug and then with a grin, he said, " Don't feel sorry for me I feel sorry for you. I'm leaving you here." In that moment I realized that he was right. Mr. Joe lived for six months. During that time he declined very slowly at first. It started with mild confusion and forgetfulness, to not even being able to recall his wife's name, even when she sat right in front of him. Mr. Joe never lost his faith though. I told him happy Easter before the holiday. He explained he would be having the real Easter in Heaven with God when he passed. How could a man have such strong faith to not remember his wife's name who sat beside him, but still remember such strong things about the Lord, who he'd never laid eyes upon? A month before Joe died he became bedridden and was unable to speak. We would talk to him at length. He even got to where he could barely open his mouth and swallow his food. He was transported to the local hospital for his last few days. His family was more comfortable with the thought of him passing there. His wife never left his side. When we were waiting for him to be moved to his floor I bent down and said "Joe, when you get up there you put in a good word with the man upstairs for me. I need all the help I can get." He smiled and spoke for the first time in over a month and told me he would. Mr. Joe died the next day with a smile on his face and all I could think was, "You lucky son of a gun." Talk about a change of heart. I know Joe was put in my life for a reason and Hospice is my passion!
  11. NurseAlwaysNForever

    Fixodent or Forget it!

    I sat down to read allnurses yesterday evening at about 6 pm. So, she arrived and we chit chatted all the way to the nursing home, having a good ole time. When we arrived the nurse was befuddled. She had no idea what would cause such copius amounts of secretions so suddenly. She had suctioned 300 cc's of clear liquid from the man's mouth. My co-worker and I entered the room to find a man who was showing no s/sx of "distress" per se. He was sating at 95% on 2lpm via n/c. Neither of us had ever laid eyes on him before. His lungs were clear to all fields, but when he talked it sounded like he was talking through a snorkel. We wrote an order for hyoscamine and he was given some out of the ER box. He swallowed the pill and the water with ease. He was suctioned again for comfort with a suction cath. I could barely make out anything he said. All I could make out was teeth. I said, "You want me to put your teeth in?" He shook his head vigorously no. "Teef" He gurgled. "Do your teeth hurt?" He said no, then pointed to his throat. "Your throat hurts?" He nodded his head yes. His Adam apple was very enlarged. I looked at the long-term care facility nurse and asked, "How far did you go when you suctioned him?" She assured me she had not gone any further than his mouth, I was doubtful. "Teef." He gurgled. I decided to examine his gums, maybe she had hurt them while suctioning. I asked him to open his mouth, he only would slightly. I opened mine, stuck out my tongue and said, "Ahhh." He opened him slightly. I repeated it, "Ahhhhhhhh." Open your mouth wide. He kept pointing to his gums. By now 5 minutes had passed. The man was just looking at us, fear in his eyes. Still showing no true distress. His wife was sitting in the chair next to him watching television. Once again I told him to open his mouth and stick out his tongue, and once again I opened my mouth and stuck out my tongue. "Ahhhhhhhhhhhhhhhhhhh." He opened his mouth a little more than previously and I saw two front teeth sticking out from the back of his throat. I looked at my co-worker, dumbfounded and said, "I think he swallowed his dentures." He started shaking his head yes vigorously and opened his eyes wide. Without thinking I yelled, "Get me some pliers, forceps something." The long-term care facility nurse headed out quickly. I lowered the man's bed because every time he opened his mouth they slipped down farther. I attempted to reach in and grab them, but every time I touched them they sunk in a little further. My co-worker who's hand is much smaller than mine reached in and was able to retrieve them. We rolled the head of his bed up and asked him if he was alright. He said that he was and then he asked for a pain pill. The long-term care facility nurse returned with a pair of tweezers, holding them up in the air for us. My co-worker and I started laughing, as did the patient and the other nurse. We advised him not to wear his dentures for a while, to eat a soft diet and to use Fixodent or forget it. So much for an uneventful night off.
  12. NurseAlwaysNForever

    The Mystery of the Denture Bandit(s)

    This went on for several weeks, so I took it upon myself to put the dentures in all of the patient's mouths who could not do so their self, and I did daily random denture checks. I would make my way checking and talking to my denture patients just to see if they still had them in. I figured if I kept a close eye I could see where they were going. My suspicion was that a patient with Alzheimer's was picking them up and hiding them and that housekeepers were finding them and returning them. I wanted to find out which pt, so I could keep a closer eye. I never told anyone about my denture mission, and I don't even know why I was so concerned with it, however, I was. I began to notice the most unusual pattern. The dentures disappeared about every 4th day and returned 2 days later. Always usually coming up missing in the afternoon and returning in the afternoon. Nurses worked 12-hour shift, aides worked 8-hour shifts. I began seeing that the dentures were coming up missing on the same rotation of aides. I don't know why I never realized whether or not any of them were missing their teeth. I guess because the thought of them actually taking the dentures never crossed my mind. I only thought that maybe a certain group of aides was being irresponsible with them. Finally, we had a patient with dentures come up missing that never showed back up, just a few weeks later another pair came up missing and never showed back up. This was very hard to explain to the families and our facility was going to have to replace them. They even suggested moving their family member to another facility if they weren't found. Two of our aides came in and were assigned to my hall, a husband and wife. I hadn't had them for a few weeks. I sent them into one of the patient's rooms who was missing their dentures. It was an Alzheimer's patient. I had not explained that their family was visiting. I heard yelling "You bleeping thief... How dare you..." I made my way to the room and found the patients' son holding my aide by the collar. I was about to call the police but decided to diffuse the situation. "Sir, please calm down. There must be some misunderstanding. Let's talk about this." He let go of the aide and said, "He stole my mom's teeth. The sorry bleep stole my moms' teeth." I said, "Surely there is a misunderstanding." He said, "No, I would know those teeth anywhere, they are mom's." I looked at the aide and apologized, and asked him to please show us his gums so we could see that they were real teeth. He hesitated, but with prodding, he proceeded. When he opened his mouth the dentures dropped off of his gums. I was shocked. I never knew he had dentures. How observant of I? We had him spit them out, and right on the side was the patient's name. Apparently, he and his wife had been taking the teeth home to clean them and try them on and would bring them back when they wouldn't fit comfortably. They had finally found a pair for each of them. They were fired and turned in to proper authorities. I still kick myself in the rear for not inspecting my fellow co-workers' mouths. Who would have thought.....
  13. NurseAlwaysNForever

    Halloween Humor: There's A Dog Loose!

    We had plans for children to visit the long-term care facility I worked at and we were going to hand out candy. I thought it might just liven things up a bit if I were to dress up. Plus, it isn't so uncommon to for nurses to dress up in nursing homes for Halloween. I put much thought into my costume. I didn't want to wear anything that would impede my working ability or scare the patients. I finally decided to dress up as a dalmatian. It would be easy enough to assemble and would not scare the children or patients. I put my hair up in pigtails, painted a black spot on my nose and a few black dots on my face, and pinned a tail to the back of my costume. I even fashioned a collar and rabies tag out of a choker necklace. I wore white scrubs and put black spots all over them. Looking in the mirror, I thought I was pretty cute. Not anything near scary, more like cuddly. I arrived at work early with bags of candy in tow for my patients. I was excited to see the reactions from my patients and the looks in their eyes. Most of my patients laughed as I entered the nursing home that day and truly enjoyed seeing their nurse in costume. However, one of my mental illness patients found no humor in the situation at all. She was terrified of dogs and every time I would get near her, she would get upset. As I would walk by she would yell "skedaddle. Git dog. Shoo." Or other things like that. It ended up becoming such a problem that I asked the other nurse on duty to assume her care for the day. She agreed, with a laugh. I thought this had solved all problems. Directly after lunch, I noticed this patient pacing back and forth talking on the resident's phone. I could hear her saying, "yes, out in the open. Loose, yes. I know it's a public place... Has no business here.. Yes, running around all over the place." I figured she was telling a family member about my costume and really didn't think too much about it. Heck, you can't please everyone and I didn't have time to go home and change. Within 15 minutes we had a visit from a man in uniform. No, not the police... Yes, the dog catcher. He said, "I've had a report of a rather large dalmation running loose, have you seen one?" The other nurse and I burst out laughing. We were laughing so hard and we just couldn't stop and every time we looked at him with his blank, dumbfounded stare we would start right back up. Finally, I sat down to try and catch my breath and I looked up at him. He said, "Ohhhh... You're the dalmation?"
  14. NurseAlwaysNForever

    Thanksgiving Humor

    I look forward to the holiday season all year long. The day came and I went to work a little less than enthusiastically. I didn't want to be there, but I realized that my patients needed me regardless. The cafeteria personnel had informed us that they would be serving us Thanksgiving dinner when they served the residents their lunch. My husband offered to bring me a plate, but I explained to him that I didn't want him to have to leave his family to bring it. He didn't listen, and he brought a plate for me and the other nurse working that day. We were very happy to have the home cooked meals and politely refused the cafeteria lunch. We snuck our covered dishes to the break room and put it on top of the fridge where no one could find it, not taking the time to even peek inside, and quickly returned to our med passes. Around an hour later all of the residents were fed, medicated, and laid down if they wanted to be. We made our way to the break room to enjoy our Thanksgiving dinner. My stomach was growling and felt like it was actually starting to digest itself. I was starving. I reached up on the top of the fridge to grab my long awaited holiday meal. My mouth watering at the thought of the wondrous Thanksgiving feast that awaited me. I could almost taste the Turkey and dressing. I couldn't feel a thing up there. I pulled up a chair and peeked over the edge, nothing. It was gone. We looked in the fridge, in the microwave, in the trash, even asked other staff members. No one had seen it. We began to search patient rooms and see if one of them were enjoying it. It was nowhere to be found. We did find two residents, a husband, and wife eating ham, sweet potatoes, deviled eggs, pecan pie. They asked what we were doing. We explained that our Thanksgiving dinner had come up missing, and we were looking for it. The husband replied, "We had this delivered, but our trays are there if you want them." Again, we politely declined and continued our search without luck. I looked at my fellow nurse and said, "Who eats ham for Thanksgiving?" She shook her head, "not me. We gotta find those plates. I'm starved." We looked for quite a while, but finally, we did give up looking. Our stomachs were growling as we returned to work. Soon my husband called, "Honey, how was your dinner?" I didn't have the heart to tell him that it had been stolen, so with my stomach protesting loudly, I lied, "Wonderful. The pumpkin pie was great, the turkey was moist, the dressing wonderful. I am really looking forward to eating some more when I get home." There was a long pause on the other end of the phone and then my husband replied, "Mom burnt the pumpkin pie and we had ham this year."
  15. NurseAlwaysNForever

    Chocolate Anyone???

    Maybe she would win the contest at the nursing home. I smiled when I saw her, she had chocolate smeared all over her face and hands. I was pleased that she had enjoyed herself so much. I asked her "Is that good?" She nodded yes and said, "you can have a piece." I explained that I was a diabetic but thanked her and proceeded to go out and get a washcloth to clean the chocolate off of her face and hands. I got the washcloth and returned to her room and wet it with warm water. She was an Alzheimer's pt and often was very combative and angry. She had a tendency to yell and scream out obscenities. I wanted this time to spend with her when she seemed so lucid and at ease. I wanted to talk to her and asked her if her nephew had brought her the chocolate. I asked her who the pictures on the wall were. She was able to answer pretty correctly. I had an awful cold, and my nose was so stuffed up. An aide came in and made a horrible face. "What is that smell?" I shook my head, explained I couldn't smell a thing. Never once thinking that the "Chocolate" was the culprit. My little old lady with her gray hair pulled up on her heard in a graceful bun was smiling. I remember thinking that she was so happy, maybe I should bring her chocolate more often. I remember really wishing I could share this moment with her, maybe eat my own piece of chocolate with her sometime. Just to know that it brought her such pleasure, and would be nice for me too, would kind of give me a chance to "cheat" on my diabetic diet a little. "Would you like some chocolate?" she asked the aide. The aide opened the box to get a piece and almost gagged. She quickly covered the box and said, "No thank you." I looked inside expecting to find holes poked in the chocolates, instead, however, all the chocolate was gone, and inside each small brown paper cup was a nice, rolled up ball of poo. Upon further inspecting her nails I realized that it was not chocolate I was cleaning up. We wheeled her down to have a shower and I returned to dispose of the Russel Stovers wanna be's. She never noticed they were gone. And from then on out I did occasionally bring her one small piece of chocolate, and I would have a sugar free piece of my own. I still laugh when I think about it and have to wonder if she realized what was in the box or not. Needless to say, I will never accept candy from a patient.
  16. NurseAlwaysNForever

    Anniversary Interrupted

    He appeared to be in agony. I asked him where he hurt. He shook his head no. I felt through the blankets and he seemed to be distended. His abdomen was very hard. He had an order for PRN cath so I returned to the nursing supply room and got a cath kit. I made my way down to his room. His wife was in the bed next to him sleeping. They had been married for several years and had many children. He had suffered a stroke a few years back and was aphasic, though he still had good movement and strength. He saw the cath kit and vigorously was shaking his head no, and he was holding on to the covers for dear life. I explained that he felt distended and I needed to put the cath in to relieve the pressure. He kept shaking his head back and forth. We talked for several minutes, me explaining why I had to do this, him shaking his head no. He finally relented and let go of the cover, almost in defeat. He put his hand over his face. You could see the pink flaring across his cheeks. I was puzzled. I had never encountered this. Surely at his age, he had been cathed before. I explained that I would be as quick as possible and that I would be as easy as I could. I pulled back the covers and automatically wondered what was wrong with him, and then I realized what I was seeing. I was very embarrassed, as was he. I quickly covered him back up and told him I was sorry. At that time I turned to leave and was just trying to get out as quickly as possible, both for his sake and mine. His wife awoke, sat up and began calling me a tramp, a floozy, and every other name in the book. She said, "I slipped him 4 Viagra, not for your enjoyment, but for mine. You've ruined it. Ruined it all." She was outraged. I tried to explain the situation, but she would not believe anything I said. Come to find out it was their anniversary and she had plans for the night, even including a nice negligee. I had no idea what to say. I had never encountered that type of situation before. I did tell her that we would close her door and would only come in if they called for us. This seemed to calm her down a little.
  17. NurseAlwaysNForever

    Brave Little Soldier Boy

    That I wasn't sure I would be able to, that I really didn't want to ever be in that situation. I got the job and was told that if we got any kids I probably wouldn't have to take care of them. We don't get many children on our services. It wasn't long before we did get a 13-year-old little boy. I'll call him Robbie. Robbie had been diagnosed with brain cancer at the age of ten during a routine eye exam. He had undergone chemo and radiation and was in remission for a little over a year. During his one year follow up they found that he now had spinal cancer and there was no treatment for him. Robbie came on service with us. He was nearing the end of his 7th-grade year and was determined to go to school daily. He was able to walk at first, however, before the end of the school year he was w/c bound and had a foley cath in place. He was steadily getting weaker and declining more and more every day. He never asked for any special treatment or for anyone to take care of him. He was loved by everyone at his school. On the last day of school, we got a call and I made a trip out. He was so very sick. He hadn't even woken up for most of the day. I told him we were going to take him home early, but he refused. Robbie finished his 7th-grade year out. Even as his health was failing him he remained full of life. He wanted to go out on a date before he passed. He did and even had a limo ride. He wanted to go to Sea World, and did, in his w/c. Make a wish sent him to meet the Orange county chopper people and he got to ride on a Harley. By the 3rd week of summer vacation, Robbie was starting to lose feeling to his feet. I seemed to be finding reasons to "stop by" almost daily. By the start of his 5th week, I was his nurse and still found reasons to stop by daily. I came in one day and Robbie was writing furiously in a spiderman notebook. I said "Whatcha writing soldier?" He looked up and said, " My will. Do you think you could help me? I keep forgetting to remember stuff." We wrote his will out, him dictating, me transcribing. Baseball cards - My big brother. One day he might be on one. Fishing stuff - My dad. He'll be sure to catch a big one. Clothes - Goodwill. They won't fit anybody at home. Important stuff/papers/awards - Mom. She won't lose 'em. Room - My little brother. He shouldn't have to keep sharing with my sister. Stuffed animals - My little sister. She'll love 'em to pieces. The list went on and on. These were the ones that stuck with me the most. We had his will notarized and he was so proud that he had done it. He said, I gotta plan my funeral next you know. I hafta get ready to go to Heaven with Jesus. I hugged him and held him tight. Told him everything would be okay, all the while begging God not to take him from me. Not to put his family through this. Constantly asking why? In time, I realized that even though Robbie was only 13 he was much more prepared to pass than most of the adults I knew. He had no anger or fear. He accepted his fate. He spent days planning his funeral. The music, the color of his casket piece, his casket, his clothes. He had to have a casket with an angel on all four corners so they could "Carry him to Heaven". By the middle of summer, Robbie was paralyzed from the chest down. He itched fiercely and began to have severe pain. We put him on Atarax and Duragesic patches. He never complained, never got angry. He was such a soldier. He passed away in his sleep a week before school started back up. We had started continuous care, and he was lying in my arms as he took his last breath. His funeral was the most beautiful funeral I had ever been to. Maybe it was knowing that he planned it, every last little detail, almost like one would plan a party. It was beautifully choreographed..... He was buried in a Harley T-shirt and jeans. He had a guitar pick in his hand. They played when I get where I am going, Who you'd be today, I will always love you, You raise me up, and many more. His flowers were all red, orange and black. Several of them had motorcycles in them. He even was buried in the spot he picked out under a weeping willow. He told his momma that he wanted to be buried there so that when he went to be with Jesus she wouldn't have to cry because the tree was doing it for her. What did I learn? That God knows what he is doing and takes us when the time is right. Robbie was so much more prepared and ready for his death and it couldn't have come at a better time for him. And guess what... I love pedis now. Somehow it is the most fulfilling thing you can do, even if it is helping them have a comfortable passing. My little soldier boy, I salute you and will never forget how brave you were as you set out on your journey.
  18. NurseAlwaysNForever

    I'm Leaving You Here

    That is a beautiful song and I am so happy that Hospice was able to help ease your brother's passing. It is stories like yours that remind me why I continue to do what I do. Thank you!
  19. NurseAlwaysNForever

    Pain Not Controlled With Dilaudid Pum

    We use methadone as well. Also, does she have any renal failure? With renal failure the Duragesic does work best for pain control. I generally don't like Duragesic d/t poor absorption but have found it to be beneficial at times.
  20. NurseAlwaysNForever

    I'm Leaving You Here

    I didn't find my niche, it was found for me!!! It was almost as if I had been battling God's plan for my life for years and he finally got through to me. I am so thankful to be doing what I do and wouldn't change it for the world.
  21. NurseAlwaysNForever

    roxanol in neb treatments

    all pts metabolize meds differently. Anyway, Roxanol is a very effective neb treatment as long as not sugar based. It has no effect on pain management at all, merely relaxes the lungs and decreases discomfort. Does not work on the full body system at all.
  22. NurseAlwaysNForever

    roxanol

    Roxanol, non sugar based can also be used as a neb to relax the lining of the lungs and decrease respiratory discomfort. It can be mixed with Albuterol, Atrovent, combination of the two, Xopenex, or plain old Saline. Works very well.
  23. NurseAlwaysNForever

    What Diagnosis would you say this patient is?

    Why not just use ES Alzheimer's. If the resp distress is secondary to that?
  24. NurseAlwaysNForever

    How soon to specialize?

    I have been a nurse for 3 years. I worked at a nursing home for the first year and a half and have been in hospice since. I love where I am at, my boss tells me I'm good at what I do. I feel that hospice is my calling and I am greatful daily for the opportunity I have had to be a part of hospice. I think you need to get at least a year of nursing under your belt and then go for it.
  25. NurseAlwaysNForever

    LVN Hospice Certification

    I am currently attempting to get my hospice certification and was wondering if there are any books to use to study for the test.
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