Callinurse

I recently went out to a home vent case and the plan of treatment included a procedure that I have never heard of and I would like to know if any of you have experience with this. It was explained to me that if I push manually on the bladder area that it will expell urine. This patient is semicomatose, & experiences no pain during this procedure. She is place on the bedapin then the crede procedure. I have tries to search this on line and can't find any information on this procedure. Please reply if you know anything related to this. Thank you, Callinurse

I would ask her exactly why she couldn't interview you. Just ask her like you are asking her "How are you?" "Can you tell me why you will not be able to interview me?" See what she says. She may have forgotten to tell you that she'll have to get back to you, or perhaps JCAHO just showed up and she lost her mind. Hopefully its not what you are thinking. If it is look for hospitals with a new grad program. Good luck, Calli

Ok, this is one from the Rahab setting ..... "If you can pick your nose and feed yourself then I will not put your member in the urinal. You will have to do this yourself!"

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Is this a LTC = Long Term Care Facility or a ALF = Assisted Living Facility? In California in an ALF staff that have been trained to state specifics can assist in giving meds. If the pill or liquid needs to be put in the mouth they have to call the lvn/rn. The resident needs to be able to put the tablet or liquid after it is poured into the mouth. My sister does this and I was very nervous for her in the beginning. However, I had no ALF experience and was not aware of the regulations that govern ALF'S. Calli

I am not sure but I have heard if the facility is less than 99 beds they are not required to have 24 hour RN coverage in the building. Calli

Man if you held down a 320 bed facility does that mean 4 assessments a day with every 4th one a comprehensive??? My hats off to you ! Calli

It is a violation of the hospital policy if the policy is updated and it is a HIPAA violaition. It doesn't matter if it is a test result or any other part of your medical record. Check out this link: http://www.hhs.gov/ocr/hipaa/ HIPAA itself is quite lenghtly. The federal regulations = laws also have a standard you might say dictionary to tell you what certain words mean EVERYTIME they are used. You should know how to read these. Like when "must" is use, it means that there is no room for intrepretation or flexability. It must be exactly what they write. This site also has a link to file a complaint if you think you records have been violated. The best thing is to not go against your hospital policy. If the policy is at fault the hospital will be held liable. If you are at fault for using the policy then you can be find. I dug a little further and this is the actual HIPAA regulation: http://aspe.hhs.gov/admnsimp/pl104191.htm it also includes the definitions. The fine can maxes out at 25,000 per calendar year. However, this what not meant to keep your record from you. It was meant to protect you record. I think one of the first sections of the regulation states the purpose. If anyone could get your info can you imagine how a health insurance company might reject your policy renewal if they new you had Diabetes or HIV? There has been a system for accessing your record for years. Its like everything else we have to respect the systems. All or nothing. there is no inbetween. I think I am going to sign off on this thread. I just hope that students don't get the wrong impression from others opinions. As new nurses it is common to assume what you see others do to be correct. Keep your good habits because you will see plenty of lazy or poor habits. I hope these links will help those of you who are truely interested in looking at HIPAA. Have a happy New Year ............. Calli

Yes, this is a HIPAA violation. I used to teach the classes when we first introduced this to all staff. It is even against HIPAA to look up anything on a patient on your floor that you do not work with. Please don't give the wrong impression to some one here that do not know for sure what the law states. A facility will doubtfully terminate you for this unless the doc complains about something or if they are trying to get ride of you anyways. When you are admitted to the facility or go to have blood work or even pick up a prescription for the first time each year they often give you a copy of HIPAA. Take a look at it. I was involved in damage control for the facility I worked at in 1996. That was when it was first passed but there were so many components to the law that it was not enforced until hospitals had time to correct many different systems. This is the same reason you must always use a fax cover sheet even if you are just faxing to another department in the same building. I would not comment if I didn't know it for fact. Calli

If you accessed your file in medical records it was probly according to HIPAA regulations. What you refer to as "presonal impressions" are actually part of your physicians assessment of your presentation. Just because you were anxious at one contact doesn't mean your doc is going to expect you to be anxious everytime he sees you. If you are truely an anxious person all the time then you already know this and know how this can affect your health. He/She has a responsibility to note this in the physician's assessment. It doesn't mean its a negative attribute. I hope that you are your 100% self when you go to the doctors. If you are not comfortable with him/her maybe you should get a doc that you at relaxed with. Just a suggestion. Calli

Just remember that care plans must be individualized for each patient. Example: two patients with kidney failure might not have a fluid restriction. If you get the preprinted ones make sure before you use them that you cross out anything that is not current for the patient. If you have specific care plan you need you might think of posting them and maybe nurses or students on here will send them to you. Good luck! Calli

Wow, I never thought my restraint skills would be used at home. I might have to try this one. Calli

you need to remember that reason for covering them must be related to the 3 day stay. if this resident goes our for pneumonia then the g-tube at this point which is no longer a new g-tube and is not related to the 3 day stay. this is an excellent reference: for consumers medicare coverage of skilled nursing facility care pp 14-15 for consumers medicare coverage of skilled nursing facility care pp 14-15 as posted above. if you are in doubt and need someone to confirm your decision making you can always call your state rep. the admissions coordinator or marketing person should also be up on this. check out the reference it is what medicare recipients receive to read to know what their benefits are. calli

Part of the HIPAA ensures that each facility will keep of log of who has had access to your medical record or any medical record. How can they do that if they don't know you accessed it. A lab result it self or an xray result it self is not the total answer. It takes a doctor to state the final diagnosis. Sometimes it takes more than one test to give the entire picture. The law is the law ..... I am sure that by now you have signed and will sign each year that you will adhere to the HIPAA laws. If not I hope you will soon. Its a requirement for the hospital to do so. It seems stupid but its the system we work in. When you sign in to the computer with your password they can track what you looked at. It would hate for you to loose your job because you did something so silly. This will be a popular thread. If you are a Kaiser patient you can get an email as soon as your test are complete. I love this because I don't have to wait for a call or follow up. Just thought I would mention this in case you worked at Kaiser. Calli

If you check your local library you may find nursing care plan books. You may also check your local hospital. The library is often open to the public. Hope this helps... Calli

Bottom line ...... A nurse can not "TAKE CALL" for an MD. Every MD must have a "ON CALL" replacement MD or take the call him/herself. I would get management involved and they need to clarify with this doctor the expectations with caring for the residents in your facility. Second note, this nurse, be it LVN or RN, should be written up if not terminated. This is a very clear stepping outside of the scope of practice. This person should also be reported to the board. I wouldn't want to be one of the family members of these patients. Calli

I have been a nurse for awhile and an MDS nurse for 4 years and there are days that I still feel like your icon "head into brick wall" because that would be better than the headache of the day. LOL Antipsychotics, Antianxiety, Antidepressant, Hypnotic and Diuretics all place the resident at a greater risk for FALLS !!! That is first on my mind. Each of them has a potential to cause the blood pressure to go down and that will cause dizziness, lightheadedness and a potential fall. Diuretics will cause someone to just getup and go to the bathroom. They can forget they just had their leg amputated or that they had a stroke and one side of the body doesn't work. When you have your monthy staff meetings and they give informaiton about the psychotropics and the regulations just make notes. You will learn over time what you need to know. You have one great quality.... Never stop asking questions ! Not all of us can teach but we all can certainly learn. We can never know it all. Good luck! There are many helpful people on the site. Come back often and read the threads. Callinurse

This situation needs follow up on several different levels. First of all, so everyone else will know that she is OCD, it needs to be added to her Diagnosis profile. If her Seroquel has a qualifyer in the order "OCD manifested by .... " , that is sufficient to add it. I would also care plan her messiness. If she is unable to organize her area I would suggest making an agreement with her that the CNA will meet with her weekly to assist her with organizing her area. Give her the power. If the goal is to make her area more organized and clean it doesn't matter how its accomplished. She can just think its the weekly special time for her to be assisted. Its the fear of not being in control that is the worst. Take baby steps. Just having someone in there once a week with the purpose of "cleaning up" will help the situation for her and the facility. To me, with her statements of, "just wishing she would die !!!!!!", she is severely DEPRESSED. Weight loss also goes with depression. Tearfullness and crying are both possible indicators of depression. A good psych eval is in order. Remeron and Lexapro are both good antidepressant that also work well with poor appetite. I always suggest a non-psychotropic appetite stimulant prior to the psych approach but clearly she needs both. I would also look at all her meds. It might not be the Seroquel that is making her sleepy. Also check her night time sleeping. If she is awake at night or gets up very early she may get tired at that time because she doesn't have a good sleep routine. I have worked with a fair share of OCD patients. I have never worked psych. One thing that I always hear from the OCD patient is why they do what they do. In my experience 100% of them have a reason for what they do and have never had one yet say, "I know this seems silly but I want it this way." they always have a reason or justification. I would care plan the major ones to start with. Like others have suggested add it the to Cardex or the CNA ADL cheat sheets, so everyone knows who works with her can provide her with what she needs. I would also make sure she has consistent staffing as much as possible. The CNA's more than likely know her every special need. The more she has the same staff she won't have as many changes with people moving things or doing things differently and this could greatly effect her quality of life. I would also make sure the CNA's know how important it is for this resident to NOT hear anyone laughing at her. I would also request her primary MD to evaluate her. Maybe her labs need to be drawn again. Rule out any pain she may be having. Is she constipated???? Ask her when she was living independently how often did she move her bowels? Maybe she went twice a day or everyday. We usually don't get concerned until they do go on the third day. It can make a big difference in someones life "Constipation vs. regular bowel pattern". However, the key thing is her regular not ours. There are so many little things that could be effecting her. Does she get visitors? Are there any volunteers that can visit her just to read the newspaper or to help her write letters. Maybe she can start a journal. Get her mind off her problems. And, yes review yourself. You will find as you get more years under your belt that OCD patients are the same but very different. Here are a few good "reliable" links to check out: The simple but useful encyclopedia - Wikipedia: http://en.wikipedia.org/wiki/Obsessive-compulsive_disorder#Diagnostic_criteria National Institute for Mental Health: http://www.nimh.nih.gov/health/topics/obsessive-compulsive-disorder-ocd/index.shtml The Mayo Clinic: http://www.mayoclinic.com/health/obsessive-compulsive-disorder/DS00189 The Obsessive Compulsive Foundation: http://www.ocfoundation.org/ I keep my own care plan library on dx's, s/sx, etc that I have review over the years. I would suggest the same and update it as you learn. I keep mine on a memory stick that I spend 10$ at Walmart. One of my best investments so far. If I am at work and need to use it, I plug it in. If I am at home and want to update it, I plug it in. Hope this helps, Callinurse

NurseExec, Thank you so much. I really appreciate this. I haven't been able to PM yet but I think with this post I will have 15 posts and then they will let me post. I will PM my email to you for the file. Thanks again, Calli

What nerve they had Achot Chavi ! They really wanted you to leave. Well, I have good news! I started a new position last Friday. They were even nice enough to give me the 3 day weekend. I am earning 3 dollars more an hour. It is a very professional setting but not stuffy. They are friendly and people smile. So, onward and upward for me. The 3 dollars more an hour will help me catch up in my bills. I feel so bad for the kids. I haven't been able to do any school clothes shopping. Its a good thing no one had any growing spurts. Thank you for your response, Callinurse

We are starting a daily pps meeting after standup each morning. I know this is a common practice but I have never had it in place. I am looking for help from those of you who already do this. What type of worksheet do you prepare so you can review all needed information. I know I have all the information needed but its more than likely on a few different forms. I would appreciate any help that is provided. Callinurse

Thank you, I spend more time and went to the web site. It kind of answered some questions about retirement and which health cariers they use. Callinurse

Ok, I tested online for the California State System. They really didn't post much about the benefits offered. I have been a nurse for 16 years. I would fall in under "over 4 years of experience". How often do they offer raises? Do they offer merit and cost of living raises? What about education funding? Retirement? Can anyone give me information? I am looking for my next position and I really want to start someplace where I can retire. My last position I was there for 12 years and my new DON fired me because I was not an RN. Long story ..... but I really thought I would retire there. Thanks for the info in advance. Callinurse

[quote=Notmywil;2815063 Plastic containers you might discard could be used to brew "hooch." Beware accumulations of fruit (i.e. orange peels)--they can brew hooch out of some pretty disgusting things. Could you please clue me in? What is a "Hooch"? Sounds like something discusting? Thanks, Callinurse

YES, I did the unemployment papers already. I spoke to the Administrator and she said she is not going to answer the claim which means I will get it under default, Its far from my usually wage. I have one position that i am interested in but its taking forever and a day to get an interview. So, until then I will try to make the best of it. I have been the sole support for my family since 1990 when my husband had a motorcycle accident. So if anyone hears of any open or soon to open MDS Coordinator positions in southern California please let me know. Callinurse