nsgnva

I have a general question for all you oncology nurses out there. We have a resident (patient) in our LTC/SNF facility who is receiving radiation and chemo (temodar) for glioblastoma. It's been a very long time since I worked the oncology unit at my local hospital, but I recall there were sometimes special precautions we had to take. I understand the precautions to protect the resident, because of the potential for white cell destruction and higher risk of her getting an infection.But aren't there precautions we are supposed to take to also protect the staff?? Seems I recall something about some chemo drugs excreting in the patients urine? If someone would so kindly lead me in the general direction for information, I'd greatly appreciate it.

My sister has been having these bizarre "spells" that sound like either some sort of syncope or seizure. She had a 3 day portable heart monitor and nothing showed up, her labwork was good. She is on a stable dose of Synthroid and no other medical problems. She found a post somewhere in which a girl described exactly what my sister is feeling and was never able to explain. I will copy and paste it and welcome all input!Here it is.... "My auras scare the life out of me. They just burst onto me like a really strong deja vu. I start to feel really dizzy and I get the weirdest thoughts of some ridiculous memory, that I can't understand why I should be remembering it. It could be a song, a talk with someone from years ago, or other things that I have no reason to remember. I can't talk properly while this happens and I have to try and talk myself out of it. I try to breath in through my nose and fight it as hard as I can. I use this analogy... It's like a big black hole appears beside me and if I look into the black hole and try to see what's in there I'll fall in. If I fall in a seizure will kick in. The after effect for me is tiredness and I just feel depressed and down because it's so hard not knowing when the next one will happen."

I couldn't help but comment on this one....If your LTC is anything like the one I work in, you will get PLENTY of PSYCH experience:bugeyes:

Well, our facility is being sold, so I was wondering if anyone out there works for (or has worked for) Consulate Health Care.? I only know of one other nursing home in the area and I heard they cut their staff from 2 nurses/60 residents to ONLY 1 nurse to 60 residents. All input welcome.

Thank You! I've always been concerned in LTC with some of the things they tell the LPN's they can do. It's always "it's a facility decision" or "the state lets you do anything under the supervision of an RN" (even if we have only 1 RN in the bldg and nowhere around), etc. I just sent an email to our state board of health professionals for answers.

I'd like to thank all the nurses who answered my questions about portacath procedure. I give due respect to new nurses, because I trained in 1973-74,worked in a hospital for 15 years, but was limited in things I could do as an LPN, but my gut instincts told me that my much younger,much less experienced manager was wrong to tell me that you should never aspirate for blood to check placement.

thank you for your response. I should've been more specific about the RN's "hands on" training.The RN at our facility told me the procedure and then stood by me and talked me through it step by step so if there were problems or questions, she'd be right there with me.

I work in LTC. Several years ago a resident of mine went in the hospital for portacath placement. I went to visit her so I could observe the ICU nurses accessing and flushing, because if this resident ever needed flush/meds, I'd need to know how. The ICU nurse showed me how to access, withdraw blood to check placement, then she proceeded to administer the IV meds.When the resident returned to my facility, she never had any IV's or IV meds ordered, but required monthly flushes to keep the portacath patent.Since I was the primary nurse for this resident, it would be my responsibility to flush it every month. I trained and worked in a hospital that did not allow LPN's to work with portacaths. So I went to an RN and asked her what to do. She said our facility allowed LPN's to do this and she would be happy to give me hands on training. With this accomplished, I have flushed the portacath every month for over 2yrs. Well, I recently had problems with it and could not get a blood return, nor could I get the flush to go in. I reported this to my unit manager, and tried again the next day. Still no go! So I reported it to her again.She advised me to put a note in the MD rounds book, which I did. The MD on rounds said to make an appt. with the surgeon who put it in and see about getting it removed....seeing as how all she has received through it, for 2 years, was flushes. So I set up the appt. In the meantime, my unit had a change of managers. The new manager asked me what the appt. was all about, so I explained to her all that had transpired the past few months. She talked to me like I was an idiot. I have been a nurse longer than she has been alive, but excuse me for not having trained in portacaths until 2 years ago! She said "You NEVER aspirate blood to check for placement. There is no where for the portacath to go. It doesn't migrate anywhere, or infiltrate, so there is no need to draw back on it to look for blood in the line" Who is right? The ICU nurse at the hospital who showed me how to do it, the RN who gave me hands on training, or the new LPN manager???

Another thing to keep in mind is the effects of psych meds on BP when you think the drug is no longer in the system. I had a case of a woman who was in her 40's and took 0.5 Ativan one evening. The next day, long after you'd think the drug was metabolized, her BP dropped to 70/40 and she passed out. The doctor switched her to Xanax, and no more BP problems.

I agree with the other responders....don't tell the people at work! Sad, but true, some in our society aren't very understanding. Things happen at work and I hear "probably that nut job on the psych meds did it" Without my Wellbutrin XL , I'd have killed a few of those unsympathetic co-workers:smokin:. And who knows, maybe whatever led to all the problems that required you to go on meds, aren't there now, or aren't as bad, and you will handle the med adjustments just fine.So take the advice of the others and see a professional and seek other outlets for friends,fun and stress relief. good luck

You sound like a great "hands on" kind of manager. Yes, I would be very grateful if I had a manager who helped out. But that's not the case where I work. We have a wound nurse for the bldg, two MDS nurses. The manager does not answer the phone, do admissions, do orders or pretty much anything else "on the floor". She is in meetings or in her office the entire day.We might see her 2-3 times in a 10 hr day.

Would you be my supervisor?!! I had an admission on the weekend, in addition to all my regular duties, and the supervisor said "oh, I'm sorry to hear that" ( on the phone, no less ). There are only 5 units in the entire bldg. and I never even see her the whole time I'm there.

AMEN TO THAT!!! I LIKE HOLIDAYS AND WEEKENDS BETTER FOR THE SAME REASON....MANAGEMENT JUST GETS IN THE WAY

Do any of you responding to Matt's questions, and any regarding LTC, have other nurses on the unit, serving in other capacities? Such as treatment nurses, or "charge" nurse ( overseeing the unit, md rounds,orders, etc)??Or have a unit clerk who answers the phone? I am an LPN, have 37 residents. All the beds are dually certified ICF/SNF, so at at given time I can have as many skilled residents as they see fit to put on my unit. I have had as many as 8 skilled/29 ICF at one time. And I am the ONLY nurse/clerk!. Meds,treatments,charting,doctor's rounds,orders from the doc, orders to write from the rehab dept., all phone calls, all family interaction, supervision of my CNA's....which is usually only 3, on 7-3 shift. I start my am med pass at 7:30, finish at 10:30 and have a 15minute break. Then I resume meds, starting with all the ac lunch, fingersticks/sliding scale insulins, and then into the lunch/post lunch meds. This usually lasts until 1:30 or 2pm. THEN, I have to do all the other duties I listed above. Oh,and now we have to review and sign off on the CNA's adl records...which are 4 pages long on every resident. And the manager has now said she is going to divide up the monthly summaries for the floor nurses on each shift. If I do my duties with no phone calls, or doctor's orders,family issues,etc. I can finish by 4-4:30. Most days I am there til 5-5:30. And Lord help you if someone has a fall! Then you got neuro checks and incident sheet to file, doc/families to call. Or find a skin issue...we have to do a skin impairment form,write tx orders,notify dietary to consult on nutrition, file a "change of condition" form, notify md/family.:bluecry1::bluecry1: My doctor tells me my dizzy spells are caused by stress. YOU THINK!! I know this is lengthy and probably repetitive of things I've posted before. But to those of you who have any help at all with other nursing duties, be very grateful.

with a rude and nasty co-worker like that, I'd seriously think about looking for work elsewhere, or ask for a permanent floor as soon as one is available. Tell your DON that you don't feel like you can give the quality care you desire when working in the float pool.I so wish that I could be more help, but speed comes with time, and cutting corners only diminishes your feeling of integrity. Believe me, I see it all the time. I'm always reprimanded for not getting my work done in 8hrs (meds,treatments,rounds,dr's orders, admissions....etc...I do it ALL for 37 residents...ICF and Skilled!! mix ). I could easily get done in 8 hrs if I sat on my butt and skipped half the meds, like some nurses.But like one of the other responders...it's your license on the line...stick to your integrity and go with what your heart tells you to do.

I was wondering if anyone would come up with the same solution I have used! I am the only nurse, on 7-3, with 37 residents. Many of the residents come from a hospital setting with med times being very strict....when at home,the residents, for the most part, weren't that strict on themselves. I also work evenings when there is a "call-in" and I am mandated to stay. Seeing all sides, I ask the doctors to review the meds/times. More often than not, the docs are very understanding and will order all pm/hs meds at 7pm, if there are no contraindications. This allows the nurse to give one pass on some of the residents between 6-8pm. Freeing up more time to give ones that must be separated, such as your qid meds. Example, I have a resident that gets Ktab and metoprolol at 6pm, but zyprexa at 9pm.The doc agreed that both could be given anytime between 6-9 without ill effects,,,hence 7pm schedule.

you are so right! our elderly in this country get the worst care at the hands of Medicare/Medicaid. The only ones that get good care are at private paid facilities, but then for nurses, those are usually the worst paying facilities

That's absurd! If it is meant to sound more important, to benefit the company of course, it should be "RN Clinical Associate" and come with a raise!

I wish I had that kind of staffing! I work in LTC. I have 40 residents. Mon-Fri we have a unit manager there, but she spends all her time on paperwork and meetings. I am responsible for ALL charge nurse duties, "desk" duties, meds, tx's, etc. I am lucky to have 3 cna's. There are no med techs/med aides allowed in Va. except in an Assisted Living environment. And on the weekends, I usually have only 2 cna's. And this is on 7-3 shift, the busiest, with these poor, overworked girls trying to get everyone bathed, feed, turned, dried, out of bed, back to bed........And all of our beds are certified snf/icf,,,so we can have any proportion of skilled to intermediate care at any given time. Currently I have 6 skilled/34 icf. but staffing stays the same. One nurse, 2-3 cna's. So wherever you are, consider yourself lucky.