ybstressed

Hello everyone! I'm currently helping an agency with review and improve their documentation. After review several of the patients charts I noticed that there is no documentation of any education. Now, I know that the nurses are educating on something. How can you do a home health visit and not educate on something? Its not possible, but the nurses are not documenting their education. When I send message to them about corrections their response is.......I completed a skill so I do not need documentation. The agency that I previously worked for required documentation of education on every visit. Plus, as I stated above, as a nurse you are constantly educating patients. Why not document what you are already doing? So my question is.....Should there be documentation of education at every visit for the note to compliant with state agencies? If so, can you point me in the direction of this documented somewhere? I've looked and I'm having trouble finding this information.

@cathiwithani - Did you you state they are no longer hiring LVN's.

Hello all, I am going to register for A&P and would like some suggestions on professors. I tried to go onto ratemyprofessor.com but no luck. Thanks in advance. [email protected]

Anyone in the dallas program?

Is anyone still following this thread. I'm thinking of enrolling in the pre-liscensure program but I do not have a ADN. I am LVN. Do I still have a change of being accepted?

I totally agree! The previous home health agency I worked for provided a certified wound care nurse that would evaluate the patient and then I would do all the dressing changes. They also had a dietician that would consult with the patients when needed. I just don't know what to do! I have informed my ADON, and the owner and no one seems to care. The only response I get is " send him to the hospital'. Isn't the point of home health to prevent hospitalizations? I just feel for this patient because he needs a better quality care and I don't know what to do. I am putting in my two week notice but I want to make sure this patient is taken care of before I leave.

Hello, I am a home health nurse looking for a visiting wound care nurse that I could refer my patients to. I must admit my agency does not have a wound care nurse on staff and I have a patient who is in desperate need of one. I have advised him to schedule an appointment with a wound clinic but he refuses because he would have to call a ambulance to get there. Please help! Also, does anyone know of a nutritionist that will travel to patients home for diabetic education.

I have been a nurse for a year and this is how I remember the basic idea: HypOtonic -- I picture a HUGE SWOLLEN hippo that is about to bust walking from the vascular space into a cell while spewing the fluid. ( I know I'm odd) HypERtonic - I picture the same above but the hippo is walking out of the cells into the vascular space. Isotonic -- I just picture a perfectly happy normal size hippo in the extracellular space just chill. As far as trying to remember what fluids are in what categories is very easy....on your home made report sheet I type the most common solutions we use with little abbreviations that pertain to what type of solution it is. Some people will say that I am cheating but it is a QUICK reference and I am getting to the point that I do not need to use it as much. Soon, I will not need to use it at and then I can use that area for the solutions we don't commonly but still use at times. Then, once I have those down, I will start replacing that area with information that I would like to retain. I also have gift...I tend to remember all the bad things that can happen because I am completely terrified that it will occur with my patients so here is my list: Isotonic - NS, D5W, and Ringers lactate/acetate These fluids replace fluid loss - they replenish and may expand that intravascular space my friend. So watch out for patients who have HTN or CHF that could have some fluid overload. I always remember that d5w likes to be a little trickster and acts hypotonic due to the dextrose, which causes the lovely liver to start converting and could cause a liver disease patient to become acidic. Avoid LR if the PH is above 7.5 . I write this on my sheet like this 7.50/LR= NO NO Hypotonic - 0.45 saline, 0.25 saline (w/w/o dextrose)

i have worked at house call service for the past 6 months and i can't begin to explain the problem of addiction at our practice. i, the doctor, the patient specialists (if any), and any other members of the patients medical team attempts to help a patient who is truly in pain. now, with that said, i never judge a person's pain level. i truly believe pain is determined by the person. i also believe that pain can come from physical injuries or mental issues and the word "pain" can be abused by many to get (as my patients would say) hydrocortisones or the good stuff. the more you work with patients on such medication you will be able to determine: 1) who is truly in pain and need medication with other treatments 2) who is in pain but their pain has been managed poorly by script happy practitioners 4) who is good at what they do and do anything possible to get what they need (remember - these patients need treatment to for their addition) the practice i work at uses multiple resources such the patient's pharmacy we have on file, the patient's insurance company, and personal investigation to see if the patient is obtaining multiple scripts from different providers. we also use these sources to make sure the patients pain is being managed appropriately. some insurance companies actually mail out a list with a detailed history of the patients scripts that have been filled and written and will give us the md's name and the pharmacies that they have been filled at. the providers also have the patient sign a controlled substance agreement that details when we will refill prescription, how we will refill the prescriptions, what will have happen if the script is ----- lost/destroyed/flushed/pills spilled/pharmacy did not give the right amount/my dog ate all the pill/the pills fell in the toilet/my aunt died and i need the pills to relax/my lady parts hurts i need fentanly/i spilled the pill box and ran over pills (only the pain pills)/i left them when i was on vacation but can you call them into the pharmacy (a local pharmacy)/i left them in another stat for the 5th time/i smoke weed and the pills help (we truly enjoy honesty)/i'm drunk and i need loratab/i have diarrhea and tylenol3 helps but i'm out (120 pills given) because i couldn't read the directions that have been the same for the past 2 years...etc. so when i receive the chart of new patients or established patients that require some form of pain management i: 1) the physician and i do a very detailed review of the chart and determine what diagnostic test are needed before treatment can be prescribed, what pain medication will benefit the patient, what other disciplines will benefit the patient, the physiological needs of the patient , and other factors. 2) once a treatment plan is developed the we go back to the patients home and go over our findings, have a controlled substance agreement signed, and tell the patient it is their responsibility to complete all aspects of the treatment plan and to follow all the guidelines of the controlled substance agreement plan. if any of the guidelines or if the treatment plan is not followed we will review why the guidelines/treatment was not followed and go from there. i am glad to say that most people that are truly in pain follow the plan very well. there is the issue of fixed income, poor insurance coverage, and other socioeconomic issues. many of our patients are on fixed incomes and find it hard to pay copay's for office visits, pt, ot, transportation, etc. this makes it extremely difficult to treat these patients especially when we are attempting to lower their dosages of medication will using alternative therapies. i am proud to say that i have worked extremely hard building relationships with many people in the medical community and i have been able to help numerous patients with this issue. now the patients that have psychological issues that have caused addiction and patients that are using and selling the medication are discovered quickly and require a more in depth treatments. we usually refer for a psychological evaluation and if they deny we will not fill their medications. we then refer them to pain management. we try to avoid this since we are seeing patient that are home bound but if they are not willing to receive proper treatment then we can't help them. if we find out they are selling and abusing we refer the patient to rehab. if the patient denies our help we do not fill any prescription for them and cancel their services after we give then the names and number of multiple treatment centers. they are adults who need to take responsibly. plus, how dangerous is it for our employees to go into the home of someone who sells drugs. you never know what could happen. also, if they are able to go out and sell their pills then they are not truly home bound. we only fill prescriptions while in the home and we write the fill date on the script. we provide enough pills until the next visit and if the amount of pills is not efficient and the patient request a new control such as fentanly we refer. we visit all of our patients monthly. we contact the pharmacy and tell the pharmacy that the patient will be dropping of a script and leave the fill date on the voicemail. the majority of our pharmacist will contact our office, hold the prescription, and verify the prescription if the patient has multiple writers or if they gut feeling something is wrong. we do not call the rx's into the pharmacy because we prefer to have a paper record. our records are meticulous! we do random drug test if we feel that something doesn't feel right and we do this without warning. if they deny their prescription is filled for 2 weeks and we refer. so this probably doesn't help you at all and i'm sure i rambled on and on but i love the program we have because so many people benefit from it. we are able to manage our patient's pain efficiently and help patients that have true addictions.

Nomadmomma......so how is the micro class?

Oh...on more question. I am taking part B summer one session with Pleifer. Has anyone taken him and is her good?

Thanks for the reply. Sounds easy. I was worried all the test had to be proctored which would be really hard for me. Since it just one I am paying for the class right now :).

Did you have to have labs proctored or any test proctored. Also, what is up with the A&P 2 part A and part B. What does that mean?

I want to make sure I'm reading the post right. I have signed up for online chem. I will have to buy a software to complete the labs and I will have one in classroom lab to complete. I will also have to find proctor for the last exam...right?

Oh darn. I want eveything to be online. I don't have time to go to campus. I guess I have to wait until the fall semester.

I have been searching high and low for a summer online A&P course with no luck! Is there any open A&P 2 summer course open out there?

hello all. i am looking for a online summer a&p 2 course. i don't care about the cost but i need it to be online and would like non-proctored exams so i can complete everything online. i work 4 pt jobs and i really need online so i can complete the class during my night shift. if the exams need to be proctored do you think they would allow the librarian at my hospitals library be the proctor? thanks!

fyi....called the bon and was informed that texas has a grey area when it comes to the above duties. i was told it is pretty much up to the facility and the nurse. if the lvn has a iv cert. then it is up to the facility...and the facility will usually have special training for the lvn proving competency. .

thank u so much for the reply. I got 80ml/hr also but i wanted to make sure it was right. For some reason I always second guess myself.

Order: Protonix 15mg/20ml; give IV infusion BID over 15 minutes. I have no idea why I am drawing a blank but I am so any help would be great!!! Thanks

Thanks! I will call the BON on Monday. I the web page should be easier to read.

Hello all! I have a few questions? 1. Can a LVN administer Fat Emulsion? 2. Can a LVn administer heparin through central line with TPN? 3. Can a LVN change a central line dressing? I have check on the Texas BON but I'm lost. Thanks in advance.

I'm a new grad LVN (lvn as of 1-14-10) and I make 25/hour @ a HHA. (dallas, texas)

Ok I need major help and guidance: One of my patients had an order for wound care. The doctor wanted his bandages changed every day until his next visit. The problem.....the order was given to the patient with no information about the clinic (like doctors name, address, phone number, etc) and the order also instructed the patient to hold bp med until bp improved (bp was low at the clinic). I assessed the patient and his bp was low 94/56 and his wound and dressing looked GREAT. So I decided not to dress the wound at the time due to the fact I felt as if I did not have a complete order, I did not have all the supplies needed, and the packing material given to the patient was opened and on the floor. I decided that I would call the wound care clinic, get an order faxed, obtain some sterile wound care supplies, and then change the dressing tomorrow. I also decided, although the wound care doc said hold bp meds, that I would call the pcp and inform him of the low bp. When I called the pcp office the docs wife answered the phone and she was SOOOOOOO rude. I tried to get informed about the patient's referral to the wound clinic and she argued with me for about 30 minutes to tell me she did not know what I was talking about, then when I told her about his low BP she told me that she could give any treatment advice because she did not have complete information. I calmly told her that it was my job to inform the doc when the patients vitals are abnormal ...she then stated that I needed to have the patient call the office and she hung up on me. So after all that I still went to the office and attempted to gather supplies for my wound patient so that I could do wound care the next day but some of the supplies were not available. So I decided to gather all my supplies tomorrow...get the orders....and head to the patient's house. Well I guess this choice was not correct.........I was told by my employer that I did not handle the situation correctly and that I should not have left until I had orders from the wound care clinic...... Should I have waited:confused:? Even if I did wait I did not have the supplies needed to dress the wound. I just feel so terrible. I feel like I let down my employer and my patient.

OMG WHAT A DAY!!!! I need help, support, and advice. I am new LVN as of 1-14-09 and have been working with a awsome HH since the end of Jan. I have been seeing patients for the past two weeks and thought I was doing great......unitl........today!!!!! 9am Started my day with a great patient. No problems and a great daughter taking care of her. The patient is only on 3 meds and she 95! I attempted to do education on a few of her hypertension meds and her daughter cut my off stating "my husband is a doctor so I don't need med education" my reply was " thats great! So, after I finish teaching your mother about her meds, you can answer her questions when I'm gone". JUST LET ME DO MY JOB LADY! 10am Pulled up to a patients house. No one is home! This is the second time I have been to see this patient and no answer. Call the main office to verify the address and I'm at the right place. Called the daughter to see if the patient is at home and just can't come to the door but no answer. So I left to see my next patient. 11am :redbeathe:redbeatheSweet older man who is easy to teach, actually using all my teaching to reduce his bp, and is always happy to see me gets his visit with a thumbs up. BP wnl's, no recent falls, and a healhty diet!! Whoot whoot:yeah: 12am Got to my next patients house and his son (plus three friends) stop in their tracks....sit on the couch....and watch me with their jaws on the ground:eek:. Not only do they watch me but they try to hit on me while I'm attempting to assess the patient. YOUR GROWN MEN ....ACT......YOUR.......AGE!!!!!! SO.....as I'm giving the patient a good look over the caregiver gives me wound care orders with no doctor info....a bag of opened supplies, and told me the wound care nuse instructed them to stop his bp meds until bp is wnls. BP was super low(94/54)....normal pulse.....heart RRR with pacemaker. So....I decided not to change the wound dressing with the opened (no longer sterile dressings) and to call the doctor requesting faxed orders to the office, get supplies for the woundcare, and to take care of the low BP. So I will call the doc after lunch (office was closed) and go from there. ....inbetween the above and the below visits my 10am called me back and stated that I had the wrong address and that she forgot to call the office with the new info. She then begged me to see her mother, which I agreed to do, as long as the caregiver is there (the patient only speaks spanish). OK....ON THE NEXT VISIT. 12am Next patient, at first, did not like me because I look like I'm 15 y/o. But, after the first visit, she just loved me and I love her! She is a great patient and is really trying to improve her health! 1pm I finally get to see the patient that I missed at 10. And low and behold the caregiver ONLY speaks spanish to!!!!! Wow...so how am I supposed to teach her about her condition when all I can say in spanish is pain and hello:uhoh3: 2pm Time to call the home office and check on the order for my wound pateint....get the supplies....go on a interview at 3pm. 230pm Completed a quick interview...got the job......now time to go to the office. 3pm Got to the home office...asked the front desk for the orders for my wound patient....no orders!!! OF COURSE...I then ask the front desk for a few supplies which starts a yelling match between the front and the supply guy! So after 10 minutes I walk in the back myself and grap my own supplies. I then called the my "wound" patients pcp for the wound clinics number that they referred him to and to report the low BP. The docs wife answers the phone and states that she does not know what wound clinic the patient went to and and asked" are you in the home with the patient" I stated no and continued to tell her about the patients low BP. She then says (angry tone) " if you are not in the patients home then why are you calling". I then state "because I'm the HH nurse and I need orders due to the low bp and a few for wound care". She then states " thats what I asked you the 1st time" and then I said " no....you just asked me if I was in the home and I'm not...I'm at the office" she then states " DO YOU KNOW WHO YOU ARE TALKING TO....I'M THE DOCTORS WIFE". OH....REALLLY....COME ON! She said to have the daughter call the office and they will deal with it tomorrow. Wow!!!!!!! I dont even know if I handled the situation right but the day is over and I will start a new one tomorrow! For for the poor grammer and spelling...Im just to pooped to care!