redheadedvixen

wow......I'm thinking I'm lucky... To the doctor of my hospice patients... Thank you for allowing me to teach you new things every now and then, thank you for telling me I'm doing a good job once in a while, and thank you for helping me up off the floor after you told me you trust my judgement and value my opinion!!! And most of all thank you for knowing what the meaning of the word TEAM is.

Oh and the best supplemental book I ever used was the NCLEX made incredibly easy.....I bought it in my 2nd semester and used it all the way through, bought a new version of the same one to study for the nclex....

I've been out of school for a couple of years but I used a digital recorder in class, burned the lectures onto cd's and listened to them several times. Plus I would listen with laptop in lap and make myself study guides (I'm a little OCD when it came to the study guides...they were color coded etc... lol). I found my recorder to be the best purchase I ever made. Also used lots off coffee, chocolate and the best group of friends from class I could have ever asked for.

Since my agency purchases the narcotics we are responsible for the disposal and the kitty litter method is working well for us. We bring the bottles back to the office to dispose of them though.

I would ABSOLUTELY recommend a year of med-surg or another type of hospital experience first. I became a hospice nurse after two years of experience in cardiac and oncology and still sometimes I worry that I'm not making the right decisions. You are on your own 99.9% of the time and while I can call the office to ask for advice there isn't always time to do it. So yes get some experience at just being a nurse first and good luck!!! :)

I have this patient with dementia who doesn't really have the ability to verbally express his pain. In his life before dementia I am told that he was very stoic and would never complain of pain even if he was in agony. I have found him several times moaning and groaning in his bed holding one part of his body or another. His family doesn't want him to take anything stronger than Tylenol, they say he's never been in pain and they don't believe he is now. His DOCTOR says moaning and groaning and holding your body doesn't mean you are in pain. :angryfire I was flabbergasted at this. Our medical director is going to intervene in this but has anyone had problems like this with physicians and families not wanting you to properly address a patients pain? How did you handle it? As for that doctor.......someday I'd like to be his nurse.... Yes sir I understand you just had an amputation....I have your tylenol right here.......... (oh that's so not nice )

We are using the kitty litter/coffee grounds method because of concerns about the drugs going into the sewer system.

Ok I'm confused by that statement vs the one in the original post..... " i felt that using roxanol to slow him down did not seem appropriate, somehow."

No tachypnea isn't always an indicator of pain but in a dying person who is otherwise unresponsive it's either pain or anxiety, either way you don't want to leave someone in that state from the hospice perspective. We want them comfortable, it doesn't really matter why they are tachypneic when they are in the dying process we just don't want them to stay that way, it's much kinder to give them something to ease their breathing.

I don't want to criticize but I agree with all of the above. In my mind a respiratory rate that fast = air hunger... I wouldn't want to die feeling like I was starving for air.....next time give the meds...liberally and often. When a patient is actively dying I don't really worry about giving too many meds, my only focus is to keep them comfortable and anxiety free which means roxinol or oxyfast and ativan intensol as often as they need it. Don't beat yourself up over this one though, use it to learn for the next one.

Our medical director is just switching everyone to oxyfast....just have to use 1/2 the dose because it's twice as strong.

If I am in a pt's room when you enter please don't ask me to leave, maybe I need to be able to reiterate what you tell them after you leave since I can't read your writing most of the time. 99% of the time the patient is going to ask me what you meant by such and such anyway! Oh and do me a favor.....if you write a stat order don't put the chart back in the rack...

I guess I am lucky enough to be married to a man who finds me HOT in scrubs lol. But for myself...to keep my sexy it's all about the panties that only I know are there... I had really long hair, got tired of having to pull it up all the time and cut it into a sexy shorter style.....LOVE IT. Chap stick is the only make up but unless it's a really special occation that's all I wear any other day anyway. I think it's really just about the things that you do for yourself whether it's a work day or not that keep the sexy going...

All the docs in my part of the country (missouri and arkansas) tell us to give lantus no matter what their intake status is because it IS the basal insulin. I've given it to many an NPO patient and have never bottomed one out using just Lantus with no SS.

Yes, both states are aware that I am licensed in both and there are no conflicts in holding both.

Don't know about putting a hold on a license but I do hold licenses in two states without a problem from either one.

How about a small one time dose of IM haldol just to get her calm then getting the roxanol increased to at least 10mg every hour along with some liquid ativan. We use the roxanol and ativan scheduled in hospice and it works very nicely. Once she's calm you should be able to get the dropper at least inside her lip which is good enough. Fentanyl patches give such a low hourly dose that alone probably won't do much to relieve her acute pain.

I was taught in nursing school that you ALWAYS clean up a body after death. How would you like to say goodbye to your loved one who is lying in a puddle of their own excrement or covered in vomit!!! I didn't know there were places that don't do this..I'm shocked! I always give the family the option to leave or stay if they feel comfortable. I don't always give a full bath if they've had one recently but I ALWAYS do peri care, wash their face and hands and comb their hair, put a fresh gown on......ALWAYS. Not only is it respectful to the patient who has just passed I also believe it shows the family that we really did care for their loved one. Sorry about the vent but this is a pet peeve of mine, I've had problems in the past with aides who would not help clean a body, other nurses who complained about "having" to do it while washing the body. I don't care if the person is dead you don't complain about them while you are working on them. :angryfire Some people will say that it's just a body...blah, blah, blah. Yes but it is also someone mother/father, sister/brother, wife/husband. I would want my family members body taken care of respectfully and want them freshly cleaned when I come in to say my last goodbye.

When I was a nursing student I was doing a round in ICU, the director of the unit came out of a room and said we really need you in here, we have a code brown!!! I had no clue what that was even though I was in my last semester... He held my chin and swiped under my nose with a very minty lip balm and gently pushed me into the room. My heavens it was everywhere, poop on the bed, the floor, the patient....everywhere. The lip balm kept me from getting the full impact of the smell and I was soon joined by three other students. We looked at each other with that where do we start look. Weakly from the bed the patient said "Oh girls I am so sorry!" Immediately it was apparent what we had to do, just clean it up like it was an everyday occurance, reassuring the patient that it was nothing to be sorry for that it was OUR JOB. I've always treated doing unpleasant tasks just exactly that way ever since it's just part of the job right along with the other tasks that I love doing.