Lynx25

Hey, that might work! I've never seen them used before, but I can get them through Medline. Thanks for the assist.

Oh I called the surgeon- he told me to dc the bag and apply xeroform. I just don't have any idea how to secure the whole thing to avoid further trauma. I can't get it through anyone's head that he has to be handled with caution. It's a 15:1 aide ratio- and I think they are going in there doing care by themselves. The treatment isn't my problem- it's protection.

Oh my goodness, I've only been inside two burn centers, but BAMC's unit was freaking beautiful.

I tried to ask this on another site- was met by a barrage of "OMG CAN'T DIAGNOSE ON THE INTERNETS!" Let's see if this does any better. I have a very obese patient, with split thickness grafts to his entire abdomen. He has a small fistula to one area, that occasionally leaks stool. Someone decided to slap a colostomy bag over the fistula, and now we have a large area of graft missing, because of the fragility of the entire area. I've also noted that he's acquired several smaller areas of shearing from what I assume is improper handling during care. The ostomy bag is no more, and I've covered the whole thing with Xeroform and ABD pads after a call to his surgeon, but does anyone have a particular product that you think would be good to stabilize and protect the area? Maybe something to put over the Xeroform and gauze? I really don't have anything large enough to protect the whole area- it's a bit of a loose patchwork. It's not currently infected. Total graft area, I'd say 2'x1.5' roughly.

I have a patient with a stage 4 ulcer, that's not making any progress. It's about the size of the top of a Gatoraide bottle, were someone to punch a hole in his thigh with one. There's some pale pink granulation at the base, but the periwound has a thick, soft white layer that extends down the sides of the wound. The layer extends above the level of the healthy skin. The previous wound nurse was charting this as eschar, but I was under the impression eschar was a darker color. I would be hesitant to chart it as slough, as it doesn't really resemble it. It's almost like a thick moist callus. (Moist due to moist wound dsgs) I'm of the opinion he could use a sharp debridement and a vac or graph, but it's not something we do here, and it's like pulling teeth to get a wound clinic appointment. Could someone with more experience help me out a bit?

I'm so glad we don't have "Customer service surveys" here. I get away with this- "I'M GOING AMA!!!" "K. Here's a box."

We got some storebought cupcakes, and a threat... "If the weather gets bad, you are required to stay overnight at the hospital. You will not be compensated for time spent sleeping at the hospital, if staying greater than 16 hours." I called our board of labor. Apparently that's legit. Whatever- if weather gets bad, my SO has a little bronco that he built for rock climbing, so it should be just FINE on the ice.

I was a medic, and was quite annoyed when I discovered, that in my state I was ONLY allowed to drive the ambulance. I went LPN, and rather wish I had gone for Paramedic instead. Nurse or not, Combat medics aren't given enough credit to apply to their civilian careers.

Protip: That New-Skin stuff sold at pharmacies is exactly the same as super-glue. Source: Boyfriend went into their facility to do some industrial type welding on their vats they make it in. Two different vats (Newskin, regular superglue) in the same room- he asked what the difference was- they told him: "Price."

We are a smoking facility. It's a pain in the ass. We only do it three times a day, but nursing/CNAs do it each time. It's terrible because if we are behind, the patients are NOT understanding, and will often begin to curse, yell, and sometimes chant about SMOKE BREAK SMOKE BREAK SMOKE BREAK. Like the OP, they gather to go smoke right by my nurses station. I'm very glad we do not have to do it every two hours, I'd never get anything done.

You can have mine. I quit! Best thing I've done for myself in years.

I imagine that "these LPNs" don't particularly care for your attitude. Most "people" wouldn't.

Uhm.... Have you guys EVER seen facebook ads that make any dang sense? There was one on mine with a woman smearing what appeared to be fake blood all over her face, with the ad reading, "Woman finds MIRACLE cure for wrinkles!!! Doctors HATE her!!" Seriously guys. It's the internet. You're going to have to be more discerning about what gets your feathers ruffled.

D: As a LTC nurse, I was always reassured that "Granny" who has been acting out a bit lately, would be kept safe and seperate, in her own little geri side of the mental health facilty. How awful. What is WRONG with the administration?

If this is the worst thing that happens to you in a day, you have had an excellent day.

I tell them to go get me coffee.

I was attempting to give someone their insulin. When I walked in the room, the woman rips off her covers, pokes her rear in the air, and screams "DO IT TO ME BABY!!1!"

Oh God. Two hours? How rude. Here's what I'd do, but I've only ever worked at one facility so I don't know how much it would vary. 1) CHEAT SHEET Print out a census of every person you will be caring for. Have the orienter/ offgoing nurse mark every person who has.. -Crushed Meds -Thickened Liquids -Insulin and Accuchecks -Peg tubes/ feeding tubes/ IV medication -Disruptive behaviors, or little rituals that will throw grandma completely off her rocker if disturbed. (ie: I get my pills one at a time with fruit punch or I go socking staff in the kidneys for the rest of the shift) -Fill your cart. Ask the offgoing nurse to help you make sure all of the supplies you'll need are there. Serious time saver. -Don't stand around gossiping and giggling with everyone at the desk. I see co-workers doing this, they end up two hours behind, and then they gripe and complain when management cracks down on OT. 2) CHECK LABS We do our own labs here. Note any abnormals and call them in. I do this right off the bat because I usually get all of the PT/INRs on my shift 3) ACCUCHECKS AND INSULIN Our check times are scheduled like 30 minutes before the medpass. I do them first, some nurses do it with the medpass. I'd recommend doing it before you start meds. 4) MED PASS #1 Start at the beginning, and work your way down. I can't stand a group of people pawing at my cart, and demanding to be next. Nope. I start at the beginning of the book and work my way through. Much reduced risk of med error IMO. IT'S GOING TO TAKE YOU WAY TOO LONG THE FIRST TIME. Don't panic. It takes everyone forever when they first start. You are throwing out meds to 30 people at an average of 10 pills a pop, and you only have a couple of hours to do it. 5) Chart/ Treatments How did your first medpass go? Did you finish more than an hour before time for the next medpass? Great! Sit down and chart. The CNAs can help you out with how much Ms So-and-So ate, or anything strange that came up. If you have treatments, you can also do them here. Don't go alone, ask a CNA to give you a hand. 6) MED PASS #2 If your facility is like mine, you'll have two medpasses, and this one is not terrible. Still, I'd stay start it an hour before the scheduled times. It's still legal, and it will make sure you don't run over. 7) Finish it up Finish charting, finish treatments, hit your cart with a bleach wipe and get out of there. I've been LTC for about a year and a half, and very rarely stay late. I have thirty residents.

You guys are great- I will bring up all of your suggestions in the AM meeting- I appreciate everyone's input

They are very sweet, very passive people. The patient has been with us for quite a while.

Last week, we spotted a new interviewee trotting down to the DON's office in a tiny t-shirt, out of which exploded her not-so-tiny belly, and some short-shorts. For extra classy points, she had two packs of cigs rolled up in her sleeves. Nailed it!

Maybe some of the noobieishness (?!) has worn off since she posted this two years ago. At one point in time, I had 18 piercings in. I didn't get struck down by lightning, so I'm assuming I'm good to go.

So sorry this has happened to you, what a terrible situation.

"...who were unaware of the associated dangers" What the actual F. NO we don't need special shiny syringes for this! We need people that know pills don't get shot up into your veins!

I will attempt to get him a trip to the wound clinic and hope that one of them has some spectacular idea. We do not have a certified nurse at this facility. I volunteered to go get trained for wounds, even just at the LPN level, and they said it was cost-prohibitive. When the administration recieved 4 tickets for a wound care conference, at a value of ~$150 each, they took the administrator, (no clinical license, 0 wound care responsibility) the DON (does 0% wound care tx) and ADON (again 0% wound care tx) and some supervisor, who afterwards told me she thought wounds were 'icky'. The nurses that do treatment were invited to go- if we paid. x.x