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  1. notanumber

    Raising them right.

    I like working with new nurses, generally, because we learn alot from each othee and I get a chance to help them mature into competent, confident professionals. But. What do you do with a young colleague who went from school to team leader of a whole floor (LTC) and is sloppy, at times unprofessional in conduct, lacks finesse in dealing with resident and family behaviors, and worst of all - overly confident and resistant to criticism? I like this one, but it's come to a point where I feel he needs a heart to heart/'Come to Jesus' talk with myself or another colleague, or a disciplinary meeting with the nursing manager. Concerns have been raised kindly before, but it goes in one ear and out the other. I want this person to succeed - perhaps the gentle approach isn't the right one in this circumstance. So - pass on concerns to manager and wait for them to deal with it, or pull the person aside for a serious chat?
  2. notanumber

    Teaching better RCA charting

    ADL coding is the only required charting for them, but they can do PN as well. It is usually a good thing, and apparently covered in their program, but sometimes you get notes like the above which are less than professional.
  3. notanumber

    Teaching better RCA charting

    Anyone have a handy resource (1 or 2 pages) on the do's and don'ts of charting progress notes for HCAs/RCAs? There is some questionable charting going on (e.g. "I helped her to the toilet 15 times this shift and she only peed half the time and so I didn't have much time to spend with my other residents.") Urgh. I think a handout for people to take home and read through would help - along with one on one in certain cases.
  4. notanumber

    Sliding up bariatric residents

    This is a difficult one, apparently. Bariatric res, never leaves the bed, doesn't tolerate bed laid flat or feet elevated very high, doesn't like slider sheets because they slide down too much (probably would be less if feet/legs were elevated more, but . . . ). Wants a draw sheet under buttocks only. Tells care aides to help her boost up by leaving side rails down so she can push up on them while they pull up behind her (reaching over rails) on the draw sheet. I reinforce good body mechanics (side rails down, bed elevated, HOB as low as tolerated), with little appreciation. Our OT put a turning sling under the mattress overlay, which the res refuses because of SOB. I'm not sure what else to suggest/do in this situation. I'm responsible for the safety of my team - even if they get frustrated with being told not to comply with unsafe requests.
  5. notanumber

    Are there any certifications for LPNs?

    What sort of certifications are you looking for? I have Advanced Foot Care, Palliative Care (LEAP Core through Pallium), and am going for Advanced Wound Care.
  6. notanumber

    I hate triad!

    Referring to the wound dressing/cream. It's widely used here and I see little success with it. RCAs wipe it off, it gets rubbed off, peed on, doesn't seem to do much in the way of protecting the wound, and the tubes *must* be getting contaminated. I only ever use it with a cover dressing, but most insistent it doesn't need one. Usually used for abrasians and stage 2s. Anyone else use this? Opinions?
  7. notanumber

    LTC Wound Care Kit

    I mean a carry-kit or tray that has basic wound care supplies ready to go, to be brought to the resident room for treatment. It's help to have certain things ready due to time constraints, but all sorts of things are thrown in (including sterile dressings opened at bedside, cut to size and the excess "saved for later") - not terribly aseptic. Ideally I'd like a balance between having the basics pre-prepared and not carrying around a basket of this and that between residents > We do have policies in place that have gone a bit by the wayside. Recent company handover means we will probably be re-evaluating what products we will use and negotiating a new contract (not sure who we use now, lots of Molnlycke products on hand). Betadine mostly for necrosis/eschar. Our community ET support also recommends it for stage 1/X PS on bony prominences (e.g. heels), but I've not found literature supporting that.
  8. notanumber

    LTC Wound Care Kit

    Hi all, myself and another LPN will be working on overhauling our wound care strategies. Managers would like us to start asap to get better continuity, although we will further certified in Advanced Wound Care this fall. One thing I'd like to change immediately is the wound care kits used on each floor. We have cabinets to stock dressing supplies, but the portable kit stocked with basics is essentially a generic carry caddy filled with assorted supplies. Any suggestions for a more organized kit system that is cost effective (considering we will need several), as well as suggestions as to what should be stocked at minimum? (Sterile saline, sterile dressing kit x 1, clean gauze, cotton tipped applicators, scissors, betadine, etc). What works best for you/your facility? The wounds we deal with most are: pressure ulcers, venous/arterial ulcers, and skin tears.
  9. notanumber

    Nitrospray Questioning

    I understand you are not bashing, you are educating and advising and I appreciate it. I've been in the field for several years and have never (to my knowledge) made an error like this where a patient/resident was jeopardized. I have a meeting with my immediate super this week and will discuss it again, this time in person instead of over the phone.
  10. notanumber

    Nitrospray Questioning

    We don't have a set protocol for nitro (due to the side effects) and it is rarely administered, so the rx is specific to the patient and usually a one time only order. Yes, I made an error in clarifying the order and should have specified the frequency. Fortunately there have been no long-term effects on the resident and they returned home with no significant findings. Part of what is troubling me is that I'm fairly sure if this had occured earlier in the shift and not at the end of a 12hr night, I would have been sharp enough to pick up at the time of order that the dose was not within usual parameters. Should have been less reactive and taken more time to review and process the order. I posted in part to find out 1) Is there any situation in which this dosage would have been indicated and 2) assuming it was a med error due to poor communication on both our ends and the GP did actually mean to have it spaced out, is there more I should do at this point to report the probable error (given it was reported to both managers and it did not result in injury to the resident) or file it as a learning experience and move on?
  11. notanumber

    Nitrospray Questioning

    Three together. I explained that point to the NMs as well and they both agreed that it may have been an appropriate order and I followed it correctly as stated. The typical protocol is one, wait five min, if not resolved give up to two more q5min.
  12. notanumber

    Nitrospray Questioning

    Situation - resident with cardiac hx presents with severe chest pain, altered heart rhythm (which may or may not have been chronic) and mild hypertension. Dr gives telephone order - "give him three sprays nitro and if it doesn't help, send him in." Clarification question, "Ok, give him three now and if he doesn't recover send him to hospital?" "Yes." Administered, resident presents with dizziness and tremors, then syncope and dropped O2 sats and mild hypotension, regains consciousness but ++ anxiety and increased pain, EMS engaged. Felt I should've questioned the order as the dose was excessive, especially for this age group and may have contributed to the need for EMS. Nurse managers stated all was done correctly and that the physician may have more knowledge on the patient that directed the treatment plan. I still think the order was inappropriate and could've been even more disastrous, but the moment was time sensitive and I didn't critically think the order (the drug is rarely given in this setting) until well after administration. What would you have done?
  13. notanumber

    Klazomania in Dementia

    I can only say that it is the term that best fits the symptom. We are short on geri-psychs and neurologists (well, all MDs, really) in this area and the one in charge of this case isn't particularly invested. I did come across the article you linked. PBA doesn't quite fit - the screaming doesn't occur with crying/teariness/sadness, but it does occur with agitation/anxiety (which is ongoing). The compulsion can be inhibited for short periods, sometimes with self-harm (hand biting), but suppression can heighten agitation. Emotional dysregulation, impulsiveness, poor attention span, and lack of inhibition are also present.
  14. notanumber

    Come On People, How Stupid Are You??

    That is painful. More than one? Excrutiating. I've had some "what, really?" moments with some nurses, but nothing like that.
  15. notanumber

    Klazomania in Dementia

    Wasn't sure whether this topic should be in neuro, geri, or psych, so apologies if this sounds misplaced. Does anyone have information on compulsive screaming in adults with either neuro or psych dx in combination with dementia and/or movement disorders? Not "calling out" as we think of it - compulsive, ear-shattering screaming not associated with pain or fear and not associated with epilepsy due to no loss/alteration of consciousness. Able to suppress temporarily with great difficulty, primarily occurs when alone or not directly engaged. Refractory to medical management. Very unusual and perplexing case with what seems to be a rare and difficult to manage symptom.