notanumber

Hello, I'm working on putting forward to our DOC a replacement for our facility's current palliative order sheet, one that is more customizable to the resident, presents the physician with more options, and specifies the indications more tightly. A ...

Hello, looking for some suggestions for an elderly resident with advanced ischemic disease to lower limbs. One leg has dry eschar from toes to half way up the lower leg. Not a surgical candidate. Wound care plan in place primarily betadine to keep t...

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 who...

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 ...

LTC - had a LOL with acute pain, likely exacerbation of undiagnosed compression # after a fall a week ago. Screaming, grimacing, little to no relief with repositioning. She did have a PRN for extra strength Tylenol, however given the level of pain ex...

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, ...

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.

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 dres...

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." C...

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...

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 frequen...

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.

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 disor...

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...

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

If she has an iPad, look through some apps designed for young children and/or developmentally disabled, especially those that provide direct cause-effect interaction (e.g. press a button, make a sound or light). One young gentleman really enjoyed a m...

At our facility, transfer to acute care is dependent on approval of a physician (with some judgment-based exceptions, e.g. traumatic amputation or code on someone who is not a DNR), and the decision to send or not depends on their level of interventi...

Monitored for not quite two hours with no change in symptoms, then saw some improvement, and further repositioning resolved it almost completely. Still very painful on lying->sitting->standing. Pain more or less disappeared over the next few da...

For residents in w/c's, you would position yourself behind the chair (sitting, standing, kneeling, whatever works), wrap your arms around the rib cage and administer abdominal or chest thrusts, making sure to check the mouth frequently for the dislod...

Positive reinforcement, frequent check ins, asking how I can help if I have time, finding time to listen to venting/concerns, rewards like ordering food in or bringing coffee, etc. If people feel like they're being heard and that their effort is not...

You did nothing wrong. You sound like a conscientous CNA and unfortunately got paired with a patient who has difficult family members. They probably picked up on your newness - it's like chumming the waters for persnickety people. Part fear, part tak...

In these cases, it's not typically a late nurse, it's that I receive a sick call in the middle of the night and can't fill it by 0700 (shift change). It's happened more lately because of people on vacation, or STD, and casuals not answering phones. W...

I'm in Canada. Work 12 hr nights, four in a row. It is generally expected that if days is short then the night nurse has to stay and finish a morning med pass. There is no such expectation for days to stay late. I have in the past simply refused and ...

Medical treatment is fairly well covered, but many families still struggle with expenses indirectly tied to it - time off work, temporary housing near facilities, childcare, travel, everyday expenses going unpaid because of loss of income, etc. And u...

Our facility is non-unionized but we do have an Employee's Association which is in charge of negotiating employment policies and wages. The annual wage increase is 1% across the board (which is dismal compared to average rate of inflation, but that's...