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garnetgirl29 BSN, RN

LTC, SNF, Rehab
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garnetgirl29 is a BSN, RN and specializes in LTC, SNF, Rehab.

garnetgirl29's Latest Activity

  1. garnetgirl29

    Advice with severe vascular leg wounds

    I have a patient who's vascularity is so poor, he's been denied for amputation because the surgeon feels that he will not heal. So, I am left to treating his numerous wounds that start just below his knees and continue to his heels. Bandage changes are VERY painful for this man (even with PRN and scheduled pain medication) and his severe pain is keeping him bed bound. Right now we're using anasept cleanser (blotting with gauze because he says spraying directly is more painful) and covering with adaptic, calcium alginate, ABD's and wrapping with kerlix. It's very difficult to get all the dressings in the correct place and to stay there until the kerlix is wrapped around . I really wish I had adaptic on a roll rather than little squares! We're changing daily because of the drainage and the dressings sticking to the wounds. So, I'm looking for advice on anything I can do (or suggest to the MD) to make his wound care more comfortable? I wondered if unna boot would help, but I've never used them on such large wounds with so much drainage.
  2. garnetgirl29

    Allergic reaction to dressing change?

    What are you cleansing her skin with? My guess would be that it's either the gloves or something in the cleanser that is causing her rash. How long do the rash & itching last? I would leave a note for the MD. Are you using skin prep on her? I've never seen a reaction to it, but that's a possibility, too. If she's allergic to the gloves, I would expect to see her reaction more wide spread since I'm sure the aids wear gloved while providing care.
  3. garnetgirl29

    Combative dementia patient

    I've dealt with difficult, combative residents and I always report aggressive behaviors to the MD so they can address the issues. We usually treat the behavior with a combination of medications (depakote, Ativan, Ativan/Bendaryl gel, Haldol) if other interventions fail and I have seen improvements with this. We cannot medicate (nor would I want to) to the point than the resident is lethargic, but just to make them more comfortable. If the resident is fighting and agitated, they are clearly not happy. Safety is always the primary concern. We also do not use restraints and my hall has 25 residents, the majority of which do have various degrees of dementia. I have 2 who are know to be aggressive & 5 major fall risks - 3 of which have falls on a regular basis. It is very frustrating. I hope you can find something that works for your patient!
  4. garnetgirl29

    Cutting VAC foam

    I love the spiral idea! I've only used one KCI wound vac but I loved the experience. I cut the foam into about 3 pieces to fit correctly in that very oddly shaped wound I was filling, but I will try the spiral next time around! The wound we're using a vac on right now is only a pin hole with a LOT of drainage from a hip joint after a mass removal. The dressing for this vac looks more like a duodoerm and is one big piece. It's the 4th vac we've attempted with this wound and it works like a charm. I can't remember the brand right now, but it's a new model & we have it on a trial basis at the moment.
  5. In my facility, the the nurses put out a list of what resident's they need vital signs completed for at the very start of their shift. The CNA's are supposed to complete the vitals and return the list to the nurse. We (the nurses) use this as a reference before giving certain medications and for charting. Well, the problem is that the CNA's are not doing the vitals until late into the shift which means nurses have to stop and do the vitals required for specific medications during their very heavy med pass. I am a very nice person and and I absolutely HATE calling someone out and can't stand the thought of writing someone up, but management says that the nurses are "the keepers of the CNA's" and they do not reinforce to the CNA's that they need to return the completed vitals list to the nurse before they begin their med pass. Many of the CNA seem to be taking an attitude about doing the vitals and are deliberately not doing them. Also, I've found some given to me at the end of my shift to be running fevers or having BP's way too high and the CNA did not notify me. (a nurse last week told me her CNA found a resident with A.Fib to have a pulse of 145 and did not notify her!!!) I overheard a CNA complaining about a nurse not toileting a resident when she was passing meds. Do CNA's not understand the time restraints nurses have? Is this a problem at other facilities, too?? I have 25 residents that I am *supposed* to medicate within a 2 hour time frame. How could that even remotely be possible if I have to answer call lights and do all those vitals in the midst of a heavy med pass?? I am absolutely willing to answer lights after my med pass is finished, but I cannot spare the time while I'm passing meds. The majority of my 25 residents are difficult to medicate either because they don't want the meds or they have difficulty swallowing or they have a VERY large amount of various medications. Also, as a nurse, I cannot leave just because my shift is over and if I'm not finished with everything 30 minutes after the end of my shift, management has a melt down about over time, but they also have a melt down if the nurse does not complete their charting. Last week, I needed vitals for charting and the CNA did not do them. When she announced that her shift was over, I reminded her that I still needed the vitals completed (that she knew about when her shift started 8 hours earlier). She said nothing and left. So, I was chewed out for getting OT because I had to go get those vitals to finish my charting. I feel like we are all adults and everyone knows their responsibilities. Why can't we all just fulfill the roles we were hired for?? Is this a struggle at other facilities, too?? And if so, how do you handle it??
  6. garnetgirl29

    Questioning this order???

    Ok. So I'm trying to wrap my head around this and I do feel empathy for this patient, but there are now reports that's he's becoming aroused and masturbating immediately after the stimulation. I have not yet been in the position to perform this treatment, but have administered suppositories and assisted the patient with self cathing (the orders are to educate the pt on SELF cathing, although he prefers someone else to do it). Management is well aware of the issues with this patient but there is a lot of red tape due the families connections with people in high places. I've discussed my concerns with supervisors and they agree and have also agreed to be present for his personal care. It's just a very sticky...uncomfortable...fine line as to whether this pt has a legitimate need for the stimulation vs. pleasure. I realize that he does need a sexual outlet.....but nursing staff is NOT there for that reason and I am certainly NOT willing to provide that type of service. Other nurses have stated that they will feel for stool in the vault, and if nothing is there they do not "stimulate". But...if I'm on duty when it's time to carry out this order...I'll definitely be taking my supervisor in with me.
  7. garnetgirl29

    Questioning this order???

    OK. Thank you for the input. He is allowed to have this done 3x daily and he asks for it much more frequently and even asks for it immediately AFTER having a BM. He became very upset with a nurse who refused to do it because the CNA said he had just had a large BM. On this particular day, he had a BM every shift.
  8. garnetgirl29

    Help! I need group ideas!

    When I worked in detox, the majority of my patients were IV drug users, so I did a lot of research on all the things they are at risk for just from the use of the needles. They were always very involved with this group and asked lots of questions. I covered things like abscesses, blown veins, skin infections, sepsis, and diseases that are commonly spread this way, and the risks that re-using dull needles and the increased damage it does to their veins. I usually started off with..."what's the largest organ of your body?" or "what is your body's first line of defense against infections?" Then went on to explain how the millions of bacteria on your skin help to prevent new bacteria by taking up all the space so that new bacteria cannot attach to the skin, and also that repeated breaks in the skin allow the bacteria to enter the body which leads to infection. I always included photos of various infections and educated them on the importance of having an abscess treated appropriately. I also included magnified photos of what a needle looks like brand new and after it's been used. That one always surprised them. I talked to them about sleep and nutrition and hydration. Our nursing groups were expected to be educational & were supposed to last an hour. If I had time left-over, I used that for open discussions which usually came around to questions about medications prescribed at our clinic and health concerns regarding their lifestyles. We had up to 16 clients at a time, so questions could really fill up the hour. We also did ETOH detox and if I had few in the group, I would talk about the effects of ETOH on the body, short term and long term. In another group, I explained the detox protocols we used and the expected outcomes and discussed which PRN medications were available and why and what types of symptoms they needed to report to nursing. I did another group on infectious diseases and STD's. Our counselors held groups as well and those were geared toward coping mechanisms, music therapy, community resources, etc.
  9. garnetgirl29

    Questioning this order???

    So, there is a new order for a patient whom is my age to stimulate the rectum digitally for one minute every day after dinner. This patient has paralysis but still has sensation in this area. There were already orders for suppositories Q4H PRN, which the patient asks for regularly (and has asked nurses to wiggle their finger). I have never heard of an order like this it makes me pretty uncomfortable. Has anyone seen an order like this before???
  10. Thank you. I couldn't have done it without my fiancee. I stopped working when I went to school. It was rough and we nearly lost our house, but I really don't think I could have made it if I had worked during the program. A few of my classmates worked and made it, but I don't know how. We did have a few people drop out, but a lot failed out during the 2nd semester. When I applied, it was the last year that they accepted the ACT rather than the teas(unless that has changed again), so I didn't have to take the teas. I've heard it's very hard, but they do have teas prep classes that I will definitely take before applying to the bridge program.
  11. I heard the same about Mercy and last I heard Queens was on probation, but I haven't looked into for awhile. I graduated from Gaston's LPN program in 2012. It was tough & we lost half our class before graduation. I know numerous people who are trying to get into gastons LPN-RN bridge program or the ADN program, but they've had a larger number of applicants, so I'm sure they'll be pickier this time around. I haven't applied yet because I've had some issues at home that need to be settled before I can't handle nursing school again. Good luck!!!
  12. garnetgirl29

    What is your current LPN salary

    I have two jobs. Mental Health/Drug Detox facility - $16.49/hr +benefits. PRN in a LTC care facility - $23.50/hr. Charlotte, NC
  13. garnetgirl29

    question about withdrawal protocols!

    I work in a mental health/drug detox clinic. We use the COWS for opiate withdrawal & once the client scores a 13 or higher, we use suboxone (naloxone + buprenorphine) to treat withdrawals. Within 30 minutes, the client is feeling better. We start them on 4mg BID & taper them down over a 6 day period. It works MUCH better than clonidine. We only use clonidine for HTN and if their BP can support it, we occasionally use it if someone is still having withdrawals once they've completed their suboxone protocol. Common side effects of suboxone are headache & constipation, so we treat those as needed with tylenol, ibuprophen, & laxatives. It works very well for most, but some heavy users will still have some break-through withdrawals. We just give them PRNs. We use the CIWA for ETOH and benzo detox and treat them with librium. The first 24 hours dictates whether they will be on the moderate or severe protocol, depending on how much librium it takes to treat their withdrawals. Librium is a long acting benzodiazepine that's typically used for detox. It can effect blood pressure, so per our protocol, we never give it if BP is below 90/60. We use the CIWA to assess for DT's, but in many cases, we start the librium immediately after admission, regardless of score. We do not admit anyone with a BAL above 2.0. With our protocol, we give scheduled librium & we may give a PRN librium q6H. If we feel more is needed, we call our MD. There is a lot of wiggle room with our librium protocol and most clients can safely tolerate considerably more than we actually give, but I do try to discourage PRN doses toward the end of their protocol because it's better for them to taper down before cutting them off. If they continue to ask, I'll offer vistaril for anxiety and call our MD if I feel the protocol should be extended for this individual. BTW, we only do our COWS until a 13 or greater is met and we only do the CIWA on admission. Our clients are with us for 7 days, unless an extension is needed for further treatment or for long term placement.
  14. garnetgirl29

    Is a drug rehab position good for new lpns?

    That clinic sounds awful. I work in a detox/mental health clinic and this is my first LPN job. The job is pretty easy, but my main concern is that I don't get to use many of my nursing skills. I mainly just pass meds & asses clients for effectiveness of treatment and notify the MD if anything is wrong. I give the occasional IM injection and talk to clients about drug abuse, antidepressants, anti-psychotics, etc. I've been here nearly a year & have never seen a client kill or injure anyone. I work a split between 1st & 2nd shift & am quite often the only nurse on duty. It's a not-profit agency, so pay isn't so great. Next month will be my 1 year anniversary, so I'm thinking I will start looking for something else. I need more experience and more money. When I call a referral in to the MD, if I tell him the person has a potential to be violent, he denies them. But, we don't always know about that information. The local hospital is horrible about leaving out information they know makes a person unsuitable for our facility. I would go to the interview and ask what safely measure have been put in place to ensure staff and resident safety.
  15. garnetgirl29

    How am I going to pay for RN school

    Community college is definitely cheaper. Fortunately for me, Pell grant has covered everything up to this point & I'm hoping it will cover the ADN program as well. I'm working on my last pre-requesite now and am planning to apply to the LPN-RN bridge program. That will be one year. I haven't decided if I'll go for the BSN yet.
  16. garnetgirl29

    Visitation during detox?

    We have a new site director and some of us were discussing this with her and telling her what we've witnessed during visitations and the risks involved. She agreed that visitation is not a good idea, but said that because she is new and has already implemented some other changes, she would put this one on the back burner for now. We have a mandatory next week and are going to discuss the procedures for strip searching all new admits. We currently search their belongings but not the person. I'm a little nervous about how this will play out.