KatieNoelLPN

maybe it's early and i'm tired, but what are h's and t's?

I worked as a pharmacy tech during nursing school. Right after that I was an AFL cheerleader until I realized I had to get a job that paid a hell of a lot more!

We use Horizon at our agency and for the most part it is user friendly. I like how you can send f/u notes to other clinicians (and tell if they've read them!), the non-clinical note section is helpful to for info that doesnt need to be in the formal chart such as:likes visits in the am, has 2 yippy dogs, etc. The wound addendum is okay, but can get confusing if the pt has multiple wounds, but our agency is working with McKesson to change that. Overall I'd say its great.

38 y o male walked into the ER c/o chest pain. Gray from nipple line up. We took him into the trauma room and one nurse was putting leads on as I was starting a twin cath. As i started the line he sat up and grabbed his chest, screamed, and fell back. He flat-lined. We intubated, ran in all the usual drugs, retavase, etc. Compressions for 2 plus hours. U/S of heart at the bedside. Finally called it. Not a dry eye in the room and you could have heard a pin drop. I went with the doc to tell the family. I will never forget the look on his 11 y o son's face when the doctor told them he was gone. He jerked his head away from his mom and glared at me like i had slapped him. That was the worst day of my nursing career. I still wonder sometimes if the pain from starting that twin cath was what sent his heart over. Haunted by the whole thing.

Are you suggesting that I should have googled my question rather than ask it here? 1. The internet is not the most reliable source of info. 2. I did Google it; found out there were two different surgical approaches and then came here to ask which one was seen most commonly. 3. I thought that's what this board was for? Nurse to share info about their experiences. Sheesh!!! I didn't expect for you to be so cynical and attack me for asking a question and being concerned about my pt....

HA HA! No...as you can see from my previous post (should you have read them before choosing to jump to the conclusion that I was doing homework) I am a nurse in home health. I am currently seeing a pt that was recently admitted to the hospital for a AAA repair that was found by coincidence while being examined for another issue. I was curious as to what a AAA repair entailed and what the post operative course was like. I asked about if there was a difference in procedure depending on age because I had read that a AAA can be repaired 2 ways. My pt is 31 and relatively healthy. I'm sure it sounded like a homework question, but I have posted several times on this board about my job and was genuinely curious about what my pt was going through.

How are AAA's typically repaired in pts? Is there a difference between younger pts and older? What is the typical post op recovery like?

How do you unclog a g-tube? I haven't had a pt with a clogged g-tube in a long time and can't remember what we did to unclog them. It seems like Coke was involved...

I am very aggravated at a clinical manager at my job. I work PRN for HH on the weekends. I saw a pt two days in a row for Lovenox teaching and assessment. When I first saw the pt, he had been admitted to HH the day before and the family had been taught the day before. I asked who would be routinely giving the pt his Lovenox. The wife stated their daughter would be and that she was a nurse. Okay. I instructed the wife on how to administer the injection anyways just in case. She stated she didn't think she could do it. I documented that I taught her and that the daughter would be giving the injections. I saw the same pt the next day. This time the son was there too. I taught him and the wife again and AGAIN they both stated that the daughter would be giving the shot. THe son was able to return correct demo of technique. I documented all of the above. Cut to Monday. The family calls the office inquiring about when a nurse would be coming out to see the pt and give him his shot. The case manager told them that they had been taught 3 times and that they should be okay to do it now. There would be a follow up visit on Wednesday. The family freaked and said they didn't know how to do it and that the daughter actually lives 2 counties away and can't get there everyday. Long story short the office had to send a nurse out there at 6:30 to see the pt. The next day, I walk into the break room at the office and started eating lunch when the clinical manager comes over to me and nastily stated in front of a LOT of staff and our DON, 'We had a lot of problems out of your pt last night.' I asked what the issue was and she said, 'You didn't teach them well enough. We had to send a nurse out at 6:30 last night and she wasn't very happy about it.' I told her, "Well, I taught 2 able bodied adults and they stated the daughter would be giving him the injection. I documented all of this.' (which she would have known had she taken the time to read my charting. ) She nastily replied, "Well, we had a lot of problems. You really should have scheduled them for another visit." EXCUSE ME?!?! First of all, I taught 2 people and they stated the daughter that was a nurse would be doing it. I can't help it if they changed the story and are now saying that the daughter can't do it every night. Also, they had 3 teaching visits for LOVENOX. I'm not the case manager and can't change the frequency. Plus, why would I even think they needed another visit if 2 people were taught and a daughter that is a nurse is coming over. I am just really irritated because I don't think I did anything wrong and this manager embarassed me in front of our DON and some other managers. SHe made me look incompetent. What are your thoughts?

I've seen promethazine VC syrup for cough, but not plain promethazine

I work in home health. THe other day a fellow nurse told me that any verbal order that an LPN takes has to be co-signed by an RN. I told her I didn't think so. I worked in a hospital for 5 years and the verbal orders taken by ANY nurse, LPN or RN, had to be co-signed by a doctor within 24 hours but not another nurse.She got really nasty and said 'Well, I used to be an LPN too and believe me you have to have an RN sign them.' We live in GA and I can't find anything in our nurse practice act about this.

BAL 610....walking and talking

I am finishing up a 6 week orientation for my new job at a home health agency. I work in the office doing clinical support stuff most of the time. However, I will be picking up visits on the weekends and evenings. I have learned the computer charting system (it's pretty easy and user friendly). However, there are some things that are new to me that have me freaked out. For example, I went out with my preceptor and we did a wound vac dressing change. I have never done that before and not sure I could do it again alone. Also, we had to do a PICC line dressing change. I haven't done one of those in years and forgot most of the steps. I feel so inadequate and stupid. Please tell me I will learn all this stuff back. My concern is that since I won't be in the field full time that I won't get to use these skills enough to really retain the info.

Has anyone used this documentation software in home health visits? What are your thoughts?

I have been struggling with this for a while now. Everyone tells me I need to bridge, but I am perfectly happy to be an LPN. I work in home health and I love it. I make a good salary, have good benefits, and love what I do. I have been a nurse for 5 years and I just can't see myself going back to school and working full-time. I love my life the way it is. But I feel guilty and like people look down on me because I'm not going to bridge to be an RN. Your thoughts?