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anon456

anon456

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  1. I have always wondered about this myself. As a hospice nurse we often give a LOT more doses of comfort meds than is typical for non-hospice patients. I used to be very uncomfortable with this, and this is where it's *very* important to document what state the patient was in as far as pain/discomfort before and after the intervention. . . and back off the meds as soon as the patient is comfortable. It's difficult to say what that safe or unsafe dose is for each patient-- some have been on pain meds so long they are given huge amounts that would kill an opioid naive patient immediately. I have patients on 200mcg/hour Fentanyl patches who are also getting breakthrough morphine, and they are still able to talk to me!
  2. A 36-year-old man has been arrested on suspicion of impregnating woman in a vegetative state who gave birth last month at a Phoenix health care facility, Phoenix Police Chief Jeri Williams said Wednesday. Nathan Sutherland, a licensed practical nurse who was caring for the woman at the Hacienda HealthCare facility, has been arrested and is being booked on preliminary charges of sexual assault and vulnerable-adult abuse, Williams said. https://www.cnn.com/2019/01/23/health/arizona-woman-birth-vegetative-state/index.html
  3. anon456

    A nurse with a difficult name??

    I have a "nurse name" that I use only at work, and otherwise I am called by my real name. While I expect people in my life to learn and say my name, I don't expect that of sick people or stressed out people. Nor do I want to have to explain my name because it takes away from the patient.
  4. anon456

    Walmart cashiers wearing gloves?

    I asked one of them why she was wearing gloves and she said it was to protect her nails
  5. anon456

    Allergic to cats in AL, what can I do?

    I am also not giving medical advice here-- just sharing my own experience. When I was hired to hospice nursing I was originally going to work both the inpatient units and home setting for our company. I told them I won't be able to visit homes with multiple cats or people who are smoking in their homes. They felt this was too limiting in the cases I might be able to take on home visits, so they only work me at impatient units. *However* we have patients on the units who are allowed to have their pets visit from home. I take an OTC non-drowsy allergy med on my work days to help cope with that, and with other allergens on the unit from flowers, cleaning products, oil diffuses, etc.
  6. anon456

    Something that has been eating away at me

    I agree with comments above and wanted to add: Document the heck out of the situation as you communicated with the doctor, what they said back to you, what you observed that they did, and how patient responded all the way through your shift. It covers your "assets" should your own actions be questions later. This was an old lady with history of multiple falls. It's very possible she had been declining for days or weeks at home due to natural causes. I see this *all* the time in my area of nursing. Usually patient starts to aspirate at home due to natural decline/early dying process (which can take weeks) and they also start to fall a lot. I normally see them once they break a hip and family decides not to do any further treatments due to age/risks. It's very possible this patient already had aspiration issues, pneumonia, and weakness and this latest event was just the last step to her natural dying process. As a nurse, of course, we want to not cause further interventions, but neither should we over-analyze things as long as you did your part correctly (including notifying the doctor, which you did, and double-checking policy on that type of tube and other interventions).
  7. anon456

    Weighted blanket "to prevent contractures"?!?!?

    1. Is it possible that the wife misunderstood the rationale behind the weighted blanket? For example maybe the hospice nurse told her to use rolled washclothes to prevent contractures of the hands, and the weighed blanket might be soothing.I can only imagine under that level of stress that info might have been misunderstood. 2. I work in hospice and weighted blankets are NOT considered restraints where I work now, nor were they considered a restraint when I worked in pediatrics at a leading peds hospital. They were very often used on the chronic kids and the kids found them comforting -- and not just autistic kids. 3. Weighted blankets are very soothing and therapeutic for many people for many reasons, not just autistic people. Sometimes my patients enjoy a few heavy blankets for the security. Heck, I have a weighted blanket myself and it helps me fall asleep when I have insomnia!
  8. anon456

    What Can be Done

    This is a wonderful article! I found myself going back and remembering my own version of the patient you described above, with a similar history. My patient had a severe anoxic brain injury at the age of two. When I cared for him he was in his 20's, a ward of the state, trached, vent-dependent, gtube, and so severely contracted his spine was in a C shape and his tiny legs had rotated out of their hip sockets. He did not even blink. It was painful to watch his suffering and to imagine that he had lived that way for more than 20 years. What we could do as nurses wss treat him as respectfully as possible during our shifts, bathe him, talk to him, and let him know he was safe and not alone. I am unsure if he heard or sensed us, but on some level hopefully his spirit was touched. What finally happened is the ethics board went in front of a judge and they pleaded their case, and it was decided to make him a DNR and not pursue aggressive treatment the next time he became sick. There was a next time, and when I heard he had passed away I was happy and relieved for him, that he was finally at peace. And then because of him, and others like him in my care in a pediatric hospital, I pursued hospice nursing instead. Because so many of my patients were variations of the one described above, and I just could not do it anymore. I love hospice nursing. I make people comfortable. I support them as their bodies go through the natural stage of dying. I work with both children and adults (mostly adults) and I have never regretted changing specialties. Than you again for sharing the story of this patient. May he provoke thought and may we honor his journey by trying to be the best advocates for our patients even as we are caught in the middle of a system that is often not fair or humane.
  9. anon456

    I Desperately Want Out

    In addition to the great input you've had from other posters, I was thinking that could very well be the actual job making you feel depressed, OR it could be that you are changing phases in your life from student to full-time working adult. I know for me when I finally graduated and went to work as a young adult I remember getting some sticker shock-- was depressed that this might be what the rest of my life would be like-- just work endlessly and pay bills, etc. I am always an advocate for counseling. Seriously. It's good to talk about your feelings, tease them apart and find out what the source of them is, and then what changes need to be made to get you to a better place-- whether that be a job change, a career change, or personal change (such as stress management, etc). I found my first nursing job to be very difficult and I stuck it out to the point of burn-out. I finally changed jobs and it was not as scary as I thought it would be. I now love the area of nursing I work in, and can see myself doing it until retirement. I'm so glad I didn't give up on nursing.
  10. anon456

    The Bucking Bronco in Room 116

    My heart goes out to you. I think that eventually most of us will experience a situation where we have to choose between our deeply-trained desire to follow doctor orders, and to put our jobs on the line in order to save our patient and/or our license. This is very empowering-- but extremely stressful and traumatic. Your experience sounds horrible and never should have escalated to that point. I hope the hospital had a debriefing not only to examine what could have been done better to prevent it escalating to that point, but to emotionally support those who were there. I have been a nurse for 7 years now, and I've had a few times when I had the milestone experience of being the ultimate advocate for my license and patient over doctor orders. Here are some of them: -- I was given report on a pediatric patient who was currently in ER. I knew this patient well, he was very fragile in the best of times, and per this report he sounded terrible. I decided to go to ER to assess him before taking report and accepting him as my patient on my floor (I was charge that night). Our floor was stepdown ICU at a 3:1 ratio, and I was not sure we could provide the best care for him in his current state. My assessment made me very concerned. It was both my knowledge of this patient, and a gut feeling. I refused to take him. I told them he needed to go to ICU instead. The ICU said they didn't have room for him and I said, well then he will be safe to stay in ED until there is room. I got yelled at by the ICU nurse manager, the ER doc, and again by the ICU doc. I stood my ground. He was taken to ICU an hour later. I went to check up on him a couple hours later and he had been sedated and put on some high-stakes drips. I was told that later after my shift ended he coded. He survived it and went on to live many more years. But I'm so so glad I stood my ground. -- More recently I was the only nurse of a small hospice unit with two CNA's and 4 patients. Not a bad day, right? But one patient required 3 people to care for, as they were very obese, and required frequent hygiene cares. During those times of changing this patient, we had to listen for call lights of the other patients. It was manageable though, being a small unit. THEN I was sent us this patient who was very combative and disoriented and threatening to bite, hit, smear bodily fluids everywhere, and run out the door. I asked for a sitter for this patient until we got him more sedated and calmed down. I was told there were none available, too bad. THEN I was being sent yet another patient and I said no way, I will not take report or accept another patient until we get a sitter for the disruptive one, or until he calms down and is safe. I was told I was being insubordinate but I stood my ground anyway. Well . . funny thing . . they were able to magically come up with a sitter, after all. And all ended well. When the manager heard about it the next day she said I did good. :-) -- A patient was looking very bad and I kept calling the MD and was being blown off and even made to feel bothersome for informing him of my concerns. After talking with my charge nurse, who was equally as concerned, we agreed to call for a Staff Assist, which is right below Code Blue-- it gets the ICU docs to come and assess within minutes. They took one look at the patient and he got transferred to ICU.
  11. anon456

    Jahi McMath is finally at peace

    For those who have been following this saga . . I'm glad she was finally allowed to be at peace. Jahi McMath, girl at center of brain death debate, has died after surgery, family says | Fox News
  12. anon456

    It Never Occurred To Me.

    Wonderful!
  13. anon456

    Death's Perfect Timing

    Ahhh so wonderful! Thanks for sharing! I am a hospice nurse and I have seen some amazing things that make me (and my co-workers) believers in powers that are outside our human understanding.
  14. I have struggled with this as well. My company doesn't take any particular stance on it other than to do whatever is needed to make the patient and family comfortable. I also don't want a patient to die on my watch because of poor nursing care instead of because of their underlying disease. For example I will suction a trach to keep it patent. The patient should not die from a plugged trach. They should die because their body gives out from their disease. Here's my general personal rules: -- If the patient is fully aware or even partially aware of the fact that they can't breathe because of secretions, I suction. No one wants to die this way. -- I then call the MD and advocate for further medications so the patient is not aware enough anymore. Generally if a patient is close to death from respiratory issues and aware of it, such as an ALS patient, Versed will be given to make the patient more comfortable and unaware of what is happening. -- If the patient is unresponsive because of disease and dying process but still struggling to breathe, I suction only enough to preserve the patient's dignity (no one wants to die with secretions flowing out of their nose and mouth) and I make sure they continue to be medicated for respiratory distress, just in case they are aware in some way but can't tell us.
  15. anon456

    Struggling to be a Christian Nurse

    When I was a newer nurse I sought out counseling to help me deal with these feelings, and learn healthy boundaries. I now only "own" the 12 hours I spend with the patient and I make it the best 12 hours I can for them. At the end of those 12 hours I clock out and leave it all at work. I don't hold them responsible for whatever they did to themselves (poor choices) to get where they are. I'm glad I'm not the one in the bed. And on a more personal note, my boyfriend/partner is a recovering alcoholic who ruined certain aspects of his health. I did not know him at that time and only met him after he became sober. I look back and imagine that alcoholic man he used to be-- I'm sure he was still the kind person I know and love now-- and I hurt for that man and the pain he must have be in to drink like that. And that becoming sober took a huge amount of work, pain, humbleness, and, frankly, money to pay for an outpatient program. Not everyone is that strong or has the support or strength that he did to get himself straight. I remember that we are all at different stages in our lives, in our journeys, and again, we can only meet a person where they are right now, and give them the best 12 hours we can while they are in our care.
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