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onewithhospiceheart

onewithhospiceheart

Cardiac, ER, Hospice
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onewithhospiceheart has 10 years experience and specializes in Cardiac, ER, Hospice.

onewithhospiceheart's Latest Activity

  1. onewithhospiceheart

    Medications through an ileostomy?

    Hi all, Question......have a patient with colon ca....has an ileostomy. He has mets everywhere. Pt is declining fast, I doubt this sweet gentleman will make it to the weekend. He stopped all oral intake last weekend. Has a hx of seizures, was on Dilantin 400mg BID. Wife is adamant about continuing an anti-seizure med. Spoke with our national hospice pharmacy and they advised Depakote suppositories TID. Was not thinking about no real rectal access at the time of the recommendation/order....along with the dr. who approved the recommendation. Wife tried inserting the suppository when they arrived, and could not insert all the way. Phoned our national hospice company and they said the suppository can be inserted through the ileostomy. Is this correct? I cannot find any info online stating that this practice is used. Help?
  2. onewithhospiceheart

    Good deaths versus bad

    I am so sorry for your loss....I lost my father as well, it is very hard for a girl to be without her daddy. I don't have alot of answers for your questions. I do witness deaths as a part of my job, and most often, they are peaceful deaths. I have seen patients reaching out, or focusing on things during their transition. A television show on the biography channel helped comfort me about what happens after death....it is called I survived beyond and back. It is true stories of people that have died for a short period of time and what their experiences were. Here is a link to the website....if you don't get the biography channel, I am pretty sure you can view some show segments online. http://www.biography.com/isurvived-beyond-and-back/ I wish you peace in this journey
  3. onewithhospiceheart

    LPN's

    Hi there, We are adding an LPN to our office. Just wondering how you utilize LPN's in your agencies? Do you ever have LPN's in your on call rotation? Understanding that they need to be supervised by an RN, not sure how that would work.
  4. onewithhospiceheart

    question about visits

    Hi all, thanks for the replies. I was not actually talking about face to face visits.....I am actually talking about if the patient makes a visit to their physician office. Rarely happens of course, but occassionally we have had that family that decides that they want to take their loved one into the office. I understand about the disciplines though now, that does make sense. Thanks for your replies!
  5. onewithhospiceheart

    question about visits

    Hi there, When I worked in home care, if a patient had a physician visit that week, that physician visit would take the place of our visit. Example....if pt was to be seen for home nursing 2x wk, and had a physician appt, we would ony make one nursing visit that week and document that physician visit took place of nursing visit. Is this practive the same in hospice? Can't find anything in the regs that address this. Thanks!
  6. onewithhospiceheart

    Do you hospice nurses attend funerals of patients?

    Hi there, At our agency, we attend all viewings funerals. We coordinate this between sw/spiritual/rn/business development/administrator......sometimes more than one team member will go depending on relationships made. Our presence is always extremely well received. Families are very touched that we take the time to attend. We feel that this is still our obligation to our patient/caregivers to continue to support them through the viewings/funeral. This practice is very helpful for our team, really brings closure to the team as well.
  7. onewithhospiceheart

    Thank You Hospice Nurses!!

    Beautiful story...thank you to this nurse who upheld the compassion, integrity and beauty of hospice nursing.
  8. onewithhospiceheart

    Hospice...my calling???

    What a beautiful story. Hospice is SO rewarding. I have always, during my nursing career, tried to look at each patient with the attitude of "What is this patient supposed to be teaching me?" This has helped me tremendously over the years...instead of dreading a patient, or fearing that I can't take care of them, especially the difficult ones....I try to turn the situation around....not even that I am there for the patient, but that they are there to teach me something. Sometimes it is very hard to see what I am being "taught", but I know deep down that one day the message will be clear to me.
  9. onewithhospiceheart

    lung ca symptom mgmt

    Hospicevet....how awful for you to have that patient commit suicide. I don't know what I would do in that situation. I hope that you and your team has come to terms with it, I am sure you tried your best. So sad.
  10. onewithhospiceheart

    lung ca symptom mgmt

    Hi, This patient has non small cell lung a with the tumor occluding the left lower lobe oriface. Don't know about mets....was to have a PET scan this coming week, but has decided against curative treatment, and against the PET scan. Just diagnosed within the last 2 months. This is an 82 year old gentleman...such a sweet man. He was terrified about coughing up the blood. Thanks so much for the advice and tips, it is an immense help. :redbeathe
  11. onewithhospiceheart

    lung ca symptom mgmt

    Have a new patient with lung ca...diagnosed 2 mths ago. Just discharged from hospital s/p pneumonia...was treated with vanco/levaquin. Was on 15L 02/face mask in hospital....discharged on 6L NC. Now at home 1 day. Mildly sob, wheezy, has inhalers/nebs. Has started coughing with mild hemoptysis (new). Wondering what meds I should have on hand....has obvious anxiety....only meds doc sent patient home with was prednisone taper, continue po levaquin for 7 dys and 5 mg roxanol q1hr. Patient has no pain at this point. Also has buspar at home, 5 mg.....but it knocks pt out....took 2.5 mg and did better. I know the morphine will help the patients anxiety/breathing/air hunger.....but wondering if I should get ativan to replace the buspar or just use the morphine? Also need atropine...? Any other sx mgmt responses would be greatly appreciated...this is my first lung ca pt.
  12. onewithhospiceheart

    On Call Schedule.....that is workable

    Hi all, We are currently re-vamping our on-call schedule. We want to make our on-call not be a burden (can that be done?) for the nurses, but still workable for the agency. Those of you who do on call, can you tell me what has really worked for you and your agency? For those of you whose agency has not gotten it right, can you tell me what your agency has missed? What have they not thought of? If you could run it, what would you tell them to do? How about on call pay......what do you think is fair? Thanks, I am very interested in hearing your replies.:redbeathe
  13. onewithhospiceheart

    Wasting controlled substances

    Hi all, What is the most current guideline for wasting unused controlled substances after a patient's death? Is this documented in the COP's or anywhere else? Thanks
  14. onewithhospiceheart

    Looking for Cost Effective DME Company

    Hi all, New to the board, have been a lurker for many months now. Our DME company has been unreliable and messing up our orders for quite some time now. Looking for suggestions for reliable cost effective DME company attends, wipes, nurse supplies, etc. We are located in NE Ohio. Thanks! :redpinkhe